What
are the Treatments for Heroin Addiction?
A variety of effective treatments are available for heroin addiction.
Treatment tends to be more effective when heroin abuse is identified
early. 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 treating 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 treatment
for addiction, detoxification is a useful step only when it leads into
long-term treatment 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 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 return to more stable and productive
lives.
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 treat
heroin addiction. 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 to treat heroin addiction, buprenorphine, may already
be available by the time this Research Report appears. 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 treatment 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. 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 treatment approach to meet the particular
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
ÒpointsÓ based on negative drug tests, which they can
exchange 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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