Treatment For Heroin Addiction

How Is Heroin Addiction Treated?

Heroin addiction is a complex condition that requires comprehensive, individualized treatment. Effective care often combines medications, psychotherapy, and social support to address both the physical dependence and the underlying psychological factors associated with addiction.

The ultimate goal of heroin addiction treatment is to help individuals develop healthy coping strategies and address the psychological, social, and behavioral factors that contribute to substance use. In essence, treatment seeks to uncover the root causes of addiction and promote lasting recovery through positive changes in thoughts and behaviors.

Heroin Detoxification

Detox is the first step when entering heroin addiction treatment, though many addiction experts agree that detox is not a formal stage of addiction treatment but rather a precursor.

Detox is when an individual goes through heroin withdrawal so that the drug is completely cleared from the body. Detox from heroin can be a very uncomfortable and even painful process. Heroin withdrawal symptoms often include:

Heroin withdrawal symptoms usually begin within 6-12 hours after last use, peak within 48-72 hours, and last for approximately five days. Although these symptoms can be very unpleasant, heroin withdrawal is rarely life-threatening, unlike alcohol or benzodiazepine withdrawal.

During detox, addiction professionals administer medications to ease heroin withdrawal side effects in a quiet and safe medical setting. This is known as medically supervised detox. During this initial phase, addiction professionals provide close monitoring and administer medications like buprenorphine to help ease heroin withdrawal side effects, as well as other medications that can help with symptom management.

Once the individual undergoes detox, which can take several days, they can then enter formal heroin addiction treatment.

Inpatient Treatment For Heroin Addiction

Inpatient treatment for heroin addiction involves living in a treatment facility that provides care 24/7. This can mean a hospitalized setting or a residential setting, depending on the severity of the heroin addiction and the presence of other co-occurring addictions or medical disorders.

If a person has a heroin use disorder with associated medical conditions, they may need inpatient hospitalization, where they will stabilize for a few days. Inpatient hospitalization for heroin addiction is more of a crisis-focused level of care in a hospital setting for an acute period.

Residential inpatient care for heroin addiction provides 24/7 care and support in a residential setting where the care is not as acutely focused on stabilization, crisis, and medical needs. This means that the individual lives in the facility and takes a leave of absence from school or work as they are solely focused on their inpatient treatment for their heroin addiction.

Some people may need to undergo inpatient hospitalization first, then transition into an inpatient residential treatment center, while others may not require inpatient hospitalization and can enter directly into inpatient residential treatment.

Residential inpatient treatment for heroin addiction provides daily structured support that consists of group therapy, individual therapy, and medication management. Community involvement is a major component of residential treatment, which is why, during rehab, residents have many group activities that may focus on physical fitness or mental health. These can include yoga, horseback riding, and art therapy, in addition to their structured daily group sessions.

How Long Is Inpatient Rehab For Heroin Addiction?

Residential treatment length of stay varies for each person but generally lasts anywhere from 30 to 90 days and depends on insurance coverage, severity of the addiction, and the presence of co-occurring disorders. When a person completes residential treatment, it is common for them to “step down” to a lower level of  treatment to encourage them to continue to work on their coping skills.

Outpatient Treatment For Heroin Addiction

Outpatient treatment for heroin addiction is a less intensive and less time-consuming level of care compared to inpatient treatment. It does not require the individual to live at the facility; instead, individuals can live at home and may continue to work or attend school.

Outpatient treatment for heroin addiction includes:

• Partial hospitalization (PHP)
• Intensive outpatient program (IOP)
• Outpatient treatment

Individual therapy, group therapy, and medication management are all very important components of outpatient treatment. The individual must also have a strong and healthy social support system, a safe living environment, and reliable transportation to be a candidate for outpatient treatment.

What’s The Difference Between PHP And IOP For Heroin Addiction Treatment?

The main difference between PHP and IOP is that PHP is a more intensive, day program where the person attends treatment five days per week for 6 hours a day, totaling approximately 30 hours of treatment each week. PHP for heroin addiction treatment is usually designed for people who have completed residential treatment and are not yet ready for regular outpatient treatment or who do not require 24-hour care in residential treatment but need more support than what a regular outpatient program can offer.

IOP is a less intensive treatment where the person attends treatment 3-4 days per week for a few hours each day, totaling 10-15 hours of treatment each week. An IOP is a step down in intensity from partial hospitalization but more involved than regular outpatient care.

IOP still maintains the same structured and focused treatments as other heroin addiction levels of care and includes medication management and psychotherapy approaches. Still, it allows individuals to maintain their daily responsibilities and routines, such as family life, work, and school.

General outpatient treatment is offered on a weekly or biweekly schedule and can include individual or group therapy in addition to medication management. This is commonly referred to as maintenance therapy and can continue on a long-term basis.

Medication-Assisted Treatment For Heroin

Medication-assisted treatment (MAT) is a term that refers to evidence-based medication treatments that are combined with psychotherapy to support and treat individuals who are struggling with addiction. The goal of MAT is to help people manage their withdrawal symptoms, reduce cravings, and address underlying psychological aspects associated with their addiction.

In recent years, the term MAT has been replaced with MOUD, which stands for Medications for Opioid Use Disorder and specifically refers to FDA-approved medications to treat opioid addiction. However, MAT and MOUD are still commonly used interchangeably in non-clinical settings.

Medications commonly used in MAT to treat heroin addiction include:

Methadone

Methadone is an FDA-approved long-acting opioid agonist that can be used during withdrawal and continued into long-term treatment for opioid use disorder (OUD).

Because it is a long-acting opioid, it does have addiction potential. However, methadone has less risk of addiction and overdose compared to heroin and other commonly abused opioids. Methadone must be prescribed and distributed through a medical provider. It is often administered in a methadone clinic; however, it has recently become available for at-home administration for people who are stable enough to administer it themselves.

Methadone is usually initiated in the early withdrawal period to help alleviate and curb any painful opioid withdrawal effects. Dosage can be decreased over time, especially as the person phases out of the acute withdrawal period.

Methadone can be a short-term or a long-term treatment for heroin addiction.

Buprenorphine

Buprenorphine is an FDA-approved medication to treat heroin addiction and withdrawal. It works as a partial opioid agonist, meaning that it binds very strongly to the mu opioid receptor but does not have the full agonist euphoric effects or overdose potential compared to a full opioid agonist such as heroin.

It is a first-line treatment for opioid withdrawal management as well as OUD and is an active ingredient in Suboxone®.

Buprenorphine has a low abuse potential and is a safe medication because of its ceiling effect. Its opioid effects, particularly respiratory depression and euphoria, will increase with each dose until it reaches moderate doses, where it will plateau, even with further dose increases. This “ceiling effect” lowers the risk of misuse and overdose.

Clinical assessments must be completed before buprenorphine is started in the withdrawal period, since it is known to cause precipitous withdrawal. In general, buprenorphine is administered after patients experience moderate to severe withdrawal, typically 12 to 48 hours after their last opioid use, depending on the type of opioid they are using. Buprenorphine can be used for long-term maintenance treatment for OUD, as it is known to reduce opioid cravings.

Naltrexone

Naltrexone is an FDA-approved medication to treat heroin addiction, but it should not be used in the acute withdrawal or detox phase.

Naltrexone is an opioid receptor blocker that works on the mu opioid receptor to block opioids from binding to this receptor. If someone takes heroin while on naltrexone, then they will immediately experience withdrawal (known as precipitated withdrawal) because naltrexone will kick heroin off the opioid receptor and will block the symptoms of pain reduction, euphoria, and sedation.

One of the reasons why people continue to use opioids, despite having the desire to quit, is the strong cravings and urges from the dopamine rush associated with opioid use. Naltrexone, over time, modulates this opioid-fueled dopamine surge.

Vivitrol is the brand name for the one-month, extended-release injectable naltrexone. Detoxification from heroin must be completed for at least 7 days before Vivitrol can be administered. Otherwise, naltrexone in generic form is taken orally once per day.

Suboxone®

The combination of naloxone (an opioid antagonist) and buprenorphine is considered a first-line medication for OUD.

Patients must already be in the early stages of withdrawal before Suboxone® is initiated because Suboxone® can cause precipitated withdrawal due to both of its ingredients: naloxone and buprenorphine. Practitioners will not start Suboxone until there is clear evidence of opioid withdrawal and a score of 6 or more on the Clinical Opiate Withdrawal Scale, a tool used by clinicians to rate the patient’s presentation of common withdrawal symptoms. Similar to buprenorphine, Suboxone® can also be used as maintenance therapy for OUD, meaning it can be used over a long time period.

It is important to note that while this treatment approach does focus on FDA-approved medications, these medications should be given with accompanying behavioral therapy approaches as well as peer recovery support services, since opioid addiction treatment is a multidisciplinary approach.

Featured Centers Offering Treatment for Heroin Addiction

Behavioral Therapies

Behavioral therapy for heroin addiction is a major component of treatment, as psychotherapy addresses the psychological and behavioral aspects of addiction. Addiction is often triggered by deep, ingrained traumatic events or unhealthy life patterns. Therapy approaches help people recognize and address these triggers and develop healthy coping mechanisms to navigate future cravings and triggering situations, which can reduce the potential of future relapses.

Cognitive behavioral therapy is the most widely researched and evidence-based form of psychotherapy. It is based on changing negative, unhealthy thoughts and behaviors associated with addiction into healthy thought patterns and behaviors that can facilitate recovery.

Contingency Management incentivizes treatment by providing rewards for sobriety or steps towards sobriety. An example would be collecting urine drug screens every week, and if the results are negative, the person receives a voucher worth a monetary gain or tangible goods.

Motivational enhancement therapy includes a therapist who guides the client through a client-centered conversation that allows them to internally realize their heroin addiction and how they can succeed in recovery. The therapist guides the client to intrinsically enhance motivation for change by enabling the client to discover their own reasons for wanting to succeed in recovery. By finding their own “why”, they are then motivated to succeed.

What Is Aftercare For Heroin Addiction Treatment?

Any type of heroin addiction treatment should also provide aftercare recommendations. Continued participation in counseling or support groups helps reinforce the new skills and coping strategies learned in treatment. Research shows that the longer a person stays engaged in their recovery process, the better the long-term outcomes.

Aftercare may include behavioral therapies, such as individual, group therapy, and family therapy, which have proven most effective in treating people with substance use disorders. These treatments typically begin during rehab and continue within aftercare programs.

How To Choose A Rehab For Heroin Addiction Treatment

Treatment for heroin addiction enhances a person’s quality of life and can also save lives. It reduces the risk of heroin overdose and helps people learn how to rebuild their lives and relationships.

Treatment also helps people avoid the negative consequences that often result from addiction and break the cycle. Some considerations when choosing a treatment program should include:

• What is the cost, and do they take insurance?
• Where are they located? (Do you want to stay local or travel for rehab?)
• What levels of care are offered? (Does the treatment program offer all levels of outpatient and inpatient care?)
• Does the program provide family therapy and aftercare programs?

The answers to these questions and your thoughts on them can help you select a heroin addiction treatment program that fits your individual needs and preferences. To learn more about your treatment options, explore our rehab directory or contact a treatment provider today.