Like other addiction treatments, the treatment of hydrocodone dependence requires several steps. First, the substance is cleared from the patient’s system. Second, patients are taught skills to maintain abstinence. Finally, long-term treatment attempts to keep patients from returning to active addiction.
Detoxification can be either inpatient or outpatient but both require medical supervision. Inpatient detox has the advantage of direct nursing contact to meet needs as they arise.
Detox can be as short at three days (and continued as an outpatient). Treatment at this stage is directed toward alleviating symptoms as they occur. Some clinics will taper patients off with gradually decreasing doses of opioids. Other medications (Catapres) can help with symptoms as well.
Home detoxification can be done with tapering or by substitution with a partial opioid agonist. This is a synthetic drug related to opioids with a better side-effect profile. Suboxone is one such drug. Contact with a physician is still mandated, both to evaluate the progress of the withdrawal and to advise the patient.
Initial abstinence period
While detox will remove the drug from a patient’s system, and the physical effects of withdrawal will disappear, the psychological addiction will remain. Cognitive behavioral therapy, either with or without group therapy, is the current standard of treatment.
At first, individual attention is important. Each addict comes with their own set of problems and concerns. Some of these are intimately linked to drug use.
Cognitive therapy is usually done under the direction of a psychiatrist or psychologist. Group therapy might include sessions with other addicts either formally or informally – Narcotics Anonymous (NA) is a popular choice.
The attempt is to get patients to recognize and avoid damaging behaviors and to address ways to handle cravings. At this stage, especially if treated as an outpatient, a narcotic antagonist may be prescribed as well as drugs meant to treat depression or anxiety. Narcotic antagonists (ie. naloxone) block the euphoria and addictive properties of opioids. The idea is to prevent re-use in patients who get no ‘high’ while on the antagonist.
The modern view of addiction is of a chronic disease. Much like high blood pressure or diabetes, it is considered treatable but not curable. This view mandates a program of long-term care to avoid a return to drug use.
Because hydrocodone is available by prescription, and many patients first get the drug because of a legitimate medical condition, addicts must make their regular caregiver aware of their addiction history. It is almost impossible to completely restrict access to hydrocodone containing medications. Temptations and opportunities will arise for any recovering addict. Because of this, abstinence becomes a choice that has to be made often and habitually.
The consequences of a ‘slip’ can quickly lead to a repetition of the cycle that led to addiction in the first place. Some form of long-term treatment is required to maintain recovery. This can be NA meetings or semi-regular therapy sessions.
Loved ones and friends are a first line defense and should be recruited to help monitor for a re-emergence of active addictive behaviors. Addicts are said to be ‘in recovery’ rather than ‘cured’ at this stage. Many years may have to pass before the craving to use dulled and some addicts relapse after a decade or more of being ‘clean’.
photo by Paul Bodea