Substance Abuse Treatment

Substance abuse is a phenomenon that has been clouded by myth, misunderstanding,and moral judgements.  The very nature of the problem–what substance abuse is — has long been debated.  Most people probably continue to think of substance abuse –particularly to illicit drugs –as primarily a moral or character problem, something caused by degeneracy or lack of willpower.

Scientific research into substance abuse, however, has led experts to conclude that substance abuse is actually a disease, a chronic illness like diabetes or hypertension. The American Medical Association broke new ground  approximately forty years ago when it declared alcoholism to be a disease. And in the past decade,  dramatic advances in technology have allowed scientists to examine the brain itself in search of the causes, mechanisms, and consequences of substance abuse.

Today,  scientists and physicians  overwhelmingly  agree  that  while  use  and even abuse of drugs, such as alcohol and cocaine is a behavior over which the individual  exerts control, substance abuse to these substances is something different. Scientists have begun to understand why addicted people may sacrifice every-thing  that’s important to them  — their jobs, their families, their homes — in the quest for a chemical fix.

“When you get into an addicted state, it’s a disease of the brain,” says Alan Leshner, Ph.D.,Director of the Federal Government’s National Institute on Drug Abuse.   Leshner says the stigma associated with alcohol and drug substance abuse  is one of the biggest problems experts continually face in dealing with it.   Leshner says that the public has little sympathy for addicts,but he adds that “whether you like the person or not, you’ve got to deal with [their problem] as an illness.”

Substance abuse is a disease that causes changes in the brain, which then drive certain behavior — taking the drug compulsively — but addicts can learn to change the behavior.  Treatment of and recovery from substance abuse are possible. Steve Hyman, M.D. compares  the disease of substance abuse to heart disease, which may also necessitate major lifestyle changes. “Take heart patients. We don’t blame them for having heart disease,” he says but we ask them to follow a certain diet, to exercise, to comply with medication regimes.  So it is with the addicted person — we shouldn’t blame them for the disease,but we should treat them as having responsibility for their recovery.”

Opioid Abuse

Opioid abuse occurs when the compulsive use of opioids harms a person’s health or social functioning. It also occurs when a person is addicted to or dependent on opioids. Opioids are a class of drugs made from opium, as well as synthetic or semi-synthetic drugs that resemble these opium-based drugs. Examples include heroin, morphine, codeine , hydrocodone, oxycodone , and fentanyl . These drugs are also often referred to as narcotics. This condition can be treated. Talk to your doctor if you think you are abusing opioids.

Causes

Opioids produce a quick, intense feeling of pleasure (euphoria), followed by a sense of well-being and calm drowsiness. When opioids are used repeatedly, your brain is likely to become dependent on them. Opioids are highly addictive. Opioids stimulate the release of “euphoric” chemicals in the brain. Over time, more of the drug is required to produce the same release, leading to abuse.

Risk Factors

The following factors increase your chance of developing opioid abuse. If you have any of these risk factors, tell your doctor:

      • Gender: male
      • Age: 20-29
      • Abusing other types of drugs
      • Having a psychological disorder

Symptoms

The symptoms below are associated with opioid abuse. If you experience any one of them, see your doctor.

      • Tolerance—need to increase the dose to get the same effect
      • Increasing amounts of time spent drug-seeking
      • Interference of drug or drug-seeking behavior with social, occupational, or school functioning
      • Continued use of drugs despite social, legal, occupational, or interpersonal problems stemming from drug use
      • Desire or efforts made to decrease or stop drug use
      • Withdrawal (see below)—adverse symptoms occur when the drug is not taken

Opioid withdrawal symptoms:

      • Aching
      • Fever
      • Sweating
      • Chills
      • Craving
      • Dirrhea , nausea, vomiting
      • Sleeplessness
      • Abdominal pain
      • Muscle aches
      • Goose pimples
      • Uncontrollable shivering, tremors
      • Restlessness
      • Tearing eyes, runny nose (always wiping your nose)
      • Yawning
      • Panic
      • Irritability

Diagnosis

Your doctor will ask about your symptoms and medical history. She will also do a physical exam. The doctor will ask you questions about your opioid use, such as how long you have been using opioids and how often you use them. Urine and blood tests may also be done.

Treatment

Talk with your doctor about the best treatment plan for you. Treatment options include:

Rehabilitation Programs

In rehab programs, people with opioid abuse stay in a controlled environment for 6-12 months, during which they learn how to return to society. It may be necessary to be in a detoxification center initially, where the side effects of drug withdrawal can be safely managed.

Support Groups

Narcotics Anonymous is a twelve-step program that has a good record for supporting people who are recovering from substance abuse to opioid drugs.

Behavioral Therapy

Behavioral therapy is designed to modify people’s attitudes and behaviors related to opioid abuse. In therapy, you will learn how to avoid and cope with situations in which you are most likely to use drugs.

Medications

These medicines have been shown to be effective in reducing withdrawal symptoms:

When combined with therapy, these medicines can help you to adjust to not using drugs. They may also help you to go through withdrawal at home, rather than at an inpatient facility.

Prevention

The best way to prevent this condition is to never use opioids. They can be highly addictive. If you do have to take prescription drugs to treat pain, follow the directions closely.


What is Suboxone?

Buprenorphine, a derivative of opium, has been marketed in the United States for many years as a pain relief treatment. With the recent FDA approval of buprenorphine for use in the treatment of opioid dependency, buprenorphine is now available as a prescription medication under the brand names of Subutex and Suboxone, both of which are taken sublingually (under the tongue).

How does it work?

When taken by a person who is addicted to opioids or another opioid, buprenorphine reduces craving and helps the person remain drug-free. Like methadone, buprenorphine can be used to withdraw from opioids, or it can be used continuously to help keep a person addicted to opioids from using the drug.

What is the difference between Subutex and Suboxone?

The single active ingredient in Subutex is buprenorphine, which decreases the craving for opioids and other opioids. Suboxone is a combination of buprenorphine and naloxone, which both reduces drug craving and induces withdrawal when injected.

How is buprenorphine different from methadone?

Compared with methadone, buprenorphine has a relatively lower risk of abuse, dependence, and side effects, and it has a longer duration of action. Because buprenorphine is a partial opioid agonist, its opioid effects, such as euphoria and respiratory depression, as well as its side effects reach a ceiling of maximum effect, unlike with methadone or opioids. For this reason, buprenorphine may be safer than methadone, as long as it is not combined with sedatives such as tranquilizers or alcohol.

Can a physician in a methadone clinic prescribe or dispense buprenorphine for opioid substance abuse treatment?

How do I find a doctor who prescribes buprenorphine for the treatment of opioid dependence?Physicians who have received special certification from Federal and State agencies can prescribe and dispense buprenorphine for opioid substance abuse treatment in any practice setting, including at a methadone clinic.

Doctors who are qualified to prescribe buprenorphine for the treatment of opioid dependence are listed on the SAMHSA Buprenorphine Physician Locator website: http://buprenorphine.samhsa.gov/bwns_locator/index.html. This listing contains the names, addresses and telephone numbers of qualified physicians.

How does a physician become qualified to use buprenorphine?

Physicians who want to prescribe buprenorphine must complete an 8-hour course or have sufficient experience and qualifications to be certified.

How will buprenorphine be distributed to patients?

Qualified physicians will give patients a prescription for buprenorphine. The patient can then take the prescription to a pharmacy to have it filled. By contrast, methadone can only be distributed at specialized substance abuse treatment clinics.

What are buprenorphine’s side effects?

The side effects of buprenorphine are similar to those of other opioids and may include nausea, vomiting, and constipation. Both buprenorphine and buprenorphine with naloxone can result in the opioid withdrawal syndrome if used by people on high doses of other opioids. Symptoms of opioid withdrawal can include: dysphoria, nausea and vomiting, muscle aches and cramps, sweating, tearing, diarrhea, mild fever, running nose, insomnia, and irritability.

Can buprenorphine be taken while drinking alcohol?

Buprenorphine should not be taken in combination with alcohol. Taking buprenorphine with alcohol increases buprenorphine’s respiratory-depressing effects and can be dangerous.

Can buprenorphine be abused?

Because of its opioid effects, buprenorphine can be abused, particularly by individuals who are not physically dependent on opioids. But because its euphoric effects are less than those of other opioids, so is its potential for abuse.

Is buprenorphine safe?

Because of buprenorphine’s ceiling effect, an overdose is less likely than with methadone or other opioids. There also is no evidence of organ damage with chronic use of buprenorphine, although some patients experience increases in liver enzymes. Likewise, there is no evidence that buprenorphine causes any significant disruption of cognitive or psychomotor performance. Because information about the use of buprenorphine in pregnant, opioid-dependent women is limited, methadone remains the standard of care for this group.

If you are interested in learning more about Suboxone and how it is used to treat substance abuse, then we encourage you to continue on with us. We are going to explain to you in simple terminology how the pharmacology of substance abuse relates to your rehabilitation.  We will explain how Suboxone can benefit you, if you are ready to let go of your past and give us a chance to help you. Please recognize that your problems might be severe or complicated enough that you are not a good candidate for Outpatient substance abuse treatments. In some cases the patients will have to seek Inpatient detoxification and rehabilitation for their problems.