If you are one of the more than 2 million people in the United States struggling with opioid addiction, it can be easy to feel that no treatment plan is strong enough to overpower your cravings for the drug. Opiates like heroin and their lab-created counterparts — OxyContin, Fentanyl, and Vicodin — bind to nerve cells throughout the body, producing feelings of euphoria, but the effects are not long-lived, and addiction happens quickly.
Fortunately, the science of addiction treatment has seen great progress recently. According to Europe PMC, medications designed not only to lessen the impact of drugs on opioid receptors but also to diminish cravings for it, have saved thousands of lives. New therapies and drug administration schedules have increased the percentage of patients who are able to stay on a recovery plan. Because the risk of overdose increases for users who return to a drug after taking receptor-blocking medications, this is critical.
A cultural shift in attitudes surrounding addiction has also been seen. Since the 1960s, beginning with the medical community and then spreading out to the general population, the idea that addiction is a disease and not a moral failing has been gaining traction. This change has been hugely beneficial to people struggling with addiction because of the reduction in stigma and increased the availability of treatment. While the perception of the condition itself is much improved, understanding of addiction recovery has lagged behind. Unlike many diseases, the path to wellness is seldom linear, instead twisting and looping back on itself, sometimes over many years.
The Cycle of Recovery
Opioid addiction is a complex disease with barriers to treatment that are both numerous and ill-understood. Stigma, regulation, and the conservative nature of drug treatment laws in America have prevented doctors from adopting the newest and most effective techniques. With laws limiting the number of patients each doctor may prescribe certain addiction-management drugs to, an addict seeking help for their addiction may find accessing the care they need very difficult.
Patients frequently get clean, relapse, and try again many times before they are able to finally stop using. Traditional detox approaches don’t provide support for this cycle, meaning that newly-clean addicts are left without the tools they need to continue their fight against addiction after being released from rehab. While 12-step programs can help some patients find the continuity of care needed to maintain sobriety, they are often ineffective as the only means of support after detoxing. According to Dr. Lance Dodes, author of the substance addiction recovery book Sober Truth, the perception of 12-step programs as a panacea for addiction issues is false. Speaking to NPR, he said, “We hear from the people who do well; we don’t hear from the people who don’t do well.” This information gap has served to continue a harmful history of partial treatment, failing to address the wide variety of influences that contribute to addiction.
Evidence-based plans, or EBPs, as they’re known in the medical community, seek to take into account this cyclical process by using statistical analysis of patient histories in order to determine what methods result in successful, lasting recovery.
A New Approach
According to a report published by the National Center on Addiction and Substance Abuse, a treatment that includes rigorous psychological therapy to treat the underlying causes of addiction, as well as social support that takes a whole-life approach to recovery, is the most reliable form of addiction treatment. Long-term pharmacological treatment, such as methadone and buprenorphine therapies, have been found to decrease the risk of relapse as well as the HIV and Hepatitis C infections that people suffering from opioid addiction are at risk for.
The NCAS report recommends Cognitive Behavioral Therapy and a technique known as Motivational Interviewing to be used alongside medical addiction care. In these therapies, counselors assist patients in rewiring the thought processes that contribute to their addiction. These methods, along with traditional group and individual counseling, have been shown to increase the likelihood of long-term abstinence.
From the very first step in treatment, assessing the status and needs of the patient, evidence-based care is different from traditional approaches. By identifying financial, mental, and demographic vulnerabilities as well as the behavioral ones assessed in a traditional intake process, EBP clinicians can formulate a plan for treatment that addresses the root cause of addiction. While there is much to be learned about what factors make a person susceptible to dependence, EBP plans change based on new research, incorporating new data as it becomes available, to provide the best care.
Complementing Traditional Treatments
12-Step programs provide a sense of community for many people facing addiction, but alone they do not provide the level of support needed by some to overcome the entrenched habits and social systems that keep them trapped in a pattern of relapse. In a report to the president, the National Office of Drug Control Policy found that these programs alone are rarely effective at assisting total abstinence, but when integrated into a larger treatment scheme they can be beneficial.
Similarly, while detox programs provide a temporary fix for the physical dependency users suffer from, in most cases, the effects are not long-lasting. According to the National Institute on Drug Abuse, medically assisted detox “does little to change long-term drug abuse.” Again we see that a patient only succeeds when detox is combined with a more holistic care plan.
When these and other traditional treatments are combined with evidence-based practices, the effectiveness of the programs increases. In its report, the National Office of Drug Control Policy found that — when patients had the services, support, and access to care — they needed, success rates climbed whether or not the treatment was inpatient, outpatient, or residential. An evidence-based, whole-life approach may be the single most important predictor of success in recovery.
Not every program will offer every treatment option, and patients should be prepared to do their research before choosing a program. Luckily, the information about what works and what doesn’t is more available than ever. Armed with the knowledge of what makes a truly effective plan, real and effective help is well within reach.