Heroin Rehabilitation
What is Heroin?
Heroin is an illegal, highly addictive drug. It is both the most
abused and the most rapidly acting of the opiates. Heroin is processed
from morphine, a naturally occurring substance extracted from
the seed pod of certain varieties of poppy plants. It is typically
sold as a white or brownish powder or as the black sticky substance
known on the streets as "black tar heroin."
Although less diluted heroin is becoming more common, most street
heroin is "cut" with other drugs or with substances
such as sugar, starch, powdered milk, or quinine. Street heroin
can also be cut with strychnine or other poisons. Because heroin
abusers do not know the actual strength of the drug or its true
contents, they are at risk of overdose or death. Heroin also poses
special problems because of the transmission of HIV and other
diseases that can occur from sharing needles or other injection
equipment.
What are the Rehabilitation Options for Heroin Addiction?
A variety of effective treatments are available for heroin addiction. When heroin use is detected early, rehabilitation tends to be more effective. The treatments that follow vary depending on the individual, but methadone, a synthetic opiate that blocks the effects of heroin and eliminates withdrawal symptoms, has a proven record of success for people addicted to heroin. Other pharmaceutical approaches, like LAAM (levo-alpha-acetyl-methadol) and buprenorphine, and many behavioral therapies also are used for rehabilitating heroin addiction.
Detoxification
The primary objective of detoxification is to relieve withdrawal symptoms while patients adjust to a drug-free state. Not in itself a drug addiction rehabilitation, detoxification is a useful step only when it leads into long-term rehab that is either drug-free (residential or outpatient) or uses medications as part of the treatment. The best-documented drug-free treatments are the therapeutic community residential programs lasting at least 3 to 6 months.
Methadone programs
Methadone treatment has been used effectively and safely to
treat opioid addiction rehabilitation for more than 30 years.
Properly prescribed methadone is not intoxicating or sedating,
and its effects do not interfere with ordinary activities such
as driving a car. The medication is taken orally and it suppresses
narcotic withdrawal for 24 to 36 hours. Patients are able to perceive
pain and have emotional reactions. Most important, methadone relieves
the craving associated with heroin addiction; craving is a major
reason for relapse. Among methadone patients, it has been found
that normal street doses of heroin are ineffective at producing
euphoria, thus making the use of heroin more easily extinguishable.
Methadone's effects last for about 24 hours - four to six times
as long as those of heroin - so people in treatment need to take
it only once a day. Also, methadone is medically safe even when
used continuously for 10 years or more. Combined with behavioral
therapies or counseling and other supportive services, methadone
enables patients to stop using heroin (and other opiates) and
can be an effective method of rehabilitation to opiate addiction.
Methadone dosages must be carefully monitored in patients who
are receiving antiviral therapy for HIV infection, to avoid potential
medication interactions.
LAAM and other medications
LAAM, like methadone, is a synthetic opiate that can be used
to in heroin addiction rehabilitation. LAAM can block the effects
of heroin for up to 72 hours with minimal side effects when taken
orally. In 1993 the Food and Drug Administration approved the
use of LAAM for treating patients addicted to heroin. Its long
duration of action permits dosing just three times per week, thereby
eliminating the need for daily dosing and take-home doses for
weekends. LAAM will be increasingly available in clinics that
already dispense methadone.
Naloxone and naltrexone are medications that also block the effects
of morphine, heroin, and other opiates. As antagonists, they are
especially useful as antidotes. Naltrexone has long-lasting effects,
ranging from 1 to 3 days, depending on the dose. Naltrexone blocks
the pleasurable effects of heroin and is useful in treating some
highly motivated individuals. Naltrexone has also been found to
be successful in preventing relapse by former opiate addicts released
from prison on probation.
Another medication used in heroin rehab is buprenorphine. Buprenorphine
is a particularly attractive treatment because, compared to other
medications, such as methadone, it causes weaker opiate effects
and is less likely to cause overdose problems. Buprenorphine also
produces a lower level of physical dependence, so patients who
discontinue the medication generally have fewer withdrawal symptoms
than do those who stop taking methadone. Because of these advantages,
buprenorphine may be appropriate for use in a wider variety of
rehabilitation settings than the currently available medications.
Several other medications with potential for treating heroin overdose
or addiction are currently under investigation by NIDA.
Behavioral therapies
Although behavioral and pharmacologic treatments can be extremely
useful when employed alone, science has taught us that integrating
both types of treatments will ultimately be the most effective
approach in rehabilitation. There are many effective behavioral
treatments available for heroin addiction. These can include residential
and outpatient approaches. An important task is to match the best
addiction rehabilitation approach to meet the individual needs
of the patient. Moreover, several new behavioral therapies, such
as contingency management therapy and cognitive-behavioral interventions,
show particular promise as treatments for heroin addiction. Contingency
management therapy uses a voucher-based system, where patients
earn "points" based on negative drug tests. They can then exchange
these points for items that encourage healthy living. Cognitive-behavioral
interventions are designed to help modify the patient's thinking,
expectancies, and behaviors and to increase skills in coping with
various life stressors. Both behavioral and pharmacological treatments
help to restore a degree of normalcy to brain function and behavior,
with increased employment rates and lower risk of HIV and other
diseases and criminal behavior.
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