Heroin Detox Treatments

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Old Ideas

Since so much of our scientific understanding of addiction is relatively new, and since so much about drug and alcohol addiction is tied up in belief systems, it’s not surprising that myths about this disease abound.

“There are two main misconceptions that really drive me crazy when it comes to addictions,” says Dr. Kathleen Brady, a professor at the Medical University of South Carolina. “One of them is this whole idea that an individual needs to reach rock bottom before they can get any help. That is absolutely wrong. There is no evidence that that’s true. In fact, quite the contrary. The earlier in the addiction process that you can intervene and get someone help, the more they have to live for. The more they have to get better for.”

The other big myth, says Dr. Nora Volkow, director of the federal government’s National Institute on Drug Abuse, is that you have to want to be treated in order to get better. Even as an internationally respected researcher, she once believed that to be true, Volkow says, but she knows now that people who are forced into treatment do recover. Addicts may be pushed to enter a detox center or treatment program by an employer, a companion or the criminal justice system. Employers may threaten to fire a person unless treated; a spouse may threaten to leave the relationship, or the court may offer treatment in lieu of prison. (In this case, people convicted of nonviolent, drug-related crimes may go through specialized alternative courts, called drug courts, in which they can reduce their sentence or avoid jail altogether by getting intensive addiction treatment.) In fact, research has shown that the outcomes for those who are legally mandated to enter treatment can be as good as the outcomes for those who entered treatment voluntarily.

Myths About Drug and Alcohol Addiction*

* Adapted from Myths of Addiction. Carlton K. Erickson, Ph.D., University of Texas Addiction Science

1. Addicts are bad, crazy, or stupid.

Evolving research is demonstrating that addicts are not bad people who need to get good, crazy people who need to get sane, or stupid people who need education. Addicts have a brain disease that goes beyond their use of drugs.

2. Addiction is a willpower problem.

This is an old belief, probably based upon wanting to blame addicts for using drugs to excess. This myth is reinforced by the observation that most treatments for alcoholism and addiction are behavioral (talk) therapies, which are perceived to build self-control. But addiction occurs in an area of the brain called the mesolimbic dopamine system that is not under conscious control.

3. Addicts should be punished, not treated, for using drugs.

Science is demonstrating that drug addicts have a brain disease that causes them to have impaired control over their use of drugs. Drug Addicts need drug detox treatment for their neurochemically driven brain pathology.

4. People addicted to one drug are addicted to all drugs.

While this sometimes occurs, most people who are dependent on a drug may be dependent on one or two drugs, but not all. This is probably due to how each drug “matches up” with the person’s brain chemistry.

5. Addicts cannot be treated with medications.

Actually, addicts are medically detoxified in hospitals, when appropriate, all the time. But can they be treated with medications after detox? New pharmacotherapies (medicines) are being developed to help patients who have already become abstinent to further curb their craving for addicting drugs. These medications reduce the chances of relapse and enhance the effectiveness of existing behavioral (talk) therapies.

6. Addiction is treated behaviorally, so it must be a behavioral problem.

New brain scan studies are showing that behavioral treatments (i.e., psychotherapy) and medications work similarly in changing brain function. So addiction is a brain disease that can be treated by changing brain function, through several types of treatments.

7. Alcoholics can stop drinking simply by attending AA meetings, so they can’t have a brain disease.

The key word here is “simply.” For most people, Alcoholics Anonymous (AA) is a tough, lifelong working of the Twelve Steps. On the basis of research, we know that this support system of people with a common experience is one of the active ingredients of recovery in AA. AA and the Twelve Step Program doesn’t work for everyone, even for many people who truly want to stop drinking.

Source: HBO Addiction

Advances in research have helped us to identify and understand the risk factors that can contribute to the development of drug and alcohol problems in adolescents, as well as ways to reduce those risks. One of the most important things we have learned about treating adolescents is the importance of addressing other issues in their lives in addition to their problems with drugs and alcohol. My research over the past 15 years has focused on developing more effective ways of integrating the assessment and treatment of addiction with the mental health, behavioral and family problems that are often linked to substance use in adolescents.

Parents often ask:

• “What are some of the factors that increase my child’s risk of substance use and what can I do to reduce those risks?”
• “What are some early signs that my teenager might be using drugs or alcohol?” What are the some of the risk factors?

What are the some of the risk factors?

Research has shown that children who have significant mood and behavior problems, such as prolonged temper tantrums, excessive aggression, impulsivity or risk-taking have a greater chance of developing substance use problems in adolescence compared to those who do not have these behaviors. In addition children who have learning disabilities or other academic or behavioral problems during elementary and middle school years may also be at higher risk of early drug or alcohol involvement during adolescence.

What can I do to reduce the risks?

Early evaluation and treatment

The good news is that early evaluation and treatment can help reduce the risks if your child does develop some of these problems. A number of proven interventions for childhood behavior problems focus on helping parents learn the tools of effective behavioral management such as how to notice and reward good behavior as well as how to identify and interrupt problem behavior cycles. Another important aspect of effective treatment is the cognitive and behavioral skills training that helps children achieve greater control over their own behavior, moods, and thoughts. Early diagnosis and treatment of learning disorders, attention-deficit-hyperactivity disorder and mood disorders may also reduce the risks of substance use and other associated behavioral and mental health problems in adolescence.

Be an involved parent

Research shows that parental support, monitoring and involvement in their child’s life is an important protective factor against adolescent drug use. Involvement in a child’s school reduces behavioral and academic problems and also helps parents to know their children’s friends and their friend’ parents. This helps parents connect and network with other parents in monitoring their own children’s activities as well as those of their peer group. Research clearly shows that appropriate parental monitoring protects against the risks of problem behaviors including substance use.

Open and honest communication

Regular family discussions characterized by open, honest and respectful conversation regarding behavioral expectations and consequences, including attitudes and family rules about drug and alcohol use can reduce the risk of adolescent drug use and other serious problem behaviors. The tricky part for parents is achieving the balance between being clear, consistent and authoritative when establishing household rules and the consequences of rule violation while at the same time making it “safe”for your kids to tell the truth. Make it clear to your teenager that he or she can call you anytime, day or night, if they feel that they might be in an unsafe situation. For example, let them know that if the person who was to drive them home is intoxicated, you will come and pick them up -no questions asked, at least not on the way home.

Get the help you need

All of us are affected and connected by the enormous personal and societal impact of substance use and addiction. The majority of us have had a family member or a close friend who has suffered from the impact of substance use or addiction (or we have suffered ourselves). When this happens it is important to get the additional help and support from family, friends and professionals that we need. Several individual and family-based treatment approaches are effective in treating substance use in both adolescents and adults. Information about illicit drugs, alcohol, prevention and treatment programs can be obtained on the following websites:

• National Institute on Drug Abuse (NIDA)
• Center for Substance Abuse Treatment (CSAT)
• Drug Strategies
• National Institute on Alcohol Abuse and Alcoholism (NIAAA)

Medical Detoxification is a process in which individuals are systematically and safely withdrawn from addicting drugs, usually under the care of a physician. Drinking alcohol or using drugs causes physical dependence over time in some people. Stopping the use of alcohol or drugs results in physical withdrawal from these substances in people with a physical dependence. The detoxification process is designed both to treat the acute physiological effects of stopping drug use and to remove residual toxins in the body left as a result of using the chemicals found in drugs and/or alcohol.

Medical Detoxification: In order to withdraw from certain addictive substances safely, it may be preferable and in some cases necessary to undergo medically supervised detoxification in a hospital or residential treatment center that has a detoxification unit. This would be advisable for patients that have been using an addictive substance heavily for a longer period of time and are more likely to have more severe withdrawal symptoms, or those with other significant health problems. Inpatient detoxification allows the patient to be closely monitored throughout the process and given appropriate medication to prevent severe withdrawal symptoms. It commonly involves the gradual administration of decreasing doses (tapering) of an agent that is related to the original drug of abuse that is now substituted to prevent withdrawal.

Rapid Detoxification: In this procedure drug withdrawal occurs while patients are asleep under general anesthesia. The patient is given intravenous injections of medications called opiate blockers which stop the action of narcotics and opiate drugs as well as injections of other medications that reduce the symptoms of withdrawal such as muscle relaxants or anti-nausea medications. This process results in rapid withdrawal from the physical effects of addiction. Through the use of opiate blockers such as naltrexone, naloxone, and nalmephine, physical detoxification is achieved within 4 to 8 hours. Rapid detox takes place in an intensive care unit of a hospital. Patients are usually discharged within 48 hours following recovery from anesthesia and assessment of their physical status.

Rapid detoxification helps reduce the distress of opiate withdrawal for people who are chemically dependent on narcotics such as heroin, Vicodin, Percocet, Demerol, Dilaudid, Darvocet, OxyContin, opium, morphine, codeine, oxycodone, hydrocodone, prescription painkillers, and all narcotic type drugs. It shortens the detoxification period and spares patients the pain and physical discomforts of withdrawal. It may be of great benefit to patients who suffer from severe withdrawal symptoms and who have failed repeatedly to complete conventional withdrawal programs . However, there are significant costs as well as risks associated with the use of general anesthesia. It is imperative that the procedure be performed by medical professionals who are highly trained in these procedures in a medical setting that is fully equipped to deal with any complications that may arise.

Stepped Rapid Detoxification: This alternative to rapid detoxification provides small doses of Narcan (Naloxone) subcutaneously and naltrexone orally every hour or so, together with reduced withdrawal management medications , mostly orally, as necessary. This approach using the slower oral and subcutaneous routes rid the body of the opiate more slowly than intravenous Rapid Detoxification . In addition the pacing can be controlled and responsive to any withdrawal symptoms that develop in the patient by having them quickly suck on Buprenorphine tablets under the tongue. There is less need for withdrawal management medications. The patient is alert and directly communicating with medical staff until the situation has been resolved. It is possible to be detoxified and stabilized on Naltrexone Maintenance Therapy with 2 to 4 small manageable bites. If someone tries to use any kind of opiate while they are on Naltrexone, they feel no effect because all of the receptors are completely blocked.

Ultra Rapid Detoxification: This procedure involves putting patients under general anesthesia and giving them a drug called Naltrexone which blocks all of their endorphin receptors. This accelerates the withdrawal process, pushing them into 100% detoxification within a 5-30 minute period. Although this is an extremely painful process it is tolerable under anesthesia. As with rapid detoxification, it is very costly and has significant medical risk.

Outpatient Detoxification
Outpatient medical detoxification is usually safe and effective for people who are more likely to have mild to moderate withdrawal symptoms. For instance, primary care-based opiate detoxification can be accomplished with a variety of medications such as buprenorphine-naloxone (BUP/NX) or clonidine alone or combined with naltrexone. Buprenex, newly approved by the FDA, can now be administered on an outpatient basis by physicians who receive a required eight-hour training. Using Buprenex, the detoxification can take between 7-14 days.

The mental health problems that most commonly co-occur with substance abuse are depression, anxiety disorders, and bipolar disorder.

Common signs and symptoms of depression

• Feelings of helplessness and hopelessness
• Loss of interest in daily activities
• Inability to experience pleasure
• Appetite or weight changes
• Sleep changes
• Loss of energy
• Strong feelings of worthlessness or guilt
• Concentration problems

Common signs and symptoms of mania

• Feelings of euphoria or extreme irritability
• Unrealistic, grandiose beliefs
• Decreased need for sleep
• Increased energy
• Rapid speech and racing thoughts
• Impaired judgment and impulsivity
• Hyperactivity
• Anger or rage

Common signs and symptoms of anxiety

• Excessive tension and worry
• Feeling restless or jumpy
• Irritability or feeling “on edge”
• Racing heart or shortness of breath
• Nausea, trembling, or dizziness
• Muscle tension, headaches
• Trouble concentrating
• Insomnia

Treatment for co-occurring substance abuse and mental health problems

The best treatment for co-occurring disorders is an integrated approach, where both the substance abuse problem and the mental disorder are treated simultaneously.

How do I find the right program for co-occurring disorders?

As with a substance abuse program, you want to make sure that the program is appropriately licensed and accredited, that the treatment methods are backed by research, and that there is an aftercare program to prevent relapse. Additionally, you should make sure that the program has experience with your particular mental health issue. Some programs, for example, may have experience treating depression or anxiety, but not schizophrenia or bipolar disorder.

There are a variety of approaches that treatment programs may take, but there are some basics of effective treatment that you should look for:

• Treatment addresses both the substance abuse problem and your mental health problem.
• You share in the decision-making process and are actively involved in setting goals and developing strategies for change.
• Treatment includes basic education about your disorder and related problems.
• You are taught healthy coping skills and strategies to minimize substance abuse, cope with upset, and strengthen your relationships.

Heroin and opiates are physically addicting. Heroin detox becomes necessary when the body adapts to the presence of the drug and more and more is needed to reduce the cravings for the drug. Withdrawal symptoms will definitely occur if heroin use or opiate use is abruptly discontinued.

Generally speaking, withdrawal from heroin and other opiates may occur as early as a few hours after the last use. The withdrawal symptoms of heroin addiction include:

•  drug craving
•  restlessness
•  muscle and bone pain
• insomnia
• diarrhea
• vomiting
• sweats and cold flashes

Major withdrawal symptoms of heroin addiction and other opiate addictions peak between 48 and 72 hours after the last dose. Without proper medical care seizures or convulsions can occur. The good news is that an addict can usually complete heroin detox or opiate detox within five and seven days.

Choose Inpatient Heroin Detox or Opiate Detox Programs

Heroin detox and opiate detox can be a very challenging process both physically and emotionally. It is my opinion that anyone undergoing heroin detox or opiate detox, should do so in drug rehab programs or addiction treatment programs that specialize in medical detox programs. All heroin detox programs should be medically monitored, complete with 24 hour nursing, able to dispense medications as needed and directed by a physician trained in addiction medicine (addictionologist).

Ongoing Addiction Treatments

Even after heroin or opiate detox is complete, many people require ongoing addiction treatments, therefore heroin detox should take place within one of many drug rehab centers or addiction treatment programs. Drug rehab programs provide a smoother transition from heroin detox and opiate detox programs, which are medically driven, into a clinically driven level of care within the drug rehab.

Structure is Key

Another reason we feel that heroin detox should be provided within the confines of drug rehab programs or addiction treatment programs is due to the structure they provide. Many people attempt heroin detox on an outpatient basis. While outpatient heroin detox can work for some, most addicts require the structure of inpatient detox programs to deal with the cravings and keep them away from their environment, old friends and access to opiates.

While in the grips of heroin or opiate addiction, addicts are often involved in high risk activities. By undergoing opiate detox or heroin detox in drug rehab centers, addicts receive a comprehensive physical examination. This will help identify any medical problems that are present and need to be addressed. This examination process is begun in detox and ongoing support is available if a person transitions into drug rehab.

Co-occurring disorders, also referred to as dual diagnosis, is a term used when you have both a mental health disorder—such as depression, anxiety, or bipolar disorder—and a drug or alcohol problem. Both the mental health issue and the addiction have their own unique symptoms that may get in the way of your ability to function, handle life’s difficulties, and relate to others.

Complicating the situation, the two problems affect each other and interact. When a mental health problem goes untreated, the substance abuse problem usually gets worse as well. And when alcohol or drug abuse increases, mental health problems usually increase too.

Recovery depends on treating both the addiction and the mental health problem

Whether your mental health or substance abuse problem came first, recovery depends on treating both illnesses. The good news is that most people suffering from co-occurring addiction and mental health problems are able to recover, given proper treatment and support.

• There is hope. Recovering from co-occurring disorders takes time, commitment, and courage. It may take months or even years. But people with substance abuse and mental health problems can and do get better.
• Combined treatment is best. Your best chance of recovery is through integrated treatment for both the substance abuse problem and the mental health problem. This means getting combined mental health and addiction treatment from the same treatment provider or team.
• Relapses are part of the recovery process. Don’t get too discouraged if you relapse. Slips and setbacks happen, but, with hard work, most people can recover from their relapses and move on with recovery.
• Peer support can help. You may benefit from joining a self-help support group like Alcoholics Anonymous or Narcotics Anonymous. They give you a chance to lean on others who know what you’re going through and learn from their experiences.

What comes first: Substance abuse or the mental health problem?

Addiction is common in people with mental health problems. But although substance abuse and mental health disorders like depression and anxiety are closely linked, one does not directly cause the other.

The relationship between substance abuse and mental health problems

• Alcohol or drugs are often used to self-medicate the symptoms of depression or anxiety. Unfortunately, substance abuse causes side effects and in the long run worsens the very symptoms they initially numbed or relieved.
• Alcohol and drug abuse can increase underlying risk for mental disorders. Mental disorders are caused by a complex interplay of genetics, the environment, and other outside factors. If you are at risk for a mental disorder, drug or alcohol abuse may push you over the edge.
• Alcohol and drug abuse can make symptoms of a mental health problem worse. Substance abuse may sharply increase symptoms of mental illness or trigger new symptoms. Alcohol and drug abuse also interact with medications such as antidepressants, anti-anxiety pills, and mood stabilizers, making them less effective.

Recognizing and diagnosing co-occurring disorders

It can be difficult to diagnose a substance abuse problem and a co-occurring mental health disorder such as depression, anxiety, or bipolar disorder. It takes time to tease out what might be a mental disorder and what might be a drug or alcohol problem.

Complicating the issue is denial. Denial is common in substance abuse. It’s hard to admit how dependent you are on alcohol or drugs or how much they affect your life. Denial frequently occurs in mental disorders as well. The symptoms of depression or anxiety can be frightening, so you may ignore them and hope they go away. Or you may be ashamed or afraid of being viewed as weak if you admit the problem.

Admitting you have a problem is the first step on the road to recovery

Just remember: substance abuse problems and mental health issues don’t get better when they’re ignored. In fact, they are likely to get much worse. You don’t have to feel this way! Admitting you have a problem is the first step towards conquering your demons and enjoying life again.

• Consider family history. If people in your family have grappled with either a mental disorder such as depression or an alcohol or drug addiction, you have a higher risk of developing these problems yourself.
• Consider your sensitivity to alcohol or drugs. Are you highly sensitive to the effects of alcohol or drugs? Have you noticed a relationship between your substance use and your mental health? For example, do you get depressed when you drink?
• Look at symptoms when you’re sober. While some depression or anxiety is normal after you’ve stopped drinking or doing drugs, if the symptoms persist after you’ve achieved sobriety, you may be dealing with a mental health problem.
• Review your treatment history. Have you been treated before for either your addiction or your mental health problem? Did the substance abuse treatment fail because of complications from your mental health issue or vice versa?

Signs and symptoms of alcohol or drug addiction

If you’re wondering whether you have a substance abuse problem, the following questions may help. The more “yes” answers, the more likely your drinking or drug use is a problem.

• Have you ever felt you should cut down on your drinking or drug use?
• Have you tried to cut back, but couldn’t?
• Do you ever lie about how much or how often you drink or use drugs?
• Have your friends or family members expressed concern about your alcohol or drug use?
• Do you ever felt bad, guilty, or ashamed about your drinking or drug use?
• On more than one occasion, have you done or said something while drunk or high that you later regret?
• Have you ever blacked out from drinking or drug use?
• Has your alcohol or drug use caused problems in your relationships?
• Has you alcohol or drug use gotten you into trouble at work or with the law?

The mental health problems that most commonly co-occur with substance abuse are depression, anxiety disorders, and bipolar disorder.

Common signs and symptoms of depression

• Feelings of helplessness and hopelessness
• Loss of interest in daily activities
• Inability to experience pleasure
• Appetite or weight changes
• Sleep changes
• Loss of energy
• Strong feelings of worthlessness or guilt
• Concentration problems

Common signs and symptoms of mania

• Feelings of euphoria or extreme irritability
• Unrealistic, grandiose beliefs
• Decreased need for sleep
• Increased energy
• Rapid speech and racing thoughts
• Impaired judgment and impulsivity
• Hyperactivity
• Anger or rage

Common signs and symptoms of anxiety

• Excessive tension and worry
• Feeling restless or jumpy
• Irritability or feeling “on edge”
• Racing heart or shortness of breath
• Nausea, trembling, or dizziness
• Muscle tension, headaches
• Trouble concentrating
• Insomnia

Treatment for co-occurring substance abuse and mental health problems

The best treatment for co-occurring disorders is an integrated approach, where both the substance abuse problem and the mental disorder are treated simultaneously.

How do I find the right program for co-occurring disorders?

As with a substance abuse program, you want to make sure that the program is appropriately licensed and accredited, that the treatment methods are backed by research, and that there is an aftercare program to prevent relapse. Additionally, you should make sure that the program has experience with your particular mental health issue. Some programs, for example, may have experience treating depression or anxiety, but not schizophrenia or bipolar disorder.

There are a variety of approaches that treatment programs may take, but there are some basics of effective treatment that you should look for:

• Treatment addresses both the substance abuse problem and your mental health problem.
• You share in the decision-making process and are actively involved in setting goals and developing strategies for change.
• Treatment includes basic education about your disorder and related problems.
• You are taught healthy coping skills and strategies to minimize substance abuse, cope with upset, and strengthen your relationships.

You will know if you are receiving integrated treatment because your clinician or treatment team will do several things at the same time, including:

• Help you think about the role that alcohol and other drugs play in your life. This should be done confidentially, without any negative consequences. People feel free to discuss these issues when the discussion is confidential, nonjudgmental, and not tied to legal consequences.
• Offer you a chance to learn more about alcohol and drugs, to learn about how they interact with mental illnesses and with medications, and to discuss your own use of alcohol and drugs.
• Help you become involved with supported employment and other services that may help your process of recovery.
• Help you identify and develop your own recovery goals. If you decide that your use of alcohol or drugs may be a problem, a counselor trained in integrated dual disorders treatment can help you identify and develop your own recovery goals. This process includes learning about steps toward recovery from both illnesses.
• Provide special counseling specifically designed for people with dual disorders. If you decide that your use of alcohol or drugs may be a problem, a trained counselor can provide special counseling specifically designed for people with dual disorders. This can be done individually, with a group of peers, with your family, or with a combination of these.

Source: SAMHSA’s National Mental Health Information Center

Group support for co-occurring substance abuse and mental health disorders

As with other addictions, groups are very helpful, not only in maintaining sobriety, but also as a safe place to get support and discuss challenges. Sometimes treatment programs for co-occurring disorders provide groups that continue to meet on an aftercare basis. Your doctor or treatment provider may also be able to refer you to a group for people with co-occurring disorders.

While it’s often best to join a group that addresses both substance abuse and your mental health disorder, twelve-step groups for substance abuse can also be helpful—plus they’re more common, so you’re likely to find one in your area. These free programs, facilitated by peers, use group support and a set of guided principles—the twelve steps—to obtain and maintain sobriety.

Just make sure your group is accepting of the idea of co-occurring disorders and psychiatric medication. Some people in these groups, although well meaning, may mistake taking psychiatric medication as another form of addiction. You want a place to feel safe, not pressured.

Supporting recovery from alcohol or drug addiction and mental health problems

Getting sober is only the beginning. Your continued recovery depends on continuing mental health treatment, learning healthier coping strategies, and making better decisions when dealing with life’s challenges.

• Get therapy or stay involved in a support group. Your chances of staying sober improve if you are participating in a social support group like Alcoholics Anonymous or Narcotics Anonymous or if you are getting therapy.

• Follow doctor’s orders. Once you are sober and you feel better, you might think you no longer need medication or treatment. But arbitrarily stopping medication or treatment is a common reason for relapse in people with co-occurring disorders. Always talk with your doctor before making any changes to your medication or treatment routine.
• Learn how to manage stress. Stress is inevitable, so it’s important to have healthy coping skills so you can deal with stress without turning to alcohol or drugs. Stress management skills go a long way towards preventing relapse and keeping your symptoms at bay.

• Know your triggers and have an action plan. If you’re coping with a mental disorder as well, it’s especially important to know signs that your illness is flaring up. Common causes include stressful events, big life changes, or unhealthy sleeping or eating. At these times, having a plan in place is essential to preventing drug relapse. Who will you talk to? What do you need to do?
• Adopt healthy habits to support your mental health. Basic self-care practices are essential to good mental and physical health. Eating right gives you plenty of energy and helps prevent mood swings. Sleep and exercise are also key to good mental health. Regular exercise is a powerful antidepressant and sticking to a sleep routine helps balance mood.

Helping a loved one with both a substance abuse and a mental health problem can be a roller coaster. Resistance to treatment is common and the road to recovery can be long. It’s common to feel isolated, overwhelmed, scared, and confused.

The best way to help someone is to accept what you can and cannot do. You cannot force someone to remain sober, nor can you make someone take their medication or keep appointments. What you can do is make positive choices for yourself, encourage your loved one to get help, and offer your support while making sure you don’t lose yourself in the process.

• Seek support. Dealing with a loved one’s mental illness and substance abuse problem can be painful and isolating. Make sure you’re getting the emotional support you need to cope. Talk to someone you trust about what you’re going through. It can also help to get your own therapy or join a support group.
• Set boundaries. Be realistic about the amount of care you’re able to provide without feeling overwhelmed and resentful. Set limits on disruptive behaviors, and stick to them. Letting the substance abuse problem or mental illness take over your life isn’t healthy for you or your loved one.
• Educate yourself. Learn all you can about your loved one’s mental health problem, as well as substance abuse treatment and recovery. The more you understand what you’re loved one is going through, the better able you’ll be to support recovery.
• Be patient. Recovering from addiction and mental health problems doesn’t happen overnight. Recovery is an ongoing process that can take months or years, and relapse is common. Ongoing support for both you and your loved one is crucial as you work toward recovery.

Source: Helpguide.org

The truth about the cycle of addiction

The brain and addiction… what is the relationship? There has been an ongoing debate for years about where addiction actually originates from. You will find some drug addiction treatment professionals who claim addiction is a lack of willpower, while others insist that addiction is a disease of the brain, complete with signs and symptoms. The truth about addiction, as concluded by the American Medical Association with research-based criteria, is that addiction is most definitely a disease that is chronic in nature not unlike cancer, diabetes or bipolar disorder. Another critical outcome of the research-based study showed that the brain of the individual suffering from drug or alcohol addiction is both chemically and physiologically dissimilar from that of the normal brain. This particular finding supports the theory that the brain and addiction are interconnected. This is critical to understanding addiction, its development and an individual’s recovery process.

Addiction Definition

The word addiction is best defined as the obsessive thinking and compulsive need for and use of drugs, alcohol, food, sex or anything that is psychologically or physically addicting. Addiction can also be described by the development of tolerance with distinguishable withdrawal symptoms upon discontinuing the use of the particular drug or behavior. In addition to the development of tolerance with regards to addiction, the addict or alcoholic will experience intense physical cravings for the drug accompanied by an emotional obsession to take the drug regardless of the consequences. The process of addiction that leads the individual to experience the compulsive need for drugs regardless of the consequences is directly related to the change in brain chemistry affecting the process of thought.

The Science Behind the Brain and Addiction Relationship

Scientifically-based research on the brain and addiction relationship has demonstrated to us that drugs, alcohol and specific behaviors have a significant impact on the reward center located in the brain. Levels relating to certain neurotransmitters, send messages to the brain. These neurotransmitters include serotonin and dopamine. Chronic use of drugs and alcohol tends to over-stimulate the brain until it must depend upon substances and behaviors to produce the needed chemicals. This chemical dependency is what leads to tolerance and addiction.

Most people believe that drug addiction lies in the additional use of drugs or alcohol when it truly is related to chemical imbalances in the brain and the compulsion to use, regardless of the consequences. In light of all of this scientific research, we still find professionals who adopt the philosophy that addiction is due to a lack of willpower and/or moral imperfections.

Brain Chemistry and Addiction

Most individuals suffering from addiction use drugs or alcohol to feel “good” or to self-medicate physical or emotional pain. Substance use and addictive behaviors stimulate and increase the brain’s production and use of REWARD chemicals such as dopamine. Depending on the dose of the drug, the brain accepts neurotransmitters that are significantly more intense than they would experience during the “natural” highs produced by the brain normally. In basic terms, this is why addiction takes place physically and emotionally.

Addiction Alters the Brain

Over time, the continued use of a drug alters the way the brain functions. A person’s brain becomes dependent on receiving the substance. These changes in brain chemistry create the addiction and create the tolerance, withdrawal symptoms and cravings. The only “good” part regarding drug addiction is the disease is treatable and recovery is possible.

By Jonathan Huttner

Coming back from the cycle of addiction is a long and tough road. Not only does it take a lot of courage and determination, but it’s physically and mentally taxing as well. When you’ve finished your treatment and are in recovery, you really need the love, support and encouragement of your loved ones to help you maintain your sobriety. So what happens if your loved ones cannot forgive your addiction? What if there’s so much weight in your baggage that they can’t look beyond the past?

Don’t worry. You can get past this. Here are some things to keep in mind.

First Things First

It’s important to recognize yourself first for the incredible achievement you’ve attained. At this stage of the game, you’ve completed your treatment – however personally challenging that may have been – and are now in recovery. This accomplishment alone is reason to celebrate. Sure, it would be great if your loved ones stood up and gave you credit for this, but it doesn’t detract from the fact that you did it. So, before you think about anything else, give yourself high marks for reaching this milestone.

Count Your Blessings

Now, while you are still giving yourself kudos for reaching the recovery stage, count your blessings for all the positive things that you have in your life. Loved ones notwithstanding, you do have them. Here are some that should rate high on your list. You now have a healthier physical condition, due to the fact that your body is no longer full of the harmful substances you previously ingested, or the addictive lifestyle you once maintained. You’ve made a lot of progress in understanding the roots and underlying causes for your addiction, learned how to identify triggers and how to avoid giving in to them. You worked hard on your self-esteem and self-confidence, learning that you have contributions that you can make to society. Even if you never felt that you made much of a difference before, you now know that each person can impact the lives of many around them, and that you have a tremendous opportunity to not only benefit your own future, but those of others as well.

These are all terrific blessings – and they don’t cost you a penny. While you’re at it, you can probably rattle off a few more. Include the fact that you now sleep better, are less depressed and anxious, look forward to each day rather than dreading what it will bring, and others.

How Bad is the Relationship?

Still, you need the love and support of those closest to you. Whether this is your spouse or partner, children, siblings or parents, the relationships mean a lot and are definitely worth preserving or repairing. Before you attempt to make any amends, however, you should first look at how bad the situation is with your loved ones. What do you see is the biggest obstacle to being whole again in their eyes? In other words, what will it take for them to forgive you – if you know? Maybe you think it is one thing, when, in fact, it may be something else altogether. Don’t just assume. Sit down and really try to figure it out.

Let’s say you’re the husband of a working wife who’s been struggling to keep the family together while you were in treatment. If there are children involved, magnify that struggle by increments depending on what shape (financially, emotionally, socially, etc.) the family was in prior to your entering treatment. Chances are, the inability of your loved ones to forgive you have a lot to do with heavy-duty emotional turmoil. Your spouse, for example, shouldered the burdens while you were away. She had to make many decisions on her own, not being able to get your input, or the situation demanded immediate attention. For a wife used to sharing decisions with her husband, this can take a tremendous toll.

Perhaps she had to scrimp to help pay for your treatment, since your insurance coverage either only covered part of it or you didn’t have any coverage. Having to sacrifice comforts the family has come to rely on or even pare necessities to the bone will build up resentment in the strongest and most caring person. Add that to the list of perceived grievances.

Being the sole parent also meant she shouldered dual roles in your absence. It’s tough to show love, dole out discipline when necessary, keep up appearances and try to ensure the children still have fun when you’ve got so much riding on the situation. She may have begun to wonder if the family would be better off without you. This thought, which is certainly understandable, would likely be instantly quashed as out of the question or a sign of betrayal (although it could still lurk beneath the surface). As you know from your own treatment, when you bury your emotions, they come back to haunt you or, at the very least, make growth more difficult.

While the above is just one example, the point is that you should make a list of the things that you believe stand in the way of your loved one forgiving you for your addiction. Once you have the list, you can go on to the next step.

Figure Out What to Do About It

Work down your list and try to come up with solutions to the problems. Again, this is something you do on your own even before having any conversation with your loved ones. Taking financial concerns into consideration, perhaps you can address how and when you will be able to alleviate this concern. Can you go back to your previous job? What are your employment prospects?
Did you get training in a new vocation or skill while you were in treatment? How willing are you to take any kind of job to
immediately start contributing to the family’s well being?

Recognize that you may have to start from scratch. You may have burned your job bridge behind you if you were fired for your addictive behavior. Or, your prospects upon your return may be limited for some time to come. In either case, start where you are and work your way back up. It’s really the only option you have, since you do have obligations and need to resume your role within society.

If you need training, look into how you can get it. Take any job and go to school at night, or learn a new trade or skill in an apprenticeship. Another advantage to tackling the financial concerns that may stand in the way of your loved ones’ forgiveness is that you will be doing something positive for yourself as well. Now could be the opportunity to ditch the old job you found boring or distasteful, or not reflective of your true talents or desires. Figure out what it will take for you to get where you really want to be – and then draft a plan to make it happen.

No, this goal won’t be realized overnight. It may take years for you to complete your degree, build up your own business, or become profitable, for example, but it is a positive first step toward eventually achieving the goal.

Speaking of time, it may be that you’ll need to prove yourself to your loved ones by being on your own for a while. It may be too painful for them to have you home on a full-time basis for now. You will need to accept that and really work at making the kinds of changes that can turn that around.

As for the emotional barrier that undoubtedly puts a strain on your relationship moving forward, this, too, requires time. Your loved ones may miss the financial security and feeling of self worth that came from having things in control – prior to your problems with addiction. A drastic drop in self confidence and self worth inevitably follows in the path of addiction, affecting everyone in the family. In fact, emotional turmoil is difficult for loved ones to overcome without some form of family treatment or counseling. They often are not able to see past barriers without professional help. Fortunately, such counseling is relatively easy to access – either as part of your aftercare treatment program, or through community services or self-help groups such as Al-Anon/Alateen, Nar-Anon, and others.

Remain Positive and Upbeat About the Future

Although it seems hard to look at a future without your loved ones in it, for now just keep as upbeat and positive as you can. Reach out to your support network of 12-step members and step up your meeting attendance. This is especially important at time in your life when your family environment may be severely constrained or restricted.

Your 12-step allies also include your sponsor. Don’t be afraid to ask for help from your sponsor, since he or she is ready, willing and able to give you the kind of encouragement and support you need, 24/7. You already have a pretty good familiarity with the 12-step process through contacts during your treatment program – if you went through a formal treatment program. If not, you do have a ready-made support network available to you through 12-step fellowships. There are 12-step groups for every kind of addiction. They are free to attend and have no memberships or dues. All they ask is for voluntary donations if you are able.
While the philosophies are similar and all are based on the 12-step principles, each has its own original focus and personality, if you will.

Here are some of the 12-step groups:

• Alcoholics Anonymous
• Cocaine Anonymous
• Crystal Meth Anonymous
• Debtors Anonymous
• Gamblers Anonymous
• Marijuana Anonymous
• Narcotics Anonymous
• Sexaholics Anonymous
• Sex and Love Addicts Anonymous
• Sex Addicts Anonymous
• Sexual Compulsives Anonymous
• Workaholics Anonymous

Besides in-person meetings, 12-step groups often offer online and phone meetings, blogs, and chats. Each group has its own website which provides access to articles, news, books, CDs, DVDs, and other resources, as well as helpful links for additional help. When you’re feeling down or lonely in the middle of the night, go online and check out some literature that may help – or get in touch with your sponsor or other 12-step group member with whom you have established a connection.

Make a Plan – and Stick To It

Besides continuing counseling, keeping an upbeat attitude and seeking the support and encouragement from your 12-step groups, what else can you do? The best advice is to make a plan, and stick to it. What do we mean by that? What kind of a plan are we talking about? It doesn’t matter what your plan is, or how simple or detailed. The point is that you will be doing yourself a great service by sitting down and designing a plan for your future.

Note the emphasis on your future. Here we are talking about what it is that you want for yourself one year, 5 to 10 years, or longer down the road. Make a list of your short-term (1 to 2 years), intermediate term (3 to 5 years), and long-term (5 to 10 years and beyond) goals. In the next column, jot down what you may need to do in order to reach the particular goal. This may include going to school, getting training, learning a new language, becoming proficient at a sport, joining a recreational or travel group, or something else. In the next column, write down everything you can think of in the way of resources available to help you get started. Include websites, organizations, advice or recommendations from friends, scholarships, grants, community, state or federal programs, etc.

Once you have your list, get started on the short-term goals, things you can tackle right away. Keep in mind that you should strive to make some progress each day or week toward your intermediate and long-term goals as well. This can take the form of gathering information, checking out websites, filling out applications, taking a class, and so on. Remember that your list of goals is only a guideline. Nothing is written in stone. Keep it flexible and always consider it a work in progress. Once you achieve a goal, take time to acknowledge your achievement. Give yourself the credit you deserve.

While you are pursuing your goals, and especially when you reach milestones in your sobriety (first year of sobriety, for example), take a moment to reflect how much differently you feel now than at the beginning of your recovery. Each small step you take toward the future means that much more progress that you have made. Your overall outlook will change as well. You will look forward to each day as a new opportunity to make a difference.

During this time, if not before, you may have been able to repair your relationship with your loved ones. If they have not forgiven you, they may have at least accepted your sincere expression of wanting to make amends. You will find that you will be able to move on. To do this most effectively, you need to be able to forgive yourself. Forgiveness from others, including your loved ones, has more of a chance.

There is an old expression, When one door closes, another opens. This is true in recovery from addiction as well. Open your heart to be able to receive love, as well as give it.

Source: www.drugaddictiontreatment.com

Buprenorphine was initially introduced on the market in the 1980s as an analgesic. Now, its primary use is for the treatment of opioid addiction.

One dose of buprenorphine remains active in the human body for as long as 48 hours, which provides a longer duration than morphine. This is one of the qualities that make this drug ideal for helping opioid addicts to break free of their addiction. Since the drug remains in the body for 48 hours, it also ensures that the withdrawal symptoms that people experience are significantly decreased.

Buprenorphine requires sublingual (under the tongue) administration on a frequent basis. Drug administration should always be supervised by a substance abuse treatment professional, and doses must be strictly monitored. Federal regulations require this in order for treatment centers and medical facilities to be able to administer the drug at all.

There are some side effects that can occur along with the use of buprenorphine. They range from moderate to severe, and it should be pointed out that this drug can, in some cases, produce fatal side effects. The most commonly occurring side effects include the following:

• Headache

• Drowsiness

• Dizziness

• Vomiting

• Decreased libido

• Constipation

• Respiratory depression

Respiratory depression is the side effect that presents the most serious problems with the use of buprenorphine, as it can be fatal in some people. Unfortunately, there is no way to correct or treat this problem should it develop.

While undergoing buprenorphine treatment, all patients are regularly monitored to see how their livers are functioning, as some adverse effects can be caused by using this drug.

Even though buprenorphine is used to treat people with opioid addictions, the possibility does exist for an addiction to the buprenorphine itself to develop. The types of dependencies that can develop include both physical and psychological. People who are considering undergoing treatment with this drug should be aware, however, that instances of people becoming addicted to buprenorphine are quite rare.

Often times, one of the primary questions that people have is whether they should choose buprenorphine or methadone as a treatment option. Both of these drugs are routinely used for short-term and long-term treatment of opioid addiction. Dosing requirements may be a bit better with buprenorphine simply because of the drug’s ability to remain in the body for 48 hours, thereby offering longer-term effects. With buprenorphine, patients typically only have to receive a dose every other day, while methadone requires daily dosing.

Buprenorphine also has an advantage regarding the total amount of treatment time that is required to successfully complete a detoxification program. With buprenorphine, treatments generally last for a few months, while with methadone indefinite or sometimes lifelong treatment is necessary.

It is very important that buprenorphine be administered in an inpatient treatment facility, particularly one that specializes in substance abuse treatment. Inpatient treatment programs not only offer patients detox programs, they also offer treatment or rehabilitation programs that are designed to help people learn healthier ways of living. Some of these treatment programs include counseling, diet and exercise, massage, acupuncture, and group therapy.

The purpose in these additional treatments is to give patients a better chance of maintaining success by giving them the tools they need to lead lives that are free of substance abuse. If patients learn how to be healthy and happy (physically and emotionally) then they will be far less likely to have a relapse.