Most people who are addicted to opioids require intensive rehab to recover. Opioids are powerful drugs, and repeated use causes changes to brain chemistry. Detox, counseling and medication help people heal and learn to live without drugs.
Opioid Rehab Timeline:
The goal of opioid rehab is to help patients overcome two side effects of regular opioid use: dependency and addiction. Dependency refers to physical changes in the brain that make a person rely on opioids to function. Without opioids, a dependent person experiences painful withdrawal symptoms. Addiction refers to behavioral problems associated with chronic opioid use.
Opioid rehab can be approached in three ways. The type of rehab that’s most appropriate depends on the patient’s condition.
The Substance Abuse and Mental Health Services Administration separates opioid treatment into three categories:
The types of rehab are differentiated by the type and duration of services clients receive. Types of services include medication-assisted treatments, individual counseling, group therapy and aftercare support. MATs include buprenorphine, methadone and naltrexone, which are approved to ease cravings and withdrawal symptoms.
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Medical detoxification does little to treat behavioral problems associated with opioid addiction. The goal of opioid detox is to help patients overcome dependency on opioids. At the beginning of detox, patients are dependent on opioids and are not on a medication-assisted treatment plan.
During detox, medications may be used to help patients slowly taper off of opioids. Unlike other types of opioid rehab, the medications aren’t intended for long-term use. Short-term counseling and group therapy may be introduced to increase motivation to complete treatment. But detox isn’t associated with the long-term therapy that’s required to address behavioral issues associated with addiction.
The goal of medically supervised withdrawal is to discontinue the use of medications that were introduced during detox. Patients entering medically supervised withdrawal are dependent on a maintenance medication such as methadone or buprenorphine. They may be in early- or long-term recovery from addiction.
If they’re in long-term recovery, they’ve already received counseling and therapy. They’ve demonstrated an ability to practice healthy behaviors, and they’ve discontinued compulsive behaviors that characterize addiction. They no longer need medication to aid in recovery. If they’re in early recovery, counseling and therapy are introduced as components of a treatment plan.
Medical maintenance treatment involves the use of a medication-assisted treatment for more than 21 days, according to SAMHSA. The treatment approach can include varying degrees of counseling, therapy and social support.
Comprehensive maintenance treatment plans include a wide range of medical, psychiatric and social support services. Less intensive medical maintenance treatment plans provide medications alongside limited counseling and support services.
Unfortunately, maintenance medications such as buprenorphine and methadone are not available at every rehab facility. For many people, opioid rehab begins with medical detox. Treatment specialists make patients as comfortable as possible while they experience withdrawal. Rehab centers may use nonopioid medications to treat pain, nausea and other symptoms of withdrawal.
Withdrawal from short-acting opioids, such as heroin, can begin within eight hours of last use. It usually lasts for between three and five days. However, withdrawal can last for up to 10 days, according to clinical guidelines for withdrawal management developed by the World Health Organization.
If medications are used, opioid detox is followed by medically assisted withdrawal. A doctor can help you determine what type of detox is best for you.
Factors that affect how a person detoxes from opioids, include:
Most people do not attend individual counseling or therapy sessions during detox. They may attend group therapy or other services designed to increase motivation to continue treatment, but behavioral therapy is not recommended until the worst withdrawal symptoms dissipate.
Medication-assisted treatment refers to the use of methadone, buprenorphine or naltrexone in combination with behavioral therapy. Methadone and buprenorphine can be administered temporarily or for multiple years. The length of methadone or buprenorphine treatment is determined by the patient and treatment team.
About a week after all withdrawal symptoms have dissipated, patients can be placed on naltrexone. Naltrexone can block the pleasurable effects of opioids and reduce cravings, according to SAMHSA. Naltrexone doesn’t ease symptoms of withdrawal. It reduces relapse by decreasing a person’s incentive to use opioids.
Medication-assisted treatment is considered a vital component of opioid rehab. The National Center on Addiction and Substance Abuse states that “medications prescribed by a physician are the most effective, potentially lifesaving, treatment for opioid addiction.”Read more about medication-assisted treatment
Unfortunately, some rehab facilities do not offer MATs for opioid use disorders. Individuals with severe opioid use disorders should not attend a facility that doesn’t offer at least one MAT. For people with severe opioid use disorders, multiple months or years of maintenance treatment may be necessary for long-term recovery.
Counseling and therapy begin once a person has finished detox or has been stabilized by a maintenance medication such as methadone or buprenorphine. Therapy treats problematic behaviors associated with addiction. Patients learn healthy ways to process information and manage emotions. They develop safe coping strategies. They also learn about underlying causes of addiction and how to avoid relapse.
A variety of therapeutic techniques can assist people in recovery from opioid addiction. Popular techniques include cognitive behavioral therapy, dialectical behavioral therapy, contingency management, community reinforcement approach and family-based therapies.
Therapy can occur in a variety of settings, including:
During inpatient therapy, most clients attend at least one individual therapy session each week. They also attend daily educational classes and multiple group therapy sessions each week. Most insurance plans cover inpatient rehab for between two and four weeks.
Patients then transition to outpatient therapy, which can continue indefinitely. During outpatient therapy, clients usually attend multiple one-on-one therapy appointments each week. As they maintain longer durations of sobriety, the frequency of therapy decreases.
Peer support is a key component of many treatment plans. During inpatient or outpatient therapy, some rehab centers assign a peer recovery coach or a peer leader to clients. These people can connect with individuals trying to recover from addiction. They share personal stories and recovery tips.
Many people are introduced to peer support groups, such as 12-step programs, during rehab. Others are referred to self-help groups after discharge. Peer support groups help people in recovery stay accountable, learn from others and develop a sense of purpose.
Other aftercare resources help clients transition to normal life. Some rehab clinics provide aftercare support after discharge.
Sober living homes and community groups may also provide access to support services, including:
Peer support and aftercare services decrease the chances of relapse by helping individuals in recovery rebuild their lives. Without access to a sober home or stable employment, individuals are more likely to relapse into drug use. With access to people who care and resources to learn new skills, people in recovery can pursue their dreams.
Many people continue to take methadone, buprenorphine or naltrexone after being discharged from rehab. The medications can be essential recovery resources during the first months or years of recovery.
Eventually, patients want to discontinue medication-assisted treatment. The risks of relapse increase when a person stops taking medication for opioid use disorders, but people who have maintained several months or years of sobriety may be candidates for discontinuation of treatment.
Factors that affect whether a person should end MAT include:
Patients who are noncompliant with treatment are also candidates for discontinuation. These clients should be referred to other rehab services that may be more appropriate.
Discontinuing methadone or buprenorphine can take several months because stopping abruptly can cause withdrawal. The dosage of medication is slowly reduced until the person no longer experiences cravings or symptoms of withdrawal.
Naltrexone does not cause withdrawal. It may be discontinued immediately when a doctor and patient agree that the risk of relapse is low.
Many people think of opioid rehab as a seven- or 30-day stay at a treatment facility. But recovery takes more than one month. Detox isn’t the only component of rehab. Residential therapy isn’t the final stage of recovery.
The best rehab programs provide structured treatment, including outpatient therapy and aftercare, for multiple months. Many patients continue their rehabilitation for more than one year with the help of support groups and medication.