Before discussing opiate and opioid addiction treatment, it is best to clarify these two very similar terms. Opiates, like morphine and codeine, occur naturally and are extracted from the opium poppy, while the term opioid refers to drugs that are either partially synthetic (e.g. heroin or oxycodone) or wholly synthetic (e.g. methadone and fentanyl). For convenience and because they work essentially in the same way in their interaction with the brain’s receptors, opioid is the term now favoured when discussing all three types. That is not to say that the treatment team will not be fully alive of their differences, such as relative strengths and respond accordingly.
There is another distinction of which to be aware; the one between addiction and dependence. (Although, in the scientific and clinical literature both terms have been superseded by the diagnostic category Substance Use Disorder with its gradations of mild, moderate or severe.)
Dependence is characterised by the degree of physical tolerance (the increasing amount now needed to gain the drug’s desired effect) and the consequent withdrawal syndrome that results from not taking the drug.
Addiction adds a psychological and behavioural dimension to the physical dependence, with a seemingly uncontrollable compulsion to keep obtaining and using the drug despite a host of harmful consequences across health and social domains.
Perhaps the easiest way to understand the difference is that it is possible to be dependent while not being addicted. On the other hand, addiction to opioids inevitably includes dependence. In many cases, addiction may not be far behind once opioid dependence has been established. Effective treatment takes the characteristics of both states into account.
There is a tendency to assume that all opioid addiction is associated with illegal activity. However, it is as well to remember that it may have its origins in the legitimate treatment of pain. Many people prescribed opioids for pain relief find themselves coincidentally impressed with the drug’s ability to reduce anxiety and even produce a sense of euphoria. This can trigger a powerful urge to repeat the experience and may introduce the kind of behaviours associated with addiction, some of them illegal.
Particularly when it comes to opiate and opioid addiction treatment, there are entirely appropriate interventions whose aim is confined to minimising harm. This is achieved by medically regulating the addiction through drug substitution; in a sense bringing it under control. Such treatment is often administered on an outpatient basis.
What is now known as Medication-Assisted Treatment for opioid use disorder (colloquially still referred to as addiction) has several benefits, among which are an overall decrease in opioid use, a reduced risk both of death due to opioid overdose and of transmission of infectious diseases like HIV and Hepatitis. It is one way of ending the high risk associated with using needles. Other benefits include improvement in social functioning and retention in treatment. It usually involves an extended and sometimes indefinite period of treatment.
In contrast, it is usually the case that someone seeking admission to a luxury inpatient substance abuse treatment service like Clinic Les Alpes is looking to release themselves from the opioid addiction as soon as possible; in other words, to become abstinent in pursuit of recovery. While the medical team will have gathered as much information as possible before admission, they will immediately and thoroughly reassess the individual on arrival. What drugs are being consumed, either singly or in combination? If a prescription was involved at some point what was it for? Are there co-existing or previous physical or mental health problems to complicate the picture? How depleted is the person in terms of nutrition? How are they sleeping?
Given the likelihood of imminent withdrawal from opioids and other drugs in the system, the immediate priority is to administer detoxification to manage that withdrawal. While not a potentially life-threatening process, as in the case of dependence on alcohol or benzodiazepines, withdrawal from opioids can prove very uncomfortable and is sometimes compared to a heavy dose of flu.
A variety of withdrawal symptoms can occur, including changes in blood pressure, cramps, nausea, muscle twitching, chills and sweats, as well as heightened anxiety, irritability and depressed mood. The primary aim of the medical team is to ensure the safety and comfort of the patient as they try to ease such symptoms with medication and other non-medical interventions. This will help sustain the motivation to continue. Much like in Medication-Assisted Treatment, the medical team may substitute another form of opioid for the one being taken on admission but begin tapering the dose as swiftly as possible. Sometimes non-opioid drugs, such as medication for high blood pressure, are prescribed in conjunction.
To support the detoxification process, the patient will be encouraged to eat nutritious meals regularly, drink more water, exercise gently, participate in relaxation exercises and find positive ways to distract themselves from preoccupation with withdrawal symptoms or opioid cravings. Where pain has played a part in the onset of addiction, the assistance of a pain management specialist may be called for.
Taking on the challenge of withdrawal from an addiction to opioids, perhaps developed over many years, is more easily achieved where medical interventions are integrated into a broader recovery purpose within a holistically supportive environment such as is to be found at a luxury rehab like Clinic Les Alpes.
It is understood that, on its own, detoxification plays a necessary but insufficient part in establishing recovery. This is why engagement with non-medical therapies as soon as possible is encouraged; even while still undergoing detoxification if deemed medically safe to do so. The absence of the drug will see the emergence of emotions long held at bay and those generated by the addiction.
Participation in one-to-one counselling sessions or support groups will have an important part to play in making sense of these feelings, gaining insight into personal vulnerabilities and devising strategies to maintain a strong commitment to recovery. The security and care of the treatment centre offers an opportunity to try out and practice new ways of behaving, relating and dealing with feelings that align with recovery. Recognising potential stress points and managing the emotional response to them will be vital.
Given what we know of its positive contribution to outcomes, family involvement and support are crucial components when working to treat opioid addiction. Family members will invariably need help better understanding addiction and its impact, enabling them to provide more support or step back as necessary. They will also need support in their own right as so often they will have neglected their own needs, becoming co-dependently focussed on the addiction of their loved one.
Recovery from opioid addiction or substance use disorders is not easy. The key is for the person consistently to surround themselves with and utilise the right kind of support while practicing recovery behaviours daily. Although there are likely to be bumps in the recovery road, the chances of securing sustainable remission are good