What Is the First Step in Heroin Use Disorder Treatment?
To begin the journey to recovery from heroin use disorder, it is important to see a medical professional for an evaluation. Heroin use and withdrawal can cause a range of uncomfortable symptoms that may be potentially serious for some patients, and a medical professional will be able to make effective recommendations for inpatient rehabilitation or outpatient treatment based on the severity of the person’s condition. Treatment typically includes prescription medications to ease physical symptoms and psychotherapy to help with overcoming the mental challenges associated with heroin use disorders.
During a medical appointment, the health care provider will ask the individual questions about his or her heroin use, physical health and mental health. The clinician will want to know how long the person has been taking heroin and how frequently it is used. It is also helpful for the clinician to know whether the person uses heroin intravenously or by another route. Questions will be asked about the use of alcohol or other drugs.
The physician may want to examine the patient to obtain more information about his or her overall health and how it may have been affected by heroin use. Depending on the severity of the person’s heroin use and where he or she is in the recovery process, cardiac and gastrointestinal symptoms may be present. The doctor will check the individual’s heart rate and blood pressure to see if these are elevated, and an abdominal examination might be performed if the patient has gastrointestinal symptoms.
Blood and urine tests are necessary to confirm a diagnosis of heroin use disorder. Based on the results of the lab tests, physical exam and clinical interview, the doctor will be able to recommend the most suitable treatment and rehabilitation options for the person’s individual health needs.
Heroin Abuse Statistics
Heroin is a semi-synthetic, illegal opioid that is highly addictive. Across the nation, heroin use has increased among men and women of all income levels and among most age groups. Over the past several years, heroin use has sharply increased in groups that previously had low levels of heroin use, including women, people with higher income levels and individuals with private health insurance.
In 2017, roughly 494,000 Americans aged 12 and above reported that they had used heroin within the previous 12 months. That same year, more than 15,000 individuals died from heroin-related overdoses in the U.S.
Heroin use disorders are treatable, and people with this condition can make a full recovery with appropriate support. This guide will help you understand more about treatments for heroin addiction, and it will also discuss several options for rehabilitation.
What Treatment and Rehabilitation Options Might Be Recommended?
Treatment for heroin use disorders normally requires a combination of medication and behavioral therapy. These can be administered through inpatient rehabilitation or through outpatient centers. Some people may need to attend inpatient rehab first before transitioning to outpatient services.
At the beginning of treatment, users will go through withdrawal as the body rids itself of heroin. Medical supervision is necessary during withdrawal, and some individuals may need to be hospitalized in an inpatient facility to manage withdrawal symptoms.
What Medications Are Administered During Withdrawal?
Patients who are withdrawing from heroin typically experience symptoms such as fever, elevated heart rate, high blood pressure and irritability. Tremors, anxiety, depression and severe pain in the bones and muscles could occur as well.
To ease withdrawal symptoms, clinicians may prescribe the medications discussed below.
Methadone is an oral medication that has been used since the 1960s to help patients through the heroin withdrawal process. It is a slow-acting opioid agonist that must be taken daily, and it is available through approved outpatient treatment centers. It is considered ideal for those who have not responded to other medications.
Potential side effects of methadone may include changes in heart rhythm and difficulties with urination. Individuals who take this medication will be closely monitored throughout their treatment.
Buprenorphine is a mixed opioid agonist-antagonist that was approved for use in 2002. At low to moderate doses, it produces euphoria and other effects that are also produced by opioids. However, these effects are much weaker than those of heroin and other opioids.
Once the patient reaches a moderate dose of buprenorphine, these effects level off due to the “ceiling effect” of the medicine. This feature reduces the risk of misusing or becoming dependent on buprenorphine. This medication is considered to be long-acting, and patients might not need to take it every day.
Potential side effects of buprenorphine include irritability, sleep disturbances, constipation, nausea and muscle cramps. Patients typically take buprenorphine by itself for the first two days of withdrawal before being switched to a combination medicine for maintenance treatment. It is generally given in physician’s offices, and it may be given by physicians at inpatient rehabilitation facilities as well.
What Medications Are Used After Withdrawal to Reduce the Risk of Relapse?
After the patient has completed the withdrawal process, he or she will be placed on medication-assisted treatment that could continue for many months. Methadone and buprenorphine may be used during treatment, and the newer medicines listed below might be considered as well.
1. Buprenorphine, Naloxone or Suboxone
This medication is taken orally. The combination of naloxone with buprenorphine helps prevent patients from misusing buprenorphine by injecting it. If a patient were to do this, the naloxone in the medication would cause withdrawal symptoms. Potential side effects of this medicine may include headaches, chills, lower back pain, coughing and painful urination. Patients should attend all medical appointments during treatment with this and any other medication for heroin use disorder, and they should let their health care provider know about any side effects that they experience.
Naltrexone is a medication that is injected into the gluteal muscles by a health care provider once a month. It is also available as an oral tablet, and patients on this form of the medicine need to take the tablet each day. Treatment with naltrexone can start seven to 10 days after the patient has completely withdrawn from heroin. Patients are often asked to have a urine test to verify that they are free of heroin before receiving the medication. Potential side effects of naltrexone include injection site pain, abdominal pain, anxiety, sleep disturbances and nausea.
What Psychological Therapy Is Provided During Treatment?
Psychological therapy helps patients reconstruct their lives as they recover from heroin use disorder. They learn healthy ways to cope with cravings, and they are able to explore the factors that contributed to their disorder. Therapy helps people rebuild their relationships with family and friends, and it teaches them new ways of responding to their environment and triggers.
Most patients receive group and individual therapy sessions during recovery. These can be conducted at inpatient and outpatient facilities. Patients who started therapy during inpatient recovery can continue it on an outpatient basis once they leave their rehabilitation facility.
The therapy methods used during recovery will be tailored to their individual needs. The treatment approaches outlined below are some of those that may be provided.
1. Cognitive Behavioral Therapy
This form of therapy helps individuals recognize the ways in which their thoughts and feelings influence their actions. People learn to challenge the negative thoughts that they have, and they learn to identify the triggers that lead them to use heroin. The therapist teaches the patient coping mechanisms that they can use to avoid or manage these triggers without turning to heroin. Journaling, mental distraction techniques, relaxation methods and role-playing approaches may all be used in cognitive behavioral therapy.
2. Contingency Management
Contingency management offers the individual incentives for staying heroin-free, and studies show that it is a very effective method of improving treatment retention and abstinence from drugs.
In voucher-based reinforcement programs, patients receive vouchers with monetary value that can be used for food, movie tickets or other goods that support a heroin-free lifestyle. Patients must provide a heroin-free urine sample to obtain a voucher, and the value of the voucher increases with each successive heroin-free sample. Prize-based programs work in a similar manner where patients are rewarded with cash in place of vouchers.
What Inpatient Rehabilitation Options Could Work for You?
If inpatient rehabilitation has been recommended, it is important to select a program that takes a holistic approach to treatment. The facility should address the medical, mental and spiritual needs of every person.
Our inpatient rehabilitation facilities in New Hampshire are run by our flagship substance use treatment company, Granite Recovery Centers. All of our staff members are dedicated to helping each patient on every step of his or her recovery. We invite you to explore each of our rehabilitation retreats to find out which one could be the ideal fit for you.
Green Mountain Treatment Center
Patients at Green Mountain are provided with gender-separate programs and accommodation. This treatment center uses the 12-step curriculum that helps people identify the root causes of their heroin use disorder. As users journey through the steps, they learn about themselves and discover how to find healing and purpose in their lives.
Green Mountain patients use the 12 steps in conjunction with group and individual psychotherapy sessions. Trauma therapy, cognitive behavioral therapy, dialectical therapy and grief and loss therapy are some of the approaches that may be used by our clinicians. Patients are also provided with holistic therapies, including adventure therapy, yoga, meditation and exercise.
Patients who need medically supervised detox from heroin can receive this at our sub-acute medical detox facility on the Green Mountain campus. During their detox, patients are monitored throughout the day and night by medical staff. All of the clinicians at the facility are trained in the management of substance use disorders.
New Freedom Academy
Like our Green Mountain facility, New Freedom Academy offers gender-separate programs and living spaces. Tucked in the New Hampshire countryside, New Freedom Academy has 20 beds, making it an ideal location for individuals who want to receive treatment in a smaller facility.
New Freedom Academy offers medication-assisted treatment, and doctors are on-site 24 hours a day. During their stay at New Freedom, patients participate in group and individual therapy that may include a combination of cognitive behavioral therapy, motivational interviewing, dialectical therapy and grief and loss therapy. Patients take part in process groups, and bowling and paintball outings offer the chance to release stress and form friendships with other individuals.
Family recovery workshops are a unique offering at New Freedom Academy, and they take place weekly at an off-site location. These workshops help people restore and renew their connections with family members.
What Additional Treatment Options Are Available?
After receiving inpatient treatment, many recovering heroin use disorder patients will need continued support. At Granite Recovery Centers, we provide extended care programs, sober-living programs and outpatient treatment options to help individuals live a heroin-free life.
• Extended Care Programs
Patients in our two extended care programs live in gender-separated housing. The programs provide structure and enable residents to continue the work that they began during inpatient treatment. The program is based on the 12-step curriculum, and it includes three phases to help people transition to independent living. While receiving psychotherapy and holistic therapy, residents are guided with participation in team-building exercises and goal-setting groups. Optional monitoring programs are available, and patients in the third phase of the program become mentors for new residents.
• Sober Living
Our four sober-living facilities provide residents with supervision, and they offer slightly more flexibility than our extended-living programs. Patients who are enrolled in sober living are slowly acclimated to the challenges of independent living in a supportive environment with like-minded peers. They work on housekeeping, money management and skills for job interviewing. Patients in sober-living facilities must completely abstain from heroin and other drugs, and they cannot be on medication-assisted therapy.
• Intensive Outpatient Program
Our intensive outpatient program is designed to support individuals who have transitioned to independent living and are in early recovery. Patients are provided with individual and group therapy centered on the 12-step model, and they can take part in peer support groups and goal-setting groups. Each person is given an individualized treatment plan, and we help the individual with managing his or her medications.
No matter where you are on your journey to recovery, help is possible.