Narcotic addiction is difficult to treat effectively. The recidivism (relapse) rate is high, but the longer one is off drugs, the more likely he or she will remain abstinent. One benefit of treatment is that recovering addicts live longer.Recovering addicts do not have to be consigned to a lifetime of degenerating health. With treatment, many users mature and get a fresh perspective on sober living. Treatment programs range from psychotherapy to behavior modification to acupuncture to medical intervention.
Withdrawal from narcotics is not as life-threatening or as severe as many people believe. Most addicts are withdrawn from opiates gradually, although rapid detoxification can be just as effective. Unfortunately, most patients undergoing detoxification fail to complete the full program. Freeing one’s body of drugs does not remove the person’s desire to take drugs. To help addicts in withdrawal, they receive drugs such as clonidine, buprenorphine, naltrexone, naloxone, and the best known, methadone. Clonidine was used to treat hypertension initially, and it was also found to eliminate some drug withdrawal symptoms. Naloxone reduces the amount of time addicts require to undergo withdrawal, but it triggers withdrawal more suddenly. Typically, detoxification is completed in 10 to 14 days if it is conducted on an inpatient basis. Federal guidelines allow methadone to be administered for up to 30 days on an outpatient basis, although the time can be extended to 180 days if 30 days is found to be insufficient or if the addict is likely to relapse.
Drugs that block narcotics from producing their reinforcing effects are called antagonists. Antagonists remove the physical need for opiates, but not the psychological need. They complement psychotherapy or group therapy. Examples are naltrexone, buprenorphine, nalorphine, naloxone, and cyclazocine.
Nalorphine and cyclazocine were the first antagonists used, but they have been discarded because of their unpleasant side effects. Naloxone (Narcan) subsequently replaced these drugs because it did not produce dysphoria or physical dependence. The effectiveness of naloxone as an antagonist, however, is limited. It works for a short time only. It is frequently used in emergency situations to handle overdoses from narcotics.
Naltrexone (Trexan) is administered orally and is generally effective for a few days. Taking naltrexone negates the effects of Codeine during the same period. Therefore, naltrexone is useful during detoxification. It is not recommended for people who have acute hepatitis or liver failure because high doses are linked to hepatic toxicity. In Britain, naltrexone has been shown to be somewhat effective when given to prisoners prior to their release from prison. Naltrexone is not viewed as a complete form of treatment because addicts crave narcotics after discontinuing the medication. Moreover, the dropout rate for individuals receiving naltrexone is substantial. Naltrexone works best when it is used in conjunction with some type of additional reward.
Another drug used to ameliorate withdrawal is buprenorphine. The FDA initially approved it to treat pain. It is less addictive than other drugs.
Buprenorphine also reduces cocaine use. Its long-term efficacy, however, has not been determined, although buprenorphine was shown to be more efficient than other antagonists for treating heroin addiction. Nonetheless, many people receiving buprenorphine found it improved their quality of life.
Modeled on the principles of Alcoholics Anonymous, Narcotics Anonymous (NA) is a self-help group that was formed in 1953. It is designed to help people who are addicted to medically prescribed narcotics like Codeine. Like Alcoholics Anonymous, NA is based on a 12-step model, but the groups are distinctly different. Some people are members of both groups. One difference between the groups is that to members of NA, the problem is not chemical but, rather, the result of one’s behavior. Alcoholics Anonymous deals exclusively with alcohol, whereas NA addresses all drugs including alcohol.