Managing Fentanyl Cravings
Fentanyl is an opioid medication used for pain relief following surgery and, occasionally, for other severe pain situations. Like other opioid drugs, fentanyl is capable of producing a rewarding, euphoric sensation by increasing the levels of dopamine in the brain.1
People who repeatedly seek to achieve these effects can become addicted and may crave the drug when they try to stop using, making it especially hard to quit.
Onset and Duration of Fentanyl Cravings
If you or someone you love is suffering from fentanyl cravings or addiction, call a rehab support advisor today at 1-888-319-2606
Fentanyl is a potent opioid medication that is classified as a Schedule II drug by the Drug Enforcement Administration, meaning it has a high potential for abuse. 1,4
When people who abuse fentanyl try to stop using it, they frequently experience intense cravings, or urges, to use fentanyl, despite the negative consequences associated with the drug. These cravings stem from having developed a physical and psychological dependence on fentanyl and often occur during withdrawal or as a result of triggers.
Most people will experience cravings and withdrawal symptoms within 3 to 5 hours of their last use of fentanyl. Withdrawal symptoms peak within 8 to 12 hours and resolve within 4 to 5 days, but users may continue to experience cravings for weeks or even months after stopping use.
The length and severity of these cravings vary from one person to another and depend on a number of factors, including:
- The typical dose that was taken.
- How often the drug was used.
- How long it was used.
- Individual factors, such as physiology and psychology.
Therapies and Treatments for Fentanyl Cravings
Cognitive behavioral therapy (CBT) is one of the most common therapies used to treat addiction and help people manage cravings. The major focus of CBT is to identify and understand the thoughts and behaviors that lead a person to continue to use fentanyl and other drugs.
Triggers are one of the main causes of cravings. Triggers are cues that can cause a person to want to use drugs again. They can be events, people or places. For many people, a trigger can be as simple as going to a location where they used or obtained drugs in the past.
In CBT, participants are taught techniques to “recognize, avoid and cope” as a way to identify triggers, avoid them and cope with unavoidable triggers.
CBT therapists can also employ a number of other techniques to deal with cravings, such as:
- Talking about cravings: Discussing the cravings when they are felt can help the person process the anxiety related to them. This approach depends on the person in recovery having supportive people in his or her life to be able to talk about the cravings.
- Sitting with the cravings: Rather than fighting against the craving, a CBT therapist teaches a person to go with the craving and “ride it out.” The therapist helps the recovering person identify safe places where he or she can do this and encourages them to then feel all the aspects of the craving and concentrate on it. The craving usually subsides if the person does not give in to it.
- Recall negative consequences from the use of fentanyl: When the user has a craving to use, he or she is taught to remember negative consequences of using fentanyl as a deterrent to using again. Many people write these consequences down and later read them when they need to get through a craving.
- Using self-talk: Self-talk replaces negative thoughts such as, “I can’t make it through this craving” with positive thoughts such as, “Cravings are normal. Everyone has them and people get through them.” Challenging the thought also works. For example, saying to yourself, “I’m not going to die if I don’t use fentanyl” can interrupt the automatic thoughts that lead to relapse. 2
Treatment Programs for Cravings
Treatment for fentanyl addiction involves dealing with cravings as part of the recovery process. Types of treatment programs include:
- Inpatient recovery programs: Inpatient or residential programs are live-in programs where the user often undergoes medically assisted detox and then transitions into a treatment program that includes individual and group counseling, 12-step meetings, medical supervision and aftercare planning. Programs can last from a few weeks to a few months. People who are working to overcome fentanyl addiction and cravings can receive a high level of support and care in a substance-free environment.
- Outpatient recovery programs: Outpatient recovery programs also include individual and group counseling but do not require the person to live at the treatment center. The amount of time needed to dedicate to outpatient recovery will depend on the intensity of the particular outpatient program. In general, counseling appointments and other outpatient treatment sessions are scheduled for a few hours a day, several days a week, and the person returns home after that day’s treatment sessions have concluded.
- Dual diagnosis: Some people seeking treatment for fentanyl addiction also suffer from a co-occurring mental health disorder, such as depression, bipolar disorder or schizophrenia. These people have what is known as a dual diagnosis and need a treatment program that can address both the addiction and the mental health disorder in an integrated, holistic way.
- 12-step meetings: Twelve-step recovery meetings are a very important aspect of maintaining a drug-free lifestyle after completing inpatient and/or outpatient treatment for drug addiction. Narcotics Anonymous (NA) is the most well-known of these groups that can help a person recovering from fentanyl addiction. Users can discuss their cravings at meetings, receive tips for how to manage cravings and call their sponsor if they feel an urge to use.
- Group counseling: Group counseling has been shown in research studies to be effective with people in substance abuse treatment. Group therapy provides the support of other people who are going through the same issues in recovery from drug abuse. The social interaction in a healthy, drug-free setting is also beneficial to users who typically have isolated themselves during active addiction or have associated predominantly with other people who were using drugs. 3
- Individual counseling: Individual therapy for substance abuse treatment typically involves cognitive behavioral therapy, which includes learning new ways of thinking and behaving to help avoid falling into old patterns that can lead to drug use. These new patterns of thinking can help a person in recovery to learn ways to avoid relapse.
- Contingency management: is also used in some therapy programs and uses incentives for staying drug-free. It can be very beneficial in helping people avoid relapse.
Medications Used to Curb Fentanyl Cravings
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Medications can be used to help a person detox from fentanyl and help control cravings during withdrawal. All of these medications have drawbacks and benefits, and there are many factors that need to be taken into account before they are used.
- Clonidine: an antihypertensive and sedative, is often used to help control some of the uncomfortable symptoms of withdrawal from fentanyl. It is designed for short-term use in the first stages of withdrawal, but many people complain that it does not help with some of the worst symptoms of drug cravings.
- Buprenorphine: is an opioid medication that can be used to help a person detox from fentanyl, avoid uncomfortable withdrawal symptoms and control cravings. For the treatment of opioid dependence, buprenorphine is available as a sublingual tablet and, in combination with the opioid antagonist naloxone, as the brand formulation known as Suboxone. Until fairly recently, buprenorphine was marketed under the trade name Subutex.
- Methadone: another opioid medication, is sometimes used for people who are detoxing from fentanyl, and it effectively controls cravings. Methadone has many regulations and procedures that must be followed in the prescribing and dispensing of it. It can only be given in specially licensed facilities or if someone is in a hospital receiving care for another medical condition.
How to Stop Cravings Naturally
Meditation can help slow down racing thoughts and promote relaxation.
Occasionally, natural herbs or supplements are touted as a natural cure for addiction to opioids such as fentanyl. But the Food and Drug Administration (FDA) has not approved any of them for the treatment of addiction, and they may also be dangerous because they are not regulated.
However, there are many ways to cope with fentanyl cravings that don’t involve medications.
- Exercise: Exercise is beneficial in helping with cravings as it provides a form of release for tension and anxiety.
- Diet: Eating a healthy and balanced diet can help improve mood and energy, which can make you less vulnerable to cravings due to fatigue or irritability.
- Meditation: Meditation can help slow down racing thoughts that accompany cravings and help you relax and clear your head.
- Distractions: Participating in a hobby, going for a walk, talking to a friend or family member on the phone or watching a movie can all help take your mind off of cravings.
Cravings and Relapse
Cravings for fentanyl can lead to relapse if they are not managed properly. Cravings should be expected during recovery, and a recovering user should have a plan to deal with them as they arise.
Many recovery programs will help you create an aftercare plan that includes ongoing support after you leave the treatment center. Aftercare often includes programs such as 12-step meetings, sober living arrangements or halfway houses or individual and group counseling. Participating in aftercare can help you manage any cravings that occur in recovery and help prevent a relapse.
Unfortunately, many people see aftercare as short-term, and they may not follow through with long-term involvement in support groups or use the skills they learned in treatment. This can increase the likelihood of a relapse.
Here are a few relapse warning signs or triggering events to watch out for:
- Hanging out with people you used drugs with: Many recovering users get lonely and miss the friendships they used to have. They may believe that they can maintain these friendships while remaining sober. But instead of associating with these people, a recovering user should build a new network of sober friends and family.
- Dealing with a crisis: The stress of a crisis can increase the risk of relapse. A plan of aftercare should assume that major crises, such as a death in the family or the loss of a relationship, will happen. In order to avoid letting life events trigger a relapse, a person in recovery should work out a plan in case these types of situations occur.
- Becoming isolated: Apathy can set in after people have been sober for months or even years. They may begin to get bored with their 12-step meetings or think that they no longer get anything out of the meetings. They may begin to isolate themselves, and loneliness can set in, which can trigger a relapse.
Preventing relapse requires a proactive plan for recovery. Continuing to participate in aftercare activities provides a person recovering from fentanyl addiction with help to cope with cravings and to avoid relapse when they feel overwhelmed by life events or feel isolated.
Many of the 12-step programs include sponsors, who are further along in their recovery and can help another person when they feel strong cravings to use. Sponsors make themselves available for phone calls and meetings when support is needed.
Find a Recovery Center for Fentanyl Addiction
If you have concerns about your own addiction to fentanyl or are seeking help for a family member or friend, call 1-888-319-2606 Who Answers? today. Our recovery support specialists will help you locate a treatment center in your area based on your insurance coverage.
If you don’t have health insurance, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) at 1-800-662-HELP (4357) for referrals to low-cost or free programs in your area.
. National Institute on Drug Abuse (2012). Fentanyl.
. National Institute on Drug Abuse. A Cognitive-Behavioral Approach: Treating Cocaine Addiction.
. Center for Substance Abuse Treatment. Substance Abuse Treatment: Group Therapy. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2005.(Treatment Improvement Protocol (TIP) Series, No. 41.) 1 Groups and Substance Abuse Treatment.
. Drug Enforcement Administration. Drug Scheduling.
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