Table of ContentsView AllTable of ContentsEvidence-Based Addiction TreatmentHarm ReductionMedicationsTherapyTwelve-Step FacilitationOther ApproachesChoosing a Specialist
Table of ContentsView All
View All
Table of Contents
Evidence-Based Addiction Treatment
Harm Reduction
Medications
Therapy
Twelve-Step Facilitation
Other Approaches
Choosing a Specialist
Whileopioid addictionis serious and challenging, treatments that address the physical, psychological, and social aspects of substance use disorders can help.
This article explores the available treatments and discusses which opioid addiction treatments are most effective. A multifaceted approach that combines therapy, medication, and social support can be the most beneficial in many cases.
An Overview of Substance Use
Addiction is a complex, long-term condition that develops in people who are specifically vulnerable to it. Likewise, the treatment necessary forovercoming addictionsis also complex and multifaceted.
When considering addiction treatment, it’s crucial to establish that it’s evidence-based, which means that the treatment has been studied and shown to be effective for many people with the condition.
For a treatment to be effective, a person needs help addressing the physical aspects of addiction, psychological underpinnings, as well as the social causes and consequences of their substance use.
If all of the physical, social, and mental health aspects of opioid addiction are not addressed, the treatment is less likely to be successful, and the person may relapse.
Therefore, these treatments should be part of a comprehensive treatment plan that is consistently followed before, during, and after the person quits opioids.
Side Effects of Vivitrol
Harm reduction is an approach to helping people withopioid use disorderand is often one of the first interventions tried.
Harm reduction focuses on reducing the physical and social harms that affect people who use heroin (and sometimes other opioids) rather than on encouraging the person to quit.
The harm reduction approach is especially helpful for people who inject opioids. It includes strategies such as needle exchange programs, safe injection sites, opioid replacement therapies (such asmethadone maintenance programs), and naloxone as a tool for overdose reversals.
Harm reduction saves the lives of people who may otherwise die of blood-borne infections such as human immunodeficiency virus (HIV), hepatitis, and overdose. It also helps connect people with professionals, resources, and information to help them once they seek treatment and stop using opioids.
Medical Treatments for Opioid Addiction
While treatment options have mainly remained the same over the past decade, some recent changes have helped improve the availability of treatment medications. These include changes to prescribing requirements and alternative formulations of certain medicines, explainsRyan Wade, MD, a psychiatrist and the director of addiction services at Silver Hill Hospital in New Canaan, Connecticut.
If you choose medical treatment for addiction, you’ll have several options. They may be combined with other forms of treatment, or you may need to try more than one to find one that works for you.
Buprenorphine
Buprenorphine maintenance therapy is administered through a clinic or individual clinician. In the past, providers were required to possess a DEA license to prescribe controlled substances and complete a certain amount of training to prescribe this medication. Providers were also limited in the number of patients they could prescribe buprenorphine to.
DEA policy changes have removed this “X-waiver” requirement and the cap on how many patients a provider could treat with buprenorphine.Wade says that these moves should help increase the accessibility of this treatment.
“Hopefully, this results in more providers prescribing to individuals with opioid use disorder in need of buprenorphine, as well as allowing those providers who are already prescribing to be able to treat more people without a strict cap on the number of current patients,” Wade says.
Wade also explains that changes in the available formulations can help improve its delivery and medication adherence. Previously, buprenorphine was only available as a sublingual tablet or film that dissolves under the tongue. This formulation typically had to be taken two to three times daily.
Buprenorphine is now available as a transdermal patch, a once-a-month injection, or an implant. The implant slowly releases medication and needs to be replaced every six months.
These changes can make it easier for individuals using buprenorphine to adhere to a consistent medication regimen, which can be challenging when having to remember to take a medication multiple times per day.—RYAN WADE, MD, BOARD-CERTIFIED PSYCHIATRIST
These changes can make it easier for individuals using buprenorphine to adhere to a consistent medication regimen, which can be challenging when having to remember to take a medication multiple times per day.
—RYAN WADE, MD, BOARD-CERTIFIED PSYCHIATRIST
Suboxone vs. Methadone for Treating Opioid Addiction
Methadone
Methadoneis a synthetic opioid that alters the effects of pain on the nervous system without the euphoria and sedation associated with heroin and opioid drugs.
People who are addicted to opioids, such as heroin, can be physically stabilized on methadone which allows them to engage in therapy to treat the underlying causes of their addiction.
Methadone is an effective treatment for withdrawal from opioids and is used in medication-assisted treatment of serious opioid addiction. It is usually taken orally, in liquid form, or as a tablet or wafer. It is typically dispensed through a government-approved program.
Naltrexone
Naltrexone is another first-line pharmacological therapy for opioid dependence. The long-acting injection, Vivitrol, is a form of naltrexone that eases compliance. It requires monthly injections.
This medication binds to opioid receptors, which then blocks opioids from binding and stimulating the receptors. “By occupying these receptors, the signaling in the brain that is thought to yield cravings or urges for opioids is reduced, theoretically leading the individual to be in less distress and have less physiologic drive to pursue opioids,” Wade says.
In other words, since naltrexone blocks opioid effects, it reduces the reinforcing effects of opioids even when they are ingested. Because people find that opioids are no longer reinforcing, they may be less likely to use them.
Creating this barrier of sorts helps individuals to engage with their typical day-to-day activities with less of a drive to pursue opioids and to re-establish healthier, more functional habits.—RYAN WADE, MD, BOARD-CERTIFIED PSYCHIATRIST
Creating this barrier of sorts helps individuals to engage with their typical day-to-day activities with less of a drive to pursue opioids and to re-establish healthier, more functional habits.
However, naltrexone isn’t always 100% effective. Some opioids have such a strong affinity for opioid receptors that they can overcome naltrexone and displace it, allowing them to exert their effects anyways, Wade explains.
Once-A-Month Naltrexone Injections to Treat Opioid Addiction
Psychological Treatments for Opioid Addiction
In the last few decades, psychological treatments have become more sophisticated. The approaches focus on every stage of overcoming opioid addiction, from deciding to change and quitting or reducing opioid use to becoming abstinent and avoiding relapse.
There are different approaches, but each should be tailored to meet the individual needs of the person with opioid use disorder.
Motivational Approaches
For this reason,motivational interviewingormotivational enhancement therapyis an important step in helping people who use opioids prepare to quit before they attempt to do so. The approach guides them through the variousstages of change.
Cognitive Behavioral Therapy (CBT)
Cognitive-behavioral therapy(CBT) is one of the most effective treatments for opioid use disorder. It’s also a highly effective treatment for other psychological disorders, including anxiety disorders, depression, and trauma—all of which can co-occur with opioid addiction.
If someone has an addiction to opioids as well as a co-occurring mental health condition such as depression and anxiety, CBT is often a good psychological treatment to start with.
Why Mental Health Disorders Co-Exist With Substance Use
Contingency Management
In this system of contingency management, failure to comply with treatment results in job loss, imprisonment, and loss of reputation.
How Behavioral Therapy Works
Couples Therapy
Couples counseling(sometimes called couples or marital therapy) can be an important part of a treatment plan for someone with a substance use disorder, including opioid addiction. It is often used with other treatments.
Couples counseling can be helpful for couples who wish to stay together during and after recovery and those who choose to separate.
Family Therapy
Family therapycan help families with a member or members who are dealing with addiction, but it is especially effective for adolescents with substance use disorders.
The basic approach focuses on the dynamics of the family as a whole. Therapeutic attention is not just focused on the person using a substance; instead, a family member’s substance use is considered the “symptom” of overall “disease” within the family.
When the behavior of a person addicted to opioids starts to affect their partners, children, or parents, family therapy can be helpful. Sometimes, hearing from loved ones about their experiences can motivate a person dealing with substance use to change their behavior.
Family therapy can also help family members support the person who wants to quit opioids and help each member become more aware of how they may have inadvertently contributed to difficulties that occurred in the past.
Why the Community Reinforcement and Family Training (CRAFT) Approach to Substance Use Intervention is Effective
Twelve-step facilitation is a strategy built on the premise that involvement in a mutual support group like Narcotics Anonymous (NA) orAlcoholics Anonymous (AA)can help individuals to achieve and maintain abstinence.
While there is some evidence that the approach is effective for treating alcohol abuse and dependence, evidence of its efficacy for treating opioid-dependent individuals is limited.
However, groups can also be supportive, safe spaces for people in recovery. Many members benefit from new friendships and sober activities that take place in mutual support groups.
Two examples are NA and AA, which are programs based on acceptance of the chronicity of a substance use disorder as a disease, surrender to a higher power, and fellowship among abstinent peers. Meetings are free to attend and are held every day in locations all over the world.
How to Find a Support Group Near You
There are also a few other therapeutic approaches that may sometimes be used in the treatment of opioid addiction. Such treatments have less of an evidence-base, but some people may find them useful in addition to other proven treatments.
Hypnotherapy
Hypnotherapyis a type of psychological therapy that uses naturally occurring mental states and therapeutic suggestions to help people with addictions to think differently about change.
Hypnotherapy uses hypnosis to help people access mental states ethically and responsibly. It’s not like stage hypnosis, which uses a volunteer’s suggestible mental state to entertain an audience.
Some people find hypnosis effective in helping them break through their psychological barriers to change. Hypnotherapy can be empowering and relaxing, helping someone feel more in control of their thoughts without drugs.
Using Hypnosis to Treat Addiction
Neurotherapy
Neurotherapyis less commonly used, but there is some research on its use in addictions and might be a consideration—particularly for people who haven’t found talk therapy helpful.
During neurotherapy, electronic sensors are painlessly attached to your scalp with a conductive gel. While you relax, a computer provides feedback on your mental state.
On the HorizonNew treatments may also be on the horizon. For example, devices that utilize targeted electrical stimulation may help minimize symptoms of opioid withdrawal. More research is needed, however, to understand better how such devices might be best utilized during treatment and to help people achieve lasting recovery from opioid use.
On the Horizon
New treatments may also be on the horizon. For example, devices that utilize targeted electrical stimulation may help minimize symptoms of opioid withdrawal. More research is needed, however, to understand better how such devices might be best utilized during treatment and to help people achieve lasting recovery from opioid use.
Navigating the Fentanyl Crisis as a Young Person
If you are dealing with opioid use disorder, a mental health or addiction medicine specialist can help you determine the next steps. Your chances of success depend a great deal on your motivation to change.
Addiction treatment professionals are typically licensed in some capacity, but state laws vary with respect to the qualifications these individuals must hold for licensure.
In some jurisdictions and states, there are few (if any) requirements for education and training in treating substance use disorders. Professionals may not be required to receive training for addiction counseling.
Doctors who certify with the American Board of Addiction Medicine, or those who train for years in a general psychiatry residency, have a good understanding of the disease of addiction.
Does Drug Addiction Treatment Work?
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Additionally, there may be primary care physicians, particularly those who work in communities with high rates of opioid use disorders, who are highly knowledgeable and competent in treating opioid use disorder.
Some addiction professionals ask to talk to family members or close friends, to get a more objective viewpoint of the patient’s usage pattern. There are many factors that can guide a healthcare professional to find the best individual treatment plan. It is important to tailor a plan to the individual’s beliefs and to medical science.
If you or a loved one are struggling with substance use or addiction, contact theSubstance Abuse and Mental Health Services Administration (SAMHSA) National Helplineat1-800-662-4357for information on support and treatment facilities in your area.For more mental health resources, see ourNational Helpline Database.
If you or a loved one are struggling with substance use or addiction, contact theSubstance Abuse and Mental Health Services Administration (SAMHSA) National Helplineat1-800-662-4357for information on support and treatment facilities in your area.
For more mental health resources, see ourNational Helpline Database.
How to Find the Right Addiction Recovery Program
7 SourcesVerywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Centers for Disease Control and Prevention.Prescription opioid overdose death maps.American College of Physicians.Elimination of X-waiver removes major barrier to opioid use disorder treatment.Substance Abuse and Mental Health Services Administration.2022 National Survey of Drug Use and Health (NSDUH) Releases.Schumm JA, Renno S.Implementing behavioral couples therapy for substance use disorders in real-world clinical practice.Fam Process. 2022;61(1):25-42. doi:10.1111/famp.12659Horigian VE, Anderson AR, Szapocznik J.Family-based treatments for adolescent substance use.Child Adolesc Psychiatr Clin N Am. 2016;25(4):603-628. doi:10.1016/j.chc.2016.06.001Humphreys K, Barreto NB, Alessi SM, et al.Impact of 12 step mutual help groups on drug use disorder patients across six clinical trials.Drug Alcohol Depend. 2020;215:108213. doi:10.1016/j.drugalcdep.2020.108213Spark Biomedical.Transcutaneous auricular neurostimulation (tAN) clinical trial results.Additional ReadingDehghani-Arani F, Rostami R, Nadali H.Neurofeedback training for opiate addiction: Improvement of mental health and craving.Applied Psychophysiology & Biofeedback.2013;38(2):133-141. doi:10.1007/s10484-013-9218-5Denning P, Little J.Over the Influence: The Harm Reduction Guide to Controlling Your Drug and Alcohol Use. Second edition. The Guilford Press; 2017.Haeny AM, Montgomery L, Burlew AK, et al.Extended-release naltrexone versus buprenorphine-naloxone to treat opioid use disorder among Black adults.Addictive Behaviors. 2020;110:106514. doi:10.1016/j.addbeh.2020.106514Manganiello AJ.A comparative study of hypnotherapy and psychotherapy in the treatment of methadone addicts.American Journal of Clinical Hypnosis.1984;26(4):273-279. doi:10.1080/00029157.1984.10402575Moore B, Fiellin D, Schottenfeld R, et al.Cognitive behavioral therapy improves treatment outcomes for prescription opioid users in primary care buprenorphine treatment.Journal of Substance Abuse Treatment; 71:54-57. 2016. doi:10.1016/j.jsat.2016.08.016
7 Sources
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Centers for Disease Control and Prevention.Prescription opioid overdose death maps.American College of Physicians.Elimination of X-waiver removes major barrier to opioid use disorder treatment.Substance Abuse and Mental Health Services Administration.2022 National Survey of Drug Use and Health (NSDUH) Releases.Schumm JA, Renno S.Implementing behavioral couples therapy for substance use disorders in real-world clinical practice.Fam Process. 2022;61(1):25-42. doi:10.1111/famp.12659Horigian VE, Anderson AR, Szapocznik J.Family-based treatments for adolescent substance use.Child Adolesc Psychiatr Clin N Am. 2016;25(4):603-628. doi:10.1016/j.chc.2016.06.001Humphreys K, Barreto NB, Alessi SM, et al.Impact of 12 step mutual help groups on drug use disorder patients across six clinical trials.Drug Alcohol Depend. 2020;215:108213. doi:10.1016/j.drugalcdep.2020.108213Spark Biomedical.Transcutaneous auricular neurostimulation (tAN) clinical trial results.Additional ReadingDehghani-Arani F, Rostami R, Nadali H.Neurofeedback training for opiate addiction: Improvement of mental health and craving.Applied Psychophysiology & Biofeedback.2013;38(2):133-141. doi:10.1007/s10484-013-9218-5Denning P, Little J.Over the Influence: The Harm Reduction Guide to Controlling Your Drug and Alcohol Use. Second edition. The Guilford Press; 2017.Haeny AM, Montgomery L, Burlew AK, et al.Extended-release naltrexone versus buprenorphine-naloxone to treat opioid use disorder among Black adults.Addictive Behaviors. 2020;110:106514. doi:10.1016/j.addbeh.2020.106514Manganiello AJ.A comparative study of hypnotherapy and psychotherapy in the treatment of methadone addicts.American Journal of Clinical Hypnosis.1984;26(4):273-279. doi:10.1080/00029157.1984.10402575Moore B, Fiellin D, Schottenfeld R, et al.Cognitive behavioral therapy improves treatment outcomes for prescription opioid users in primary care buprenorphine treatment.Journal of Substance Abuse Treatment; 71:54-57. 2016. doi:10.1016/j.jsat.2016.08.016
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Centers for Disease Control and Prevention.Prescription opioid overdose death maps.American College of Physicians.Elimination of X-waiver removes major barrier to opioid use disorder treatment.Substance Abuse and Mental Health Services Administration.2022 National Survey of Drug Use and Health (NSDUH) Releases.Schumm JA, Renno S.Implementing behavioral couples therapy for substance use disorders in real-world clinical practice.Fam Process. 2022;61(1):25-42. doi:10.1111/famp.12659Horigian VE, Anderson AR, Szapocznik J.Family-based treatments for adolescent substance use.Child Adolesc Psychiatr Clin N Am. 2016;25(4):603-628. doi:10.1016/j.chc.2016.06.001Humphreys K, Barreto NB, Alessi SM, et al.Impact of 12 step mutual help groups on drug use disorder patients across six clinical trials.Drug Alcohol Depend. 2020;215:108213. doi:10.1016/j.drugalcdep.2020.108213Spark Biomedical.Transcutaneous auricular neurostimulation (tAN) clinical trial results.
Centers for Disease Control and Prevention.Prescription opioid overdose death maps.
American College of Physicians.Elimination of X-waiver removes major barrier to opioid use disorder treatment.
Substance Abuse and Mental Health Services Administration.2022 National Survey of Drug Use and Health (NSDUH) Releases.
Schumm JA, Renno S.Implementing behavioral couples therapy for substance use disorders in real-world clinical practice.Fam Process. 2022;61(1):25-42. doi:10.1111/famp.12659
Horigian VE, Anderson AR, Szapocznik J.Family-based treatments for adolescent substance use.Child Adolesc Psychiatr Clin N Am. 2016;25(4):603-628. doi:10.1016/j.chc.2016.06.001
Humphreys K, Barreto NB, Alessi SM, et al.Impact of 12 step mutual help groups on drug use disorder patients across six clinical trials.Drug Alcohol Depend. 2020;215:108213. doi:10.1016/j.drugalcdep.2020.108213
Spark Biomedical.Transcutaneous auricular neurostimulation (tAN) clinical trial results.
Dehghani-Arani F, Rostami R, Nadali H.Neurofeedback training for opiate addiction: Improvement of mental health and craving.Applied Psychophysiology & Biofeedback.2013;38(2):133-141. doi:10.1007/s10484-013-9218-5Denning P, Little J.Over the Influence: The Harm Reduction Guide to Controlling Your Drug and Alcohol Use. Second edition. The Guilford Press; 2017.Haeny AM, Montgomery L, Burlew AK, et al.Extended-release naltrexone versus buprenorphine-naloxone to treat opioid use disorder among Black adults.Addictive Behaviors. 2020;110:106514. doi:10.1016/j.addbeh.2020.106514Manganiello AJ.A comparative study of hypnotherapy and psychotherapy in the treatment of methadone addicts.American Journal of Clinical Hypnosis.1984;26(4):273-279. doi:10.1080/00029157.1984.10402575Moore B, Fiellin D, Schottenfeld R, et al.Cognitive behavioral therapy improves treatment outcomes for prescription opioid users in primary care buprenorphine treatment.Journal of Substance Abuse Treatment; 71:54-57. 2016. doi:10.1016/j.jsat.2016.08.016
Dehghani-Arani F, Rostami R, Nadali H.Neurofeedback training for opiate addiction: Improvement of mental health and craving.Applied Psychophysiology & Biofeedback.2013;38(2):133-141. doi:10.1007/s10484-013-9218-5
Denning P, Little J.Over the Influence: The Harm Reduction Guide to Controlling Your Drug and Alcohol Use. Second edition. The Guilford Press; 2017.
Haeny AM, Montgomery L, Burlew AK, et al.Extended-release naltrexone versus buprenorphine-naloxone to treat opioid use disorder among Black adults.Addictive Behaviors. 2020;110:106514. doi:10.1016/j.addbeh.2020.106514
Manganiello AJ.A comparative study of hypnotherapy and psychotherapy in the treatment of methadone addicts.American Journal of Clinical Hypnosis.1984;26(4):273-279. doi:10.1080/00029157.1984.10402575
Moore B, Fiellin D, Schottenfeld R, et al.Cognitive behavioral therapy improves treatment outcomes for prescription opioid users in primary care buprenorphine treatment.Journal of Substance Abuse Treatment; 71:54-57. 2016. doi:10.1016/j.jsat.2016.08.016
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