More and more people in the US are able to identify a friend, relative or neighbor who has succumbed to opioid addiction as it increasingly damages the nation.
It’s a frightening reality, but there are options available for people hoping to gain control of their condition and live a life that isn’t dictated by these potent drugs.
What are the routes to recovery from addiction? The Guardian explored that question and more as part of a series of pieces this week looking at survivors of addiction and how to tackle it.
Can opioid addiction be cured?
There is no cure for addiction, but the disease can be managed just like other chronic medical conditions including diabetes and high blood pressure.
That’s one of the reasons people who are no longer addicted to drugs or alcohol might describe themselves as being “in recovery”. Recovery means different things to different people but generally describes someone who is able to live life without it being disrupted by addiction.
Ivana Grahovac, one of three people in recovery from opioid addiction profiled by the Guardian, said she knew she was in recovery when she woke up and “started to have thoughts of hope, excitement, of joy, ambition and to help others”.
How do you get to be in recovery from opioid addiction?
There are many routes for addiction treatment but the one with the most scientific support combines medication, counseling and recovery meetings.
“If people do those three things together, their chances of getting onto a path of recovery are significantly better than if they try to detoxify off the heroin or the pills they are taking and try to go immediately go to an abstinence-oriented program, where they are not taking any medication to help them during the early stage of their recovery,” said Samuel Ball, president and CEO at the National Center on Addiction and Substance Abuse.
How does medication help treat drug addiction?
Medication is used to stabilize people when they quit using opioids. These drugs include opioids like methadone and buprenorphine, which can reduce the painful effects of withdrawal by lowering the amount of opioids people are taking. They can also help people who want to quit using stave off overwhelming cravings.
A third medication treatment, naltrexone, is different in that it blocks the effect of opioids and it has been studied less closely than the other two drugs.
Isn’t using these drugs just substituting one type of opioid drug for another?
No, though the US health secretary Tom Price said it was last month. Price’s comment sparked a furor among health professionals – nearly 700 researchers and practitioners sent a letter urging Price to “set the record straight”.
“The perception that persons receiving long-term therapy with medications – especially with buprenorphine and methadone – are not actually in recovery is widespread but grossly inaccurate,” the letter said.
The Department of Health and Human Services then clarified that expanding access to medication-assisted treatments is a key element of the federal government’s plans to curb opioid addiction.
That said, these drugs aren’t perfect. Buprenorphine and methadone can and have been abused by opiate users, which is why it is recommended these drugs be taken alongside other therapies.
What happens if people quit using opioids without medication?
For people who abruptly quit, a cluster of unpleasant symptoms can occur as part of withdrawal: anxiety, body aches, nausea, vomiting, diarrhea, agitation.
There is a school of thought that the sheer unpleasantness of withdrawal will push someone out of addiction for good, and that certainly works for some people, but Ball warned it is not something worth betting on.
“I think If you asked me 10 years ago, I might have said detoxing and trying an abstinence-oriented approach, maybe that’s worth a try one time,” said Ball. “And then if that doesn’t work try one of the medications.”
These days, however, Ball said the addiction crisis has “become so life and death” that he thinks medication should be incorporated from the beginning of addiction treatment.
Why can’t people just decide to quit?
There is a narrative, often perpetuated by the media, of people becoming stubborn and quitting on their own once and for all – whether it’s because of a revelation triggered by an emotional low point or, in the case of one person the Guardian spoke with, spending some time in jail where they were forced to withdraw without any support.
“It’s miraculous, and great stories to hear, but I think for many people with opioid addiction, it’s not a realistic thing to plan for, if that kind of epiphany happens for you, it’s wonderful, but you can’t make it happen,” Ball said.
He said the “chances of you staying alive for a longer period of time” are much higher if you access other forms of treatment, particularly medication.
How effective is rehab at treating addiction?
If pop culture is your guide, the answer to addiction can be found at a swanky beach house rehab center in Malibu, California, or sunny Florida.
These centers – just like residential centers in less idyllic locations across the US – can certainly be effective, but they aren’t required to provide evidence-based treatment, so the efficacy varies wildly.
Some centers don’t have a trained physician or psychiatrist on staff around the clock or only offer a couple hours of therapy each week – an insufficient amount for someone who has deemed their problem so severe they aren’t safe at home.
Also, there is a potentially enormous cost tied to rehab that do not always reflect the quality of service. Insurers don’t always cover these programs, and if they do, they limit how long they will cover the service for.
That is a huge problem because addiction experts agree that addiction can’t be resolved in a short period of time.
How long does it take to recover?
This is obviously different from everyone, and must be considered alongside the fact that relapse is common.
Though it would seem like taking up drugs again is a failure, the US National Institute of Drug Abuse (Nida) said relapse is a sign that treatment needs to be adjusted or started again and is certainly not an indication that someone has irreparably harmed their chances of living a life free from addiction.
Relapse is common for 40% to 60% of patients being treated for addiction and 50% to 70% of people with asthma and hypertension, according to the Nida. The agency notes those disease also have physiological and behavioral components people must manage, particularly when experiencing a relapse.