Treating Opioid Addiction
Presented by
Chip Abernathy, LPC, CAC
Increase in Opioid Usage: Heroin
Significant increase in Opioid Usage in U.S. in past
two decades
• Treatment admissions for heroin steadily
increased 1992-2008
• Increase in heroin purity- able to sniff or smoke
it vs. IV use
• More young people using it, thinking less
addictive if not IV
Increased in Opioid Usage: Rx
Pain:5th Vital Sign
Also, around 1997, pain was identified as
‘5th vital sign’ - more people being appropriately
treated for pain - significantly more opioids
being prescribed
• More opioid-related problems: OD, death,
addiction
• Treatment admissions for opioid pain reliever
addiction increased more than fourfold between
1998 and 2008
U.S. Worker Positive Urine Tests, 1999
and 2009
1999
2009
U.S. Annual Total Opioid Rx 19982002
Annual Numbers (in Millions) New Nonmedical Users of Opioids (12 or Older)
U.S. Rx Opioid Deaths 2001-2005
What Do We Do About This?
We’ve got to do something.
Treatment of Opioid Addiction
Two Distinctly Different Approaches
The two most prevalent approaches:
•Drug Substitution Treatment, which is also called
‘medication-assisted treatment’ in the U.S.
•Abstinence-Based Treatment, in which total abstinence
following a brief detox is the goal
Both have ‘evidence-based’ data to support their
positions
History/Trends
Drug Substitution Treatment
Heroin: Touted As Both a Cough Suppressant and A
‘Non-Addictive Substitute’ for Morphine - 1895
Heroin Ad
Heroin ad
1914 Harrison Anti-Narcotic Act
Act of Congress - used registration and taxation to restrict use of
opiates and cocaine for legitimate medical purposes. Use of
opioids went from uncontrolled access under Federal law to
access controlled by physicians.
The Harrison Act was interpreted to mean that opioids could
not be used for the treatment of opioid addiction.
The Harrison Act has had a far-reaching effect on addiction and
its treatment that continues to this day.
A Lot of Opiate Addicts in America in
the 1920’s
U.S. Public Health Service research concluded that
there were 110,000 to 150,000 opiate addicts in
the U.S. in 1920’s (U.S. population in 1920 was
approximately 118,000,000). That’s around 10%
of the U.S. population.
A specialized hospital for the treatment of addicts
was suggested.
Nyswander and Dole and Methadone
Maintenance - 1960’s
1963 Nyswander and Dole, physicians, were early advocates of
methadone maintenance
Based on Lexington and Ft. Worth federal government treatment
data, other studies of the day, and personal opinion - boldly
proclaimed that large numbers of opioid addicts were:
 incapable of enduring abstinence
 and that narcotics maintenance was the only viable treatment
option for large numbers of addicts.
According to this view, addicts needed narcotics the way
diabetics needed insulin: to achieve normal metabolic
Methadone – 1970’s - Politics and
Crime Reduction
1970’s large numbers of methadone clinics open Nixon’s 1972 re-election campaign - cut down on
crime caused by heroin use
Most methadone clinics were breeding grounds for drug
activity.
Methadone Benefits
Methadone Maintenance Therapy (MMT) has been around
for over 45 years and has been well-researched. Studies
have shown that MMT
 reduces illicit drug use;
 improves health in many cases;
 advances personal, academic and workplace
functionality;
 increases treatment retention;
 and reduces chances of accidental overdose (although
methadone OD rate has been dramatically increasing in
recent times).
Methadone Adverse Events Since 1997
On a national level, as reported to the FDA, methadonerelated adverse events
 increased nearly 1800% between 1997 and 2004;
 fatalities increased 390% from 1999 to 2004 (the
most recent national data available),
 and methadone was the drug with the greatest
increase in fatalities; methadone also is the sixth
most frequently suspected drug in death and serious
nonfatal outcomes.
Drug Abuse Treatment Act - 2000
The Drug Abuse Treatment Act of 2000 now
allows doctors to prescribe Suboxone® and
Subutex®, both opioids, from their offices for the
treatment of opioid addiction
... and thus amend the Harrison Act of 1914.
Suboxone®
The active ingredient in Suboxone is buprenorphine, a partial
opioid agonist. It also contains naloxone, an opioid antagonist
to discourage people from dissolving the tablet and injecting
it.
Suboxone may be used to
•
reduce illicit opioid use
•
help patients stay in treatment
by
•
suppressing symptoms of opioid withdrawal
•
decreasing cravings for opioids
Additional Buprenorphine Benefits




Short-term buprenorphine use is helpful for
detoxification from other opiates.
For those wishing to remain on buprenorphine
indefinitely, that is an option.
Buprenorphine can be prescribed by a local doctor in the
privacy of his or her office and can be obtained from a
local pharmacy, whereas methadone must be obtained
from a methadone clinic (OTP) and quite often on a
daily basis.
There is less chance of overdose with buprenorphine
than with methadone.
Drug Substitution Treatment - Harm
Reduction
Drug Substitution Treatment in the U.S. is considered a
harm reduction approach
tapering doses of methadone or Suboxone®/Subutex®
opioid maintenance.
Helps to: reduce the spread of HIV/AIDS/hepatitis;
reduce illicit drug use; increase treatment retention;
reduce crime to attain drugs; improve employability,
improve family relations.
Drug Substitution Treatment Today
Drug Substitution Treatment, or Medication-Assisted
Treatment if you prefer, is a popular method of
treatment in the U.S. and abroad.
In the U.S. people are treated either with
• methadone or with Suboxone®
In Europe
• heroin is also used, especially for those who do not
do well on Methadone Maintenance Treatment.
In both the U.S. and abroad, counseling is
recommended with substitution treatment.
Support for Drug Substitution Treatment in the U.S.
Drug Substitution Treatment is advocated for in the
U.S. by most of the large organizations that deal
with addiction including:
•National Institute of Drug Abuse (NIDA)
•Substance Abuse and Mental Health Services
Administration (SAMHSA)
•American Society of Addiction Medicine (ASAM)
•National Association of Alcoholism and Drug
Abuse Counselors (NAADAC)
Incongruence
NIDA, SAMHSA, ASAM, and NAADAC advocate
abstinence-based treatment for all DSM IV substance
dependence disorders
•except opioid dependence, in which drug substitution
treatment is considered appropriate treatment
For example, it would not be considered appropriate
treatment (by most) to prescribe and maintain alcoholics
on a substitution sedative/hypnotic drug such as Xanax,
tell them to go to meetings and counseling, and consider
that being in recovery.
Drug Substitution Support Groups
Since there are inherent problems with trying to
have people on drug substitution blend with
people in abstinence-based 12 Step programs,
such as NA/AA, I would suggest that anyone
prescribing substitution drugs either:
Provide professionally facilitated support
groups for these patients
Know of where such groups exist and
encourage their patients to attend
History/Trends
Abstinence-based treatment
Disease and Recovery
The philosophy of this approach to addiction counseling
incorporates two important elements:
 Endorsement of the disease model
 The spiritual dimension of recovery
These elements differentiate the approach from some other
forms of treatment and reflect the influence of 12 Step
philosophy.
Treatment Philosophy


Addiction is a complex brain disease that damages the
addict physically, mentally, and spiritually.
All of these areas need to be addressed in treatment to
support recovery.
Living a Life In Recovery
The skills necessary for long-term recovery are all directed at
finding meaning and purpose in life.
Recovery is…
 A way of thinking, a way of acting, and a way of relating to
others.
 It is a philosophy of living.
 It requires the daily effort of working a recovery program.
Spirituality
The element of spirituality is very general and not specific to
any religion.
The spiritual component implies that
 there is healing in one’s life that needs to take place
 abstinence from the drug is merely the first step in that
process rather than the ultimate goal.
A Higher Power
The spiritual element of treatment also involves…
encouraging a holistic perspective on the individual, and
suggests that recovery involves
 a return to self-respect through honesty with oneself and
others, and
 having a belief in or sense of connection to something
greater than oneself.
More Focused and Overtly Stated
Within addiction counseling, the role of spirituality in healing
tends to be more focused and overtly stated than in most
other therapeutic orientations.
Characteristics of Addiction
Substance dependence (addiction) is a disease which is
 Incurable
 Chronic
 Progressive
 Relapsing
 Potentially fatal if not treated
Addiction is a very treatable disease with success
rates about the same as other chronic illnesses such
as asthma, diabetes and hypertension.
An Old Abstinence-Based Approach
In the late 1800’s to early 1900’s ‘treatment’ of opiate
addiction consisted of treatment of withdrawal
symptoms. This took the forms of:
• just abruptly stopping use
• step down with one week of drug of choice and then
stop
• prolonged withdrawal ranging from weeks to months.
Various agents were used in the process including such
things as cannabis, strychnine, belladonna, atropine,
cocaine, quinine, whiskey, and even coffee.
Drug Laws Create Increase in Crime
1920’s
U.S. Federal Penitentiaries were
overcrowded due to the Harrison Act. Two thirds of
the inmates in Atlanta, Leavenworth and McNeill
Island prisons were there for addiction-related
crimes.
Addicts used illicit drugs, doctor-shopped, forged
prescriptions, and became proficient at faking pain
(prescriptions for narcotics were ok for pain but not
for addiction). Then/now: Same/same
‘Narcotics Farms’
In 1929 Congress approved two ‘narcotics farms’ (later named
U.S. Public Health Narcotics Hospitals)
• to relieve the overcrowding of federal prisons
• for the housing and rehabilitation of addicts/offenders who
had been convicted of federal narcotics laws.
The Lexington, KY facility was opened in 1935 for addicts east
of the Mississippi and the Ft. Worth, TX facility was opened
in 1938 for addicts west of the Mississippi. These were early
abstinence-based treatment facilities.
Both facilities eventually stopped treatment of addiction.
‘Narcotics Farm’
Later Named U.S. Public Health Narcotics Hospital
Lexington, KY
U.S. Narcotics Farm Entrance
Treatment at Lexington and Ft.Worth
Two populations were treated at Lexington and Ft. Worth –
 mandated federal prisoners and voluntary admissions. The
mandated people stayed anywhere from one to several years
and the voluntary people could sign out at any time.
Treatment included
 detox, farming or manufacturing work (payment was in
cigarettes), group and individual therapy, experimental
treatment methods, 12 Step meetings, school, church, and
vocational training.
There was four times more work than therapy.
Treatment Outcome Studies at
Lexington and Ft. Worth
90% to 96% of treated addicts returned to active opiate addiction
within 6 months of release from the federal narcotics
hospitals. A more positive way of saying it is that 4% to
10% of these addicts did not return to active opiate
addiction within 6 months following treatment.
Some saw this as treatment failure and some saw it as comparable
to outcome studies of other chronic diseases of the day such
as TB, arthritis, hypertension and diabetes.
Many saw this as fuel for the fire of prevailing public opinion that
relapse was a conscious choice of moral weaklings.
Relapse Rates are Similar for Addiction and Other Chronic
Illnesses (JAMA 2000)
90
80
70
60
50
10
0
McLellan et al., JAMA, 2000.
Drug
Addiction
Type I
Diabetes
Hypertension
50 to 70%
20
50 to 70%
30
30 to 50%
40
40 to 60%
Percent of Patients Who Relapse
100
Asthma
Minnesota Model
The 1940’s and 1950’s brought the ‘Minnesota Model’ of
treatment for alcohol and other drug dependence. This model
of treatment blended

abstinence-based treatment

professional, multidisciplinary treatment team

12 Step Program philosophy

education about addiction as a primary, chronic, treatable
bio-psycho-social disease

therapy/counseling for alcoholics and other addicts

therapy/counseling for families

aftercare planning involving ongoing AA/NA involvement
AA Comes To Be in the 1930’s
Bill W., a stockbroker, and Dr. Bob S., a physician meet on
Mothers’ Day, 1935 in Akron, OH and AA begins.
One by one, through carrying the message that recovery is
possible, the fellowship begins with a handful of members.
The Basic Text of AA, ‘The Big Book’, is published in 1939.
Dr. Bob and Bill W.
Co-founders of Alcoholics Anonymous
NA Comes to Be in the 1950’s
1953
Narcotics Anonymous as it exists today began in
Southern California. NA uses AA’s 12 Steps and 12
Traditions (with permission of AA) with minor wording
changes:
Step 1 ...powerless over alcohol (AA) ... over our addiction (NA).
Tradition 12 ... carry the message to alcoholics (AA) ... to
addicts (NA).
NA has grown from a fledgling membership in the 1950’s and
‘60’s to a continuously growing membership that today has
over 58, 000 groups spanning the globe.
Jimmy K
Co-founder of Narcotics Anonymous
AA/NA Membership History
1939 – AA begins with 100 members - after the Big Book (AA’s
basic text) is published the year ends with 2000 members due
to publicity re: book
1941 – Saturday Evening Post article about AA helps to increase
membership to 6000
1947 – Star-Telegram of Ft. Worth Texas reports that AA has
reduced war industries worker absenteeism due to alcoholism
and has helped 5000 workers return to their jobs
1953 – AA’s Twelve Steps and Twelve Traditions is published,
membership is approximately 100,000
AA/NA Membership History
1953 – Narcotics Anonymous as it exists today begins in
southern California with a handful of members
1970 – NA groups worldwide number 70
1970’s and 1980s - Minnesota Model treatment produced a
significant increase in AA and NA membership.
1976 – AA increases to 28,000 groups in 92 countries, with
membership totaling more than one million (1,000,000).
AA/NA Membership History
2000 – AA Membership tops two million (2,160,013) - number of
groups for the first time surpasses the 100,000 mark
2005 – AA’s Twenty-Five Millionth copy of the Big Book,
Alcoholics Anonymous, presented to warden of San Quentin
Prison. The first A.A. meeting in San Quentin was held in
1941.
2009 – NA Membership Survey notes over 58,000 groups –
roughly half as many groups as AA, in 131 countries - based
on AA group/member ratio, NA membership is estimated at
greater than one million
Narcotics Anonymous Evidence That
Abstinence/12 Step Recovery Is Effective
2009 Narcotics Anonymous Membership Survey
of 11,723 members years drug-free were:
<1 year - 12%
1-5 years - 33%
6-10 years-18%
11-15 yrs.-13%
16-20 yrs.-12%
>20 years-12%
Project MATCH and VA Study Show
Evidence That Abstinence/12 Step
Recovery - with Assistance - is Effective
Project MATCH, a large (1,726 participants) study of abstinencebased approaches to treat alcoholism compared three approaches:
Motivational Interviewing, Cognitive Behavioral Therapy, and
Twelve Step Facilitation.
All three were found to be effective
At one year follow-up, all three had similar outcomes
At three year follow-up, Twelve Step Facilitation had more
favorable results for sustained abstinence
VA Study of 2,045 substance abuse patients showed that
increased involvement in AA/NA meetings, reading NA/AA
literature, working the 12 steps, and having a sponsor improved
outcomes and that treatment providers encouraging these
activities significantly improved their likelihood of occurring
Minnesota Model Treatment
Challenges
Minnesota Model treatment is
 expensive
 time consuming
 and often takes more than one course of
treatment to help addicts get to the point of
having sustainable recovery
These are some of the same challenges facing
treatment of any chronic illness.
Most Believe Recovery Includes
Abstinence and More
The vast majority (84.9%) of recovering addicts studied and cited
in a 2007 Journal of Substance Abuse Treatment article
indicated that total abstinence is necessary for recovery.
Study participants also included recovery to include a new
life (22%); well-being (13%); a process of working on
yourself (11.2%); living life on life’s terms (9.6%); selfimprovement (9%); learning to live drug-free (8.3%);
recognition of the problem (5.4%); and getting help (5.1%).
A recurrent theme was that recovery is going back, regaining an
identity (a self) lost to addiction.
Terrence Gorski
Gorski’s CENAPS Model of treatment is an
abstinence-based treatment model that
incorporates relapse prevention, recovery as a
developmental process, and utilizing 12 Step
involvement.
This model helps patients and providers have a
clearer understanding of what is to be
accomplished with abstinence-based treatment
and recovery.
Beliefs Upon Which Gorski’s Developmental
Model of Recovery (DMR) are Based
1.
2.
3.
4.
Recovery is a long-term process that is not easy.
Recovery requires total abstinence from alcohol and other
drugs, plus active efforts towards personal growth.
There are underlying principles that govern the recovery
process.
The better we understand these principles, the easier it will
be for us to recover.
Beliefs Upon Which Gorski’s DMR are
Based ( Continued)
5.
6.
7.
Understanding alone will not promote recovery; the
understanding must be put into action.
The actions that are necessary to produce full recovery can
be clearly and accurately described as recovery tasks.
It is normal and natural to periodically get stuck on the road
to recovery. It is not whether you get stuck that determines
success or failure, but it is how you cope with the stuck point
that counts.
First Stage of Recovery: Transition
Transition stage: Theme: Giving up the need to control drug use.
Starts while the addicted person is still using. The tasks that
need to be accomplished in order to consider the transition
stage complete are:
1. Development of motivating problems
2. Failure of normal problem solving
3. Failure of controlled use strategies
4. Acceptance of the need for abstinence and the need for help
Transition Stage - NA Step One, Tradition
Three
An addict must see a need to stop using before they have a desire to stop using.
Tradition Three: The only requirement for membership is a desire to stop
using. NA Basic Text:
“An addict who does not want to stop using will not stop using. They can be
analyzed, counseled, reasoned with, prayed over, threatened, beaten, or
locked up, but they will not stop until they want to stop. The only thing
we ask of our members is that they have this desire. Without they are
doomed, but with it miracles will happen.” (p. 63)
NA: First Step: We admitted we were powerless over our addiction, that our
lives had become unmanageable.
Second Stage of Recovery: Stabilization
Stabilization Stage: theme: recuperating from damage caused by
addictive use. This stage IS the stage in which opioid addicts
present some special challenges and opportunities for
providers to give much-needed help. The tasks to accomplish
in the stabilization stage are:
 physically recover from acute withdrawal and learn to
manage post acute withdrawal.
 learn to manage addictive preoccupation.
 learn to manage stress, emotions, and problems.
 resolve any crises well enough to focus on recovery
 develop hope and motivation.
The stabilization stage of recovery can be particularly challenging
due to the severity of stress caused by Post Acute Withdrawal
and Addictive Preoccupation.
Special Considerations in Treating
Opiate Addicts
After stopping using, opiate addicts commonly experience…
 Discomfort of body, mind and spirit
 Vivid using dreams, drug cravings
 Depression (esp. depressed mood, anhedonia) and anxiety
 Strong urge to abort treatment due to discomfort of early
abstinence
Address Patients’ Discomfort and Any
Co-Occurring Disorders
Treatment outcomes improve if the patient’s general
discomfort associated with early abstinence and any
co-occurring mental health problems that may be
present are addressed early during treatment.
Abstinence-based treatment of opioid addiction can be
just as successful as abstinence-based treatment for
any other substance.
Post Acute Withdrawal and Addictive
Preoccupation
Post Acute Withdrawal Syndrome
starts after acute withdrawal
ends. This syndrome often lasts
for several months.
Symptoms include difficulty with…

Thinking clearly

Remembering

Stress management

Emotion management

Sleeping restfully

Physical coordination
Addictive Preoccupation is a type of
delusional thinking associated
with being a sober
addict/alcoholic and includes…

Euphoric recall (recalling only the
positives about using)

“Awfulizing” sobriety (focusing
on only the negatives about
sobriety)

Magical thinking about future use
(thinking using will somehow
make things better)
Left unattended, this becomes
obsession, compulsion and
craving.
Management of Post Acute Withdrawal and
Addictive Preoccupation
Some things that are helpful for
management of Post Acute
Withdrawal include, but are not
limited to, …

Having a structured lifestyle

Getting enough rest

Healthy diet and eating habits

Regular exercise

Social support, esp. AA/NA

Deep-breathing relaxation skills

Emotion management skills

Conflict management skills

H.A.L.T. – Don’t get too
Hungry, Angry, Lonely or Tired.
In addition to 12 step program coping
skills, such as calling on others
and a Higher Power, some things
that are helpful for managing
Addictive Preoccupation include,
but are not limited to, …

Euphoric recall – Force yourself
to remember specific negative
experiences involving using.

“Awfulizing” sobriety – Force
yourself to consider positive
things about recovery.

Magical thinking about future use
– Force yourself to consider what
would actually happen if you
used.
Teach Craving Management
Teaching opiate addicts to manage cravings is essential in the
early days of recovery (during the stabilization stage).
Early introduction to NA/AA meetings/members is crucial. The
NA Basic Text states: “We feel that our approach to the
disease of addiction is completely realistic for the therapeutic
value of one addict helping another is without parallel.”
How to Manage Cravings
Accept that you are having a craving, and tell yourself that
although it is uncomfortable, it is normal and will pass
Let another recovering addict know that you have an urge to use
– call your sponsor or someone else in NA/AA whom you
know and trust – and talk about it
Just sit with it, pray for your H.P. to remove your urge to use, and
no matter what, don’t use; it will pass. Tell yourself
something like: “Just because I want to use doesn’t mean I
have to act on it.”
Utilize Addictive Preoccupation Identification and Management
along with 12 Step practices noted here.
NA/AA is Especially Important During the
Stabilization Stage
Direct newly recovering people to NA meetings and members or ‘addictfriendly’ AA meetings.
Minnesota Model, CENAPS, Matrix, Twelve Step Facilitation - either state
or imply that the 12 Step Program is the primary agent of change in
recovery.
Doctors, nurses, therapists, counselors, others involved, can be remarkably
helpful in facilitating a person finding a new way of life through this
approach.
Stabilization Stage and Steps
“Regardless of who we are, where we came from, or what we have done, we
are accepted in NA. Our addiction gives us a common ground for accepting
one another.” - NA Basic Text
NA Step Two: We came to believe that a power greater than ourselves could
restore us to sanity.
NA Step Three: We made a decision to turn our will and our lives over to the
care of God, as we understood him.
In the atmosphere of recovery found at meetings, addicts find a way to
incorporate the first three Steps well enough into their lives and are then ready
to move on to the later stages of recovery and more in-depth Step work.
Third Stage of Recovery: Early
Early Stage: theme: Internalization of addiction, what that
means, and how to develop a recovery program that will be
sustainable. This and all the remaining stages are the same for
opioid addicts as they are for people addicted to alcohol,
stimulants, or any other drugs. The tasks that need to be
accomplished in early recovery are…
 Full conscious recognition of addictive disease
 Full acceptance and integration of the addiction
 Learning non-chemical coping skills
 Short-term social stabilization
 Developing a sobriety-based value system
Fourth Stage of Recovery: Middle
Middle Recovery: Dealing with life as it occurs, sticking with
the Program no matter what, and finding balance.
 Resolving the demoralization crisis (Continuing to work the
program even when it’s very difficult)
 Repairing addiction-caused social damage
 Establishing a self-regulated recovery program
 Establishing lifestyle balance – including establishing and
maintaining relationships in and out of 12 Step program
 Management of change
Fifth Stage of Recovery: Late
Late Recovery: growing beyond childhood limitations. The tasks
that need to be accomplish in late recovery are…
 Recognizing the effects of childhood problems on sobriety
 Learning about family-of-origin issues
 Conscious examination of childhood
 Application to adult living
 Change in lifestyle
The Relapse-Prone Style
of Coping with Stuck Points
Denial and Evasion
(The relapse-prone style)
Evade/deny the stuck point
Stress
Compulsive behavior
Avoid others
Problems escalate
Evade/deny new problems
The Recovery-Prone Style
of Coping with Stuck Points
Recognition and Problem Solving
(The recovery-prone style)
Recognize a problem exists
Accept that it is OK to have problems
Detach to gain perspective
Ask for help
Respond with action when prepared
Sixth and Final Stage of Recovery: Maintenance
Maintenance Stage: Balanced living and continued growth and
development. The tasks that need to be accomplished in the
maintenance stage are…
 Maintain a recovery program
 Effective day-to-day coping
 Continued growth and development
 Effective coping with life transitions
Coping with Stuck Points
in Recovery - Gorski
All recovery people will get stuck in recovery from time to
time. Getting stuck in recovery is neither good nor bad; it
simply is.
Those who are successful in recovery
 cope with stuck points through a process of recognition
and problem solving
 learn how to recognize they are having a problem and are
stuck in their recovery
 accept that this is OK, knowing that as fallible human
beings, everyone reserves the right to not have all the
answers.
 detach from the problem and seek help from others
Finally, when they are prepared, they take responsible action.
Has the Definition of Recovery
Changed?
Before Suboxone and its widespread support from entities such as
NIDA, SAMHSA and ASAM, most treatment providers
agreed that abstinence from addictive drugs was necessary
for recovery.
Most addiction treatment providers understood that abstinence
alone did not constitute recovery, but have believed for a
long time that a prerequisite for recovery was that
addicts/alcoholics had to stop using alcohol and other drugs,
and do the other things necessary to consider themselves as
being ‘in recovery’.
Drug Substitution Treatment vs. Abstinence-Based
Treatment
With the substantial increase in the use of Suboxone in
the past few years there has been and continues to be
considerable debate in the treatment community
about what constitutes being in recovery from opioid
addiction.
Is a person ‘in recovery’ from opioid addiction while
using an opioid drug - methadone, buprenorphine
(U.S), and also including heroin (Europe)?
Attempt to Define Recovery: Drug
Substitution Treatment
Drug Substitution Treatment advocates would likely
define recovery as
 reduced usage
 improved functioning
 retention in treatment
 reduced cravings
 stopping illicit use
Attempt to Define Recovery: AbstinenceBased Treatment
Abstinence-Based Treatment advocates would likely
define recovery as
• sustained total abstinence from alcohol and other
drugs
• improved functioning
• demonstrated commitment to lifestyle changes
necessary to maintain abstinence and restore health
physically, mentally and spiritually.
Ready, Willing and Able
When making a decision about whether an abstinence-based
treatment program is the right approach for an opiate addict,
the those involved need to help the opioid addict decide…Am
I
 ready
 willing
 able
enough, to be uncomfortable during the early days of stopping
opioid use in order to have a drug-free life? A person’s
motivation will quite often be related to their perception of
alternatives.
What Does Recovery Mean To You?
The idea of ‘recovery’ has become popular in our culture but it is
ill-defined and poorly understood.
There is no real consensus among government agencies such as
NIDA, SAMHSA and others that deal with substance use
disorders about what constitutes recovery. That fact hinders
clinical practice, research effectiveness, and research outcome
interpretation.
As a treatment provider, it is important to answer the question:
‘What does recovery mean to me?’
Principles of the 12 Steps
The primary spiritual principles often associated with each
corresponding step of the 12 Steps …
1.
2.
3.
4.
5.
6.
Honesty
Hope
Faith
Courage
Integrity
Willingness
7. Humility
8. Love
9. Discipline
10. Perseverance
11. Awareness
12. Service
References
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