There has been traditionally a tendency to use the word dependence for a medication that causes withdrawal symptoms when stopped and to use the word addiction for the reliance on illicit substances and the lifestyle that accompanies this.
Your desire to take the substance for non-pain relieving effects must be present in order to make a diagnosis of addiction. Therefore, an opiate addiction can be defined as taking opiates for uses other than pain management, either from abusing prescribed opiate medication or through the use of opiate drugs purchased illegally without a GP’s consent.
If you or someone you care about is using opiate medication beyond their prescribed intent, opiate addiction treatment should be sought and this guide will explain the different options available.
Understanding Opiate Addiction
For the purpose of this guide we have used ICD-10, which defines opioid dependence (code F11.2) as:
A cluster of physiological, behavioural, and cognitive phenomena in which the use of an opioid takes on a much higher priority for a given individual than other behaviours that once had greater value. A central descriptive characteristic of the dependence syndrome is the desire (often strong, sometimes overpowering) to take opioids (which may or may not have been medically prescribed). There may be evidence that a return to opioid use after a period of abstinence leads to a more rapid reappearance of other features of the syndrome than occurs with nondependent individuals.
Your risk of dependency or substance use disorder with opiates are increased if you fall into the following 3 groups (please note the groups are not mutually exclusive):
- If you have found a need for the mood-elevating effects of opiates and have an underlying psychological or psychiatric illness – in this instance your mental health treatment is as equally important as the dependence treatment.
- If you have no psychological distress but have found yourself using an increased amount of opiates – you would feel more willing to receive treatment for addiction and follow a reduction program.
- If you have previous substance use disorders or alcohol dependence – you may find yourself unwilling to engage in further assessment or treatment.
If you have comorbid mental health disorders, including past or current substance misuse disorders, you are more likely to receive opioid prescriptions for pain and are more likely to use problematic high doses This phenomenon has been described as ‘adverse selection’.
Getting Help for Opiate Addiction
You can start with your GP who may offer treatment in the practice or refer you to an outpatient treatment service within your local area. Charities such as Turning Point provide a “self-referral” option.
Primary care practitioners may lack experience in identifying and managing an opioid dependence syndrome and treatment in addiction services may not be able to meet the needs of a patient who is getting relief from a medication that is otherwise problematic. Finding the right fit for your needs is paramount to the success of recovery. While outpatient services such as counselling can be beneficial for individuals, they remain exposed to external influences and stresses that may prevent them from committing to treatment.
There are also private rehab facilities, which provide an integrated detox & therapy programme for those with opiate dependencies. Private rehab comes at a cost, but treatment is typically available immediately and requires an individual to commit to treatment within a residential setting. This comes with its advantages given that an individual will be monitored 24/7 without concerns for safety.
Understanding Treatment Options
The first line of treatment is to stop the usage of opiates through detoxification, but factors such as your choice, motivation to be sober, past drug dependence, length of time on opiates, quality of life and social support through the withdrawal phase, psychiatric and physical history, can be cause to motivate for a maintenance plan as opposed to detox.
Opioid Substitution Treatment: generally this involves being moved to a longer acting oral opioid like Methadone or buprenorphine.
Treatment with OSTs must be carried out by a clinician trained in opioid conversion, initially you may be required to have a period of supervised consumption so that you can be reviewed by your clinician, you will also be regularly tested for opioid and commonly used illicit substances.
Detoxification: a readily available and preferred method of treatment, detox is available as an outpatient or inpatient service.
Detox is generally offered as a tapering process using opiate substitutes.
Residential Rehab: is the process of undergoing treatment within a private rehab setting. A residential programme is a holistic approach to addiction treatment, which entails a medical detox, therapy and aftercare programmes. Typically you would stay within the treatment centre for 28 days or longer. During residential rehab, an individual will remain within a calm setting away from daily stresses or triggers. This option may be better suited for those with long term addiction issues who would struggle to remain sober without 24/7 support.
Treatment Option Considerations
- You have work or family commitments you must tend to
- You have not benefited from previous formal community-based detoxification
- You are experiencing significant social problems that will limit the benefit of
- You cannot afford private treatment or you do not qualify for a detox programme through the NHS.
- You would prefer to undergo an integrated detox & therapy programme before returning to daily life
- You require immediate treatment
- You require concurrent detox treatment for more than one substance
- You have other physical and mental health problems
- If you need a high level of medical, nursing support because of severe comorbid physical and mental health problems
- Your concurrent detox from alcohol or other drugs requires a high level of expertise.
If you are considering a home detox, you should at a minimum maintain contact with your GP or a suitable NHS service.
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Additional Treatment Support
You may want to consider becoming involved in a wider addiction treatment program in conjunction with your preferred treatment plan.
- Individual & group motivational therapy including private addiction counselling
- Relapse prevention therapy
- Support groups (Narcotics Anonymous).
The NHS has options in every local area that can help you with support during treatment, NHS Choices maintains a searchable directory of local drug treatment services.
There is an increasing recognition that drug misuse affects the entire family and the communities in which these families live.
There has been a growth in carer organisations, most notably Adfam and Families Anonymous
The Adfam website (https://adfam.org.uk/help-for-families/useful-organisations) is very useful and has a list of different organisations that you can contact for support for your family through treatment.
Families Anonymous (http://famanon.org.uk/) is a self-help service based on the 12-steps plan and is aimed at helping families affected by drug use and behavioural problems.
Citations & References