Choosing a Heroin Addiction Treatment Program
When looking for a rehab center for your heroin addiction, you should:
- Find a center that specializes in heroin addiction and dual diagnosis (if applicable).
- Check the cost and whether your insurance will cover your costs.
- Decide whether an inpatient or outpatient recovery center is best, depending on your situation.
- Make sure the rehabilitation center offers aftercare.
Heroin Recovery Options
There are two basic forms of heroin abuse treatment: outpatient and inpatient.
Outpatient treatment is when you visit a clinic or other facility to receive treatment. These treatments may include:
- Individual psychotherapy.
- Behavioral interventions.
- Group therapy.
- Medication management.
In many cases, the best treatment includes components of both medication and behavioral approaches. Methadone maintenance may also be recommended, which is the supervised use of a heroin substitute.1
If you have a more severe and long-standing heroin addiction, you may benefit from more intensive outpatient programs. You will receive a higher level of care by participating in more frequent treatment sessions.
Inpatient treatment (also known as rehabilitation or rehab, or residential care) allows you to remain in the facility for a specific length of time while you receive drug-based treatment, psychotherapy, behavioral therapy or a combination of these.2,3 Many inpatient heroin recovery programs also incorporate Suboxone-assisted detox.3 You may be required to stay for the amount of time determined by your treatment plan.
Inpatient rehabilitation facilities may be standard, luxury or executive. The facility and treatment type for each person depends on several factors, such as their history of heroin abuse and any prior treatment.
- 30-day programs are more traditional forms of rehab, in which you are administered detox (see below) and/or heroin addiction treatment over this time period.4 However, this time frame may not be long enough for some people.
- Alternative programs last 60 days or 90 days. This may be a better option because it allows for traditional month-long detox followed by tapering and other treatment.5
- Luxury treatment programs are usually located in pleasant surroundings and include features such as massage, fine dining and activities such as tennis and horseback riding.
- Executive rehabs are geared toward people who aren’t able to take time away from work while they’re in recovery. The treatment center is designed so that individuals can continue to take care of their professional needs while completing an addiction program.
Treatment for Teens
Adolescents suffering from substance abuse require special consideration. In fact, opioids (both in injectable and oral forms) are the second-most common drug of abuse among adolescent or young adults.3
Factors such as the abuse of other substances (e.g., marijuana) and psychosocial problems may influence the increased risk of opioid abuse among this group.
Many behavioral therapies, such as cognitive behavioral therapy, have been shown to help teens struggling with addiction. These programs generally target the teen’s family relationships and communication skills, and address co-occurring mental or behavioral health conditions, such as anxiety or depression, as well as polysubstance abuse.
What Kind of Detox Does It Offer?
Detoxification procedures (most often known as “detox”) are processes in which you are treated for the symptoms of heroin withdrawal at the beginning of rehabilitation.3 This may last several hours or several days.
Detox is not a form of treatment. It is the first step in a recovery process.
Detox is not a form of treatment for heroin addiction. It is the first step in a recovery process, which is then followed up with other forms of treatment such as psychiatric and/or behavioral therapy.6
While heroin detox may be very uncomfortable, it rarely presents any real health dangers. That said, a structured detox program that uses medication can help ease the unpleasant side effects. Detox is often accompanied by the administration of opioid analogs and/or antagonists (e.g., buprenorphine/naloxone or Suboxone treatment).3 These help with the effects of heroin withdrawal (e.g., sweating, pains, nausea and discomfort).
Nature and Duration of Detox
The nature and duration of heroin detox depends on the facility in which heroin addiction is treated.
- Medical detox (i.e., the supervised administration of medications to manage withdrawal symptoms) may take a number of days (e.g., 12-14).3
- Maintenance treatment involves medication being administered for some weeks.3 The doses of these drugs are reduced, or “tapered,” over time, to wean you off heroin dependence.[/callout]
Medications that can help manage symptoms of heroin withdrawal include:
- Methadone – a longer-acting opioid that produces a similar effect to heroin, but without the extreme highs and lows. Methadone is only available in clinics regulated by the Substance Abuse and Mental Health Services Administration (SAMHSA).
- Buprenorphine – a medication that can help reduce cravings and block the effects of other opioids, such as heroin. Buprenorphine is only available through physicians who have received special training.
- Naltrexone – another drug that blocks the effects of other opioids. Naltrexone is usually prescribed to users who have detoxed from heroin and are trying to remain abstinent.
- Clonidine – can help reduce anxiety, muscle aches, sweating, runny nose, and cramps.
- Lofexidine – can help reduce some of the physical symptoms of withdrawal.
Clonidine and lofexidine are alpha-adrenergic agonists and are used in detox. Their effects in the first 30 days of treatment are similar to those of opioid analogs or antagonists.10
Some studies have shown that users between 15 and 21 years are more likely to drop out of buprenorphine-assisted programs.3,6
However, they show an improved response to clonidine and methadone.3,6
Few studies directly compare medications that assist detox and maintenance, and the results from these studies remain mixed.10
For instance, while one study indicated that methadone treatment may be associated with improved adherence compared to buprenorphine or naltrexone, other studies have suggested that methadone treatment has serious limitations.
In particular, a large proportion of individuals attending methadone clinics continue to use heroin or other drugs, such as cocaine or marijuana.
Assessment for Medical and Mental Health Conditions?
The process of assessing for heroin addiction in addition to a co-occurring mental illness or health issue is known as dual diagnosis. Many heroin users struggle with dual diagnosis, but an increasing number of treatment centers offer this kind of treatment. It’s something to keep in mind if you think you may be dealing with a mental illness -such as depression or anxiety- or a health problem in addition to your heroin addiction.
Heroin abuse may be associated with a range of health issues and conditions. Hepatitis C and B are prevalent among users of drugs such as heroin.7 This is because heroin is taken intravenously, increasing the risk of blood-borne disease contraction among those who use dirty or previously used needles.7 HIV is also prevalent among injectable substance abusers.8
It’s important to give a full disclosure of your drug history at the start of a program. Withdrawing from alcohol and/or benzodiazepines at the same time as heroin potentially constitutes an emergency situation and will necessitate an even more tightly monitored, medically supervised withdrawal period.
What Kind of Treatment Does It Offer for Heroin Abuse?
Non-drug therapies for heroin addiction focus on identifying and changing the behaviors that led to or maintain the use of substances. Whether used alone or combined with medication management, they can be very beneficial to individuals suffering from heroin abuse and dependence. These options include:
Contingency management – This treatment approach uses a systematic schedule of reinforcement to reward behavior such as refraining from the use of the substance.
Matrix Model-based therapy – This treatment approach is based on the premise that individuals recovering from substance addiction and dependence require a high degree of structure. This model draws from several other behavioral approaches and includes contingency reinforcement schedules and relapse prevention.
Art therapy – This helps improve your skills in communication and self-expression. Using a wide variety of techniques, you learn to express yourself in a healthy and productive manner, which allows you to better understand and cope with your addiction.
How Qualified Are the Staff and the Recovery Center?
Find out all you can about the staff, their qualifications and any relevant credentials they should have. Make sure that the therapists on staff have completed the appropriate postgraduate education, such as a master’s, PhD, or MD, and have experience treating heroin addiction. In addition, check the staff-to-patient ratio. This may affect how much time and other resources staff allocate to each individual.
Does the Treatment Program Offer Support After You Leave?
Post-treatment support, also known as aftercare, is another factor to consider when choosing a treatment program.
Relapse, or a return to substance seeking and abuse following treatment, is common among heroin users and may be addressed with aftercare plans directed at avoiding relapse.
The treatment program can offer interventions or services to you to help you avoid relapse.
12-Step programs, such as Narcotics Anonymous, are considered supportive therapy to be used in addition to alternative treatment. These programs are delivered in a group format and are typically run by a member from the community, as opposed to a certified addiction counselor. They provide you with support as you learn skills to live without heroin.
Sober-Living Facilities or Training
Sober-living facilities or training are a way to bridge the gap between intensive treatment programs, including inpatient and residential facilities, and returning home to the environment you were in before treatment.
Transition to Outpatient
Transition to outpatient treatment, which may include a period of participating in more frequent treatment sessions through an intensive outpatient program before transitioning to traditional outpatient treatment. The treatment sessions can be once a week, every other week, once a month or even once every few months.
Relapse may also be associated with the failure of medication-assisted maintenance treatment. Naltrexone is associated with these ineffective results.10 This may be due to different effects on the body’s response to heroin compared to other medications used in maintenance programs.10 Relapse following naltrexone treatment also has a high risk of overdose because of reduced tolerance.10
How Much Does Treatment Cost?
The cost of treatment for heroin addiction and dependence will vary widely from program to program, and depends on a number of factors. In general, inpatient and residential treatment programs are quite a bit more expensive than outpatient treatment programs. This is because inpatient and residential facilities are more intensive in nature. These centers also include room and board, along with food, which dramatically increases the cost.
Ask about any potential out-of-pocket costs and what they are, including your deductible and any copayments required.
A treatment representative can help you find a program that accepts your insurance.
Look for programs that offer treatment based on a sliding scale fee schedule. This means that the fee you would be expected to pay is adjusted based on your degree of need. In many cases, sliding scale fees are based on your annual income.
Contact the Substance Abuse and Mental Health Service Administration (SAMHSA) to learn about payment and financing options without insurance.
Does Addiction Treatment Work?
Many studies have demonstrated the success and effectiveness of methadone treatment.10 Some people may respond well to a program of detox followed by a course of therapy, while others may be more suited to longer-term medication-assisted maintenance with simultaneous therapy.
A study comparing 12-week courses of these two options, including adolescent and young adult users, found that 36% in a detox group dropped out between the second and fourth week, but that only 8% in the maintenance group left in the fourth week.3
The best way to avoid relapse is to have a determined commitment to recovery and aftercare.
Find a Heroin Rehab Center Today
. Strang J, Groshkova T, Uchtenhagen A, et al. Heroin on trial: systematic review and meta-analysis of randomised trials of diamorphine-prescribing as treatment for refractory heroin addictiondagger. Br J Psychiatry.2015;207(1):5-14.
. Pani PP, Trogu E, Vigna-Taglianti F, et al. Psychopathological symptoms of patients with heroin addiction entering opioid agonist or therapeutic community treatment. Annals of General Psychiatry.2014;13:35.
. Warden D, Subramaniam GA, Carmody T, et al. Predictors of attrition with buprenorphine/naloxone treatment in opioid dependent youth. Addictive behaviors.2012;37(9):1046-1053.
. Lawental E. Ultra rapid opiate detoxification as compared to 30-day inpatient detoxification program–a retrospective follow-up study. J Subst Abuse.2000;11(2):173-181.
. Shanahan CW, Beers D, Alford DP, Brigandi E, Samet JH. A transitional opioid program to engage hospitalized drug users. J Gen Intern Med.2010;25(8):803-808.
. Bell J, Mutch C. Treatment retention in adolescent patients treated with methadone or buprenorphine for opioid dependence: a file review. Drug Alcohol Rev.2006;25(2):167-171.
. Nelson PK, Mathers BM, Cowie B, et al. Global epidemiology of hepatitis B and hepatitis C in people who inject drugs: results of systematic reviews. Lancet.2011;378(9791):571-583.
. Ray Saraswati L, Sarna A, Sebastian MP, et al. HIV, Hepatitis B and C among people who inject drugs: high prevalence of HIV and Hepatitis C RNA positive infections observed in Delhi, India. BMC Public Health.2015;15:726.
. Phillips KA, Epstein DH, Vahabzadeh M, Mezghanni M, Lin JL, Preston KL. Substance use and hepatitis C: an ecological momentary assessment study. Health Psychol.2014;33(7):710-719.
. Bart G. Maintenance Medication for Opiate Addiction: The Foundation of Recovery. Journal of addictive diseases.2012;31(3):207-225.