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 points
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.
