Opioid use disorder (OUD) – sometimes called opioid addiction – is a disease of the brain. If you have OUD, you’ll keep using opioids even if they are causing you harm and you want to stop. The misuse and dependence on opioids leads to serious health problems. It also tends to come with trouble in relationships, work, school, and other aspects of your life.
OUD is a chronic disease, but there are proven and effective treatments. As with treatments for other chronic conditions, the goal of treatment is to help with your symptoms and improve your overall health. Treatment also will help you participate in normal activities. You’ll learn how to manage your health into the future to stay healthy and avoid relapses.
You can get OUD treatment in different settings, depending in part on how severe your OUD is. You’ll usually get it through inpatient or outpatient programs that are dedicated to treating substance use disorders. Your treatment for opioid addiction will likely include both counseling and medicines. Social support, such as recovery groups, will help too, both during and after treatment.
What Kind of Treatment Will I Need?
This depends. Your doctor or other trained provider will first talk to you to find out how severe your OUD is. The severity of any substance use disorder is based on various symptoms related to your loss of control over your opioid use.
Symptoms of OUD include signs that you are physically dependent on opioids and have lost control of your use of them. They also include the consequences of your OUD and its symptoms on home life, work, and school. If you have two to three symptoms, that’s considered mild. Six or more symptoms means that your OUD is severe.
This assessment may look at various areas where you may be having trouble due to OUD including:
- Your health
- Your use of opioids and other substances
- Your mental health
- Your job
- Your legal status
- Your family and other social support
Once your provider has a full picture of your OUD and related problem areas, they can work with you to come up with a treatment plan that will suit your wishes and needs. When treatment takes all these factors into account, it’s more likely to work.
Counseling and Behavioral Therapies for Opioid Addiction
Behavioral therapy and counseling is important for you to understand how your opioid use has affected you and other people in your life. It can help you stay motivated to control your use of opioids and find the support you need.
You should get therapy with a counselor or therapist who is trained and experienced in treating substance use disorders. You may get therapy one on one, in group or family sessions, or in various combinations. Behavioral therapy can help you learn coping strategies and life skills.
Your counselor or therapist may use different approaches including:
- Cognitive behavioral therapy (CBT). This approach to talk therapy will help you learn to cope by challenging unhelpful patterns of behavior and thought. You’ll explore the consequences of your substance use and learn to monitor yourself for cravings or other situations that may lead you to use opioids again. CBT is well studied and shown to work well, especially when it’s combined with other kinds of therapy and medicine.
- Contingency management (CM). In CM, you’ll get vouchers or other rewards to help you change your behavior. Clinical studies show that it can keep people in treatment longer and lead to longer periods of success in recovery.
- Motivational enhancement therapy (MET). This approach to counseling will help you get over any uncertainty you may have about whether you want to stop using opioids. It will help you become more aware of the differences between your goals and your behavior and encourage your own desire to change. MET is shown to work, but the results are more mixed.
- Dialectical behavior therapy (DBT). This approach to therapy teaches mindfulness as a means to get control over cravings. You’ll learn to become more aware of the present moment and your own emotions. DBT can help you learn to control emotions and avoid any urges you have that are self-destructive.
Many of these approaches may be used and work best in various combinations along with medicines.
What About Medicines?
Your behavioral therapy often will go along with medicine that’s approved to treat your OUD. There are three approved medicines for OUD. They include:
- Methadone. This medicine blocks the effects of other opioids. It also helps with withdrawal symptoms and cravings. Methadone is a long-acting opioid and can be misused, too. You’ll get methadone on a regular schedule with close monitoring at a specially-licensed treatment facility.
- Buprenorphine. This medicine is also an opioid that’s used to block the effects of other opioids and control withdrawal symptoms and cravings. You can get this from a primary care or other doctor who has met certain requirements.
- Naltrexone. This medicine isn’t an opioid but it still blocks the effects of other opioids. When you take it, you won’t get the high from other opioids, which makes it easier not to take them. It’s often given as an injection that lasts for 4 weeks. Any doctor can give you naltrexone.
Your doctor can help you understand your options. You might take medicine for many years. Together with counseling and social support, these medicines can help you in your recovery from OUD. They also make it less likely that you’ll relapse.
Where Will I Get Treatment?
Where you will get treatment depends on many factors, including how severe your OUD is and what’s available where you live. Most treatment for substance use disorders happens in specialty treatment programs. They may be in a hospital or in a residential or outpatient setting. You may start in a more clinically intensive program and then progress to one that allows you to manage your treatment yourself to a greater extent.
For example, you might start with up to a week in a medically managed withdrawal program. After that, you might go to a residential treatment program for a month or more followed by outpatient care multiple times a week. You’ll likely stay in treatment for at least a year. Your specific treatment plan will depend on the severity of your OUD, your wishes, and many other factors.
How Long Will I Need Therapy?
You will need to stick to your treatment plan – including behavioral therapy and medicines – long-term for it to work. If you’re in treatment for 90 days or less, you’re not likely to get better. Treatment for at least 3 years is best to make a relapse less likely.
Is Treatment Covered by Health Insurance?
The short answer is yes. The Mental Health Parity and Addiction Equity Act of 2008 says that health insurers and group health plans have to cover treatment for substance use disorders in the same way they cover other types of medical care.
It’s still true that concerns about cost or lack of health insurance is a big reason why people don’t get the treatment that they need. Even if you have insurance, your treatment might not be covered in full. Check with your providers so you know what to expect. If your insurance carrier wrongly denies you coverage, you can find help.
Where to Find Care
It’s best to find a treatment facility or provider through your doctor or another trusted source. The Substance Abuse and Mental Health Services Administration (SAMHSA) has an online tool to help you find behavioral health services in substance use and mental health treatment facilities in your area. Many people with OUD have other mental health conditions also and it will help to address them both. You can also go to findtreatment.gov or call 800-662-HELP (4357).