Treating Heroin Addiction

The good news in the midst of the heroin epidemic is that treating heroin addiction is possible and recovery is likely if a comprehensive treatment plan is followed long term. There are many recovering heroin addicts in Narcotics Anonymous who’ve been drug free for decades. NA is not the only way to maintain long term recovery, but it’s one of the best, proven ways. Treatment of heroin addiction has a long history as we’ve found our way to where we are today.

One of the earliest attempts at heroin treatment was in 1935 at the Public Health Service Narcotic Hospital in Lexington, Kentucky. This facility was a combination of hospital, farm and prison. The recovering doctor who started an inpatient treatment facility that I worked at in 80s had gone through this treatment decades before when he was legally forced into treatment. This early treatment model tried to modify the patient/prisoner’s behavior. The idea was to instill a sense of responsibility and values through hard work and the isolation of a prison. The problem with this idea is that the doctor I referenced above had these qualities instilled in him from his childhood and medical training and became addicted to narcotics anyway. The doctor addict did not lack a good work ethic. I’m sure working on a farm helped his gigantic ego, but this wasn’t the cure for addiction. The treatment also proved ineffective for tough street addicts from the inner cities — they didn’t respond too well to milking cows and slopping the hogs.

The early failures hardened ideas that heroin addicts and alcoholics and such were incorrigible — they were irresponsible thrill seekers — they were mentally ill — they just wanted to escape — on and on. Synanon was one of these failures — at first, Synanon was based on Alcoholics Anonymous, but it took an ugly turn toward aversion therapy, shaming the addicts, shaving their heads and making them carry around disparaging signs, and really crazy stuff. Eventual discoveries in neurobiology regarding addiction changed the nature of treatment, although old ideas still abound that aversion therapy or religious conversion or jail time or talking therapy, etc, will resolve the problem. The better understanding of addiction created the Hazelden/Minnesota model of basically 28 day inpatient treatment based on addiction as a disease. Heroin treatment mainly went the way of maintenance through Methadone clinics until Suboxone, and other Buprenorphine products.

Currently, inpatient treatment has shared the load with outpatient treatment. Intensive outpatient programs utilize group therapy, education, medically assisted treatment and individual sessions to prepare the client for long term recovery management. Outpatient treatment is less disruptive, and the clients can attend treatment around their daily schedules and work. With medically assisted treatment, a heroin addict can get past the withdrawals and attend treatment long enough to learn long term coping skills and how to avoid relapse. This has been a major improvement. Although withdrawals from heroin won’t kill a person, the withdrawal is so painful that most people will not make it through the withdrawals without using heroin. Then, because they remember the pain of the withdrawal, they don’t try, or they go to a Methadone clinic to get maintenance doses. There are pros and cons to Methadone treatment, and I won’t get into that here. The good news from my perspective is Buprenorphine. Suboxone, the most popular form of Buprenorphine, acts on the opiate receptors and stops withdrawal (an oversimplification)– it’s an amazing drug, and you have to read the scientific explanations to really understand it. When a heroin addict can enter treatment without the fear of withdrawals, they can learn the same coping skills as the alcoholic to start a long term recovery management program. Addiction treatment which aims at drug free recovery is similar for alcohol, cocaine, opiates, benzos, etc.

No drug like Buprenorphine is a cure-all, it’s just a beginning, a tool that allows the heroin addict to enter treatment and establish a recovery routine that’s life long. The goal is to wean off the Buprenorphine once the person is established in recovery. We’ve seen great results with this model. Yes, heroin addiction is a huge national problem, but treatment works. Relapse happens, as in all medical conditions, but relapse is not a necessary part of the recovery process – it doesn’t have to happen. Many heroin addicts enter treatment and never use again — it can happen and it does. The old idea that treatment doesn’t work, especially for heroin addicts, has to be smashed. Treating heroin addiction is the fundamental solution to the heroin epidemic. The problem is that not all treatment efforts are equal — we must establish very strong national standards of treatment based on what works.  I’ll write about the stigma of heroin addiction in the next few days.