Traditional methods
The standard treatment consists of a period of detox, where the patient undergoes withdrawal and then receives counseling and therapy designed to keep them off the drug. However, the relapse rate with heroin is quite high and multiple cycles of rehab and relapse may be needed.
For this reason, heroin addiction treatment is best viewed as ongoing, rather than a one-time episode. Users will sometimes describe this as, "one step forward and two steps back." But ideally, each round of relapse and rehab will be less severe – eventually leading to recovery.
Another method mimics Alcoholics Anonymous and uses a 12-step program. There are various groups, with Narcotics Anonymous being one example.
Home brew
Heroin has a long history of abuse and there is also a history of home withdrawal that has emerged in the drug culture. The two methods are quitting cold turkey and weaning. Cold turkey means stopping the drug and suffering through withdrawal, usually with the aid of a friend or family member. In this situation, the other person provides support and monitors the addict.
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Weaning consists of drawing down the dose over an extended period to eventually get clean without suffering major withdrawal symptoms. This is very difficult, because withdrawal is extended over quite a long period as the dose is reduced. It is also prone to failure as the addict begins to feel that the process will never end and they should ease their suffering by taking more heroin.
In the homebrew methods, various vitamin preparations may be added along with other drugs, such as marijuana or Xanax (as a sleep aid).
Rapid Detox
This method consists of putting the addict under anesthesia and treating them with an opiate antagonist. The antagonist blocks any heroin from reaching its receptors in the body and withdrawal is sped up. The addict, however, is ‘out’ and sleeps through some of the major symptoms. Unfortunately, this has shown no better results in the long-term and carries added risks from the anesthesia. It also may require multiple cycles over time to get someone into recovery.
Maintenance
The damage heroin does is partly social. This comes in the form of not being able to hold a job and criminal behavior (and consequences) to meet financial needs. Maintenance programs try to replace an addiction to heroin with a less damaging addiction to methadone or another substance and then use that to help addicts manage their lives better. This has shown some success in Europe. Eventually, maintenance programs are meant to move addicts into recovery by way of lowered doses of the replacement drug.
Medications
Newer medications combine an opiate agonist and antagonist. One activates opioid receptors and one blocks them. But, because there are different types of receptors in the body, it is thought that activating those receptors that would otherwise cause cravings, while blocking those that provide the euphoria, addicts may be less likely to relapse. One such combination is buprenorphine and naloxone (Suboxone).
photo by Rodrigo Valladares
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