Opioid Addiction Treatment Approach
Buprenorphine – Opioid Substitution Therapy
So often people are told by those around them including poorly educated doctors that “it’s all in your head just get some will power and snap out of it”. It’s not. Post Acute Withdrawal Syndrome or PAWS is well recognized by those who understand the treatment of opioid addiction and why relapse rates out of even 30 day in-patient programs have been found to be as high as 90% or more after 1 year.
We believe that current science supports the contention that those who have struggled with opioid addiction for any significant length of time and in particular who have failed other treatment programs should be treated with opioid substitution therapy. Methadone or Buprenorphine for an indeterminate period of time are the only two treatments with significant science to back them up in the treatment of opioid addiction.
While absolute abstinence may be preferable for some substance abusers very few of those afflicted with opioid addiction will achieve it at least in the beginning of treatment without the help of medication to relieve the prolonged sickness and cravings of opioid withdrawal, which continue long after addiction has stopped.
Harm reduction therapy attitudes and techniques in relation to addictions:
Accept and respond to improvement.
The standard addiction treatments in the U.S. requires the individual to instantaneously and totally give up all use of the problem substance even in Methadone and Buprenorphine programs. Most programs reject anyone who fails to do so! This is cherry picking of clients, by working only with those who are immediately able to get better. But who then will deal with the vast majority who are not always successful at immediate cessation? What happens if relapse occurs? At RHR we recognize much can be learned with failure. Perfection is not mandatory only complete honesty and the true desire to end ones addiction.
Humility (versus perfectionism) is a skill required by both patients and our staff.
When people say, “I will not tolerate any kind of relapse” they may endanger the lives of their own patients or they must surely have perfect compliance. This is not realistic for all. It’s just that they insisted nothing less than total abstinence, so that any failures were those of their clients, and not their own. While this may comfort therapists or doctors, it is not effective therapy nor does it promote honesty.
Among misbelieves of those in the field of addiction is that addicts depend solely on their therapists, doctors or groups for any advances they make. In fact, most people get better on their own. In part, this involves experiencing and learning from the pain of their mistakes. If not for the pain of opioid withdrawal and its prolonged misery most people would quit on their own as they do with other substances.
Learning to take care of yourself is a skill.
To say one accepts that human beings are imperfect does not mean that you endorse their imperfections, failures or relapses. We want to encourage those we are helping to greater heights and larger successes. But it is the recognition and encouragement of smaller successes that lead to such progress. What we consider substance abuse therapy in the United States consists largely of exhortation—”quit drug taking and drinking!” Real treatment must improve the conditions of a range of those afflicted to be of value to as many as possible. We at RHR believe this starts with honestly accepting this is an imperfect process but one in which we honestly strive for perfection each day.
John Sorboro MD ABPN ASAM