Heroin Relapse PreventionAnna Ciulla
No longer a pure derivative of the opium poppy plant, modern-day heroin is a killer of epidemic proportions, resulting in 8,260 deaths in 2013 and continuing its deadly ascent into the stratosphere of addiction. The dangerous, highly potent opiate is a major public health concern. Within the past decade, heroin has become the subject of increasing scrutiny by government authorities wise to international trafficking practices and synthetically laced varieties hustled on American streets under code names like “dope,” “smack,” “tar,” and “dragon.”
Once an individual is heroin-dependent, acknowledging the need for treatment and taking steps to seek professional help are half the battle. Heroin addiction is a chronic, relapsing condition, and users must remain extremely vigilant if they are to succeed. Active participation in an intensive treatment program is critical to successful long-term recovery outcomes, providing heroin-dependent individuals the education and medical assistance necessary to face triggers, resist cravings and make important lifestyle changes.
Yet even the best, most comprehensive program cannot give those recovering from heroin dependence the internal motivation required to sustain their recovery through the temptations that inevitably accompany treatment. The road to sobriety is often long and winding, filled with physical, psychological, spiritual, and emotional perils. Even in the best of circumstances, recovery is a protracted process that demands total commitment by a user in order to emerge from the battle victorious.
REASONS FOR RELAPSE
Relapse occurs when a formerly heroin-dependent person begins using again after a period of sobriety. There can be many reasons for relapsing; however, the following precipitating factors are frequently responsible:
- Continued association and relationship with active heroin users
- Boredom and long periods of unproductive free time
- Erroneously or arrogantly believing one can use just “once more”
- Unresolved trauma (family deaths, breakups, legal issues)
- Major stressors that seem insurmountable (work, school, job, etc.)
When a user succumbs to the temptation to use again, which is extremely common in early recovery, they may be assailed by guilt and tormented by the belief that their recovery was a failure. Nothing could be further from the truth. When grappling with a drug as powerful and debilitating as heroin, relapse is to be expected and provides necessary tools that a user can take with them as they re-engage their commitment to sobriety with full force.
According to the National Institute on Drug Abuse (NIDA), the relapse rate for people suffering with substance use disorders is between 40 and 60 percent. At first glance, that may appear to be a daunting statistic. However, less than 50 percent of people who abstain from substance use for a year will relapse. Even better, less than 15 percent of people who abstain for a period of five years will relapse, shattering the pervasive myth that heroin recovery is “impossible” or “not worth the hardship” involved. Contrary to these rumors and misconceptions, many heroin users go on to live happy, functional lives and find personal and professional fulfillment.
Unfortunately, temptation is omnipresent in our fast-paced, substance-oriented society. From the flashy Budweiser sign at the corner market, to the shady dealer pounding the downtown streets, there is no shortage of fuel for the flame of desire. That desire is based on an illusion that taking a substance into one’s body can somehow alleviate pain, boredom, insecurity, apathy or isolation.
Regardless of the underlying cause of temptation, the best offense is a good defense. When an individual enrolls in a comprehensive treatment program, a team of highly qualified medical professionals and licensed therapists will help create a client-specific treatment and discharge plan. Reputable facilities will begin creating an aftercare plan and follow-up regimen that begins the very moment someone enters treatment. This helps ensure a balanced, well-rounded approach to addressing the underlying causes of heroin addiction.
The following ingredients are part of an empirically proven, relapse prevention strategy designed to help users struggling with all stages of addiction:
- Regular sober peer support and community involvement
- Active participation in Narcotics Anonymous (NA)
- Avoiding known social and environmental triggers
- Healthy dietary and lifestyle choices
- Regular physical and recreational activity
- Obtaining a sponsor and diligently working a program
- Strict adherence to treatment protocol
- Incorporating spirituality and faith into recovery
Medication-assisted treatment (MAT) is an integral part of heroin recovery. MAT describes the popular treatment protocol in which evidence-based pharmacological interventions are used in combination with ongoing therapy. Therapies used in MAT may include creative and expressive therapy, motivational interviewing (MI), cognitive behavioral therapy (CBT), dialectical behavioral therapy (DBT) and other group and individual therapies depending upon individual client needs. The following Food and Drug Administration (FDA) approved medications are commonly incorporated into the treatment regimen:
- Suboxone – Used early in symptom onset, this combination of buprenorphine and naloxone (an opiate antagonist) is frequently used to help prevent intravenous buprenorphine abuse. This clinically-proven medication for heroin dependence significantly lowers the risk of precipitated withdrawal. Suboxone activates the same neurological receptors as heroin and is generally well-tolerated.
- Clonodine – Classified as an anti-hypertensive, this increasingly popular medicine helps curb the symptoms associated with heroin withdrawal. Clonidine works by blocking brain chemicals that activate the sympathetic nervous system (SNS).
- Vivitrol – An injectable prescription variety of naltrexone that helps control cravings and stabilize psychological and physiological processes. The drug is available in both pill and once-per-month injectable form and works by blocking opiate receptors in the brain, noticeably diminishing the euphoric effects associated with heroin.
In addition to the primary medications used to treat the effects of heroin withdrawal itself, supplementary medication may also be incorporated into MAT in order to treat co-occurring disorders. Anxiety and depression-related disorders are often precipitating factors involved in heroin addiction and, depending upon individual client needs, their treatment is a necessary part of effective treatment.
GETTING THE HELP YOU NEED
If you or a loved one are struggling with heroin addiction or have already begun the recovery process and are struggling with temptation to use, consult an addiction professional today. Heroin is an extremely powerful opiate that alters brain chemistry, negatively impacts every aspect of the body, and disrupts mental and emotional stability. Struggling with temptation does not constitute treatment failure, and relapse is preventable with the proper therapeutic support and professional medical assistance.
For more about heroin addiction and recovery, check out these related articles:
- Preventing an Opiate Overdose with Naloxone
- Speedballing: Cocaine and Heroin’s Deadly Combination
- The Science of Drug Addiction
- Naltrexone vs. Narcam, What Are They, and How Are They Used for Opiate Overdoses and Treatment?
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International Journal of Drug Policy. Fentanyl in the US heroin supply: A rapidly changing risk environment. Aug, 2017.
Journal of National Medical Association. Is the New Heroin Epidemic New? Racializing Heroin. Vol. 109, spring 2017.
Journal of Affective Disorders. Chronology of illness in dual diagnosis heroin addicts: the role of mood disorders. July, 2015.