The First Step to Overcoming Opiate Dependence and Addiction

Brought to you by Russ Ferstandig, MD.

Without a doubt the first step to overcoming any type of opiate problem is developing a correct understanding of why one cannot stop their opiate dependence and/or addiction, and what is necessary for them to correct and permanently remove their opiate problem.  While this recommendation sounds so obvious, with opiates there is so much myth, misinformation surrounding basic opiate use, addiction, what is necessary for successful treatment and the treatment options, that it is close to impossible separate fact from fiction.

The net result is that many people engage in incomplete and/or improperly designed treatment programs that essentially guarantee relapse sooner or later.  This occurs because the physiologic and anatomic changes in their brain caused by their opiate use that are causing their acute and chronic withdrawal symptoms have not totally healed, which allows withdrawal to continue on a low grade level indefinitely.  Unfortunately, this repeated relapse leads many to falsely conclude that they cannot overcome their opiate problem, which typically produces a return to regular heavy opiate use unless they remain on Suboxone or buprenorphine for years to block the withdrawal symptoms.

Unless the brain has totally healed to its pre-opiate state from the damage caused by any opiate use, of more than 30-45 days, regardless of reason for use including medically prescribed the former opiate user’s chance of relapse on opiates approaches 100% with the passage of time.  This mild withdrawal triggered relapse process is so subtle that many people state do not realize that it is the prime cause of their relapses after a period of sobriety, “I have no idea why I tried using some opiates after such a long period of being clean because I absolutely knew what would happen (relapse), but I convinced myself it would be okay.”   Sadly, many people have uttered these words repeatedly because they are prone to repeat their errors unless their withdrawal is truly 100% over.

It is critical to remember that lasting success is essentially guaranteed if one does engage in the proper opiate treatment for their needs and works sufficiently hard in the therapeutic portion to be realistic about opiate use will do, guaranteed, to their happiness and the happiness of anyone connected to them. 

Unfortunately, the reverse is also true—half-hearted attempts and/or poorly designed treatment programs essentially guarantee repeated relapse.

Unless a program includes the following goals, it is highly unlikely an opiate user will be able to obtain lasting sobriety without relapses:

1. 100% cessation of ALL withdrawal symptoms until the brain has totally healed from the changes created by opiate use (up to 1 year with ongoing heavy opiate use (almost daily Roxy use of 500mg or more and almost daily heroin use of 10-15 bags or more) and possibly longer if IV)) and being treated properly with Suboxone.It is critical to use Suboxone or buprenorphine to stop ALL withdrawal symptoms both initially and throughout the entire Suboxone taper because craving is amongst the first symptoms to return.  The constant thinking about using and unavoidable serious distortions in judgment and thinking that make the idea of using seem okay combine to produce a deadly force that almost guarantees relapse, especially when one least expects it.Suboxone taken properly, in the proper doses and for the necessary time frame is the absolute best method to achieve 100% cessation of ALL withdrawal symptoms until the brain has totally healed.  Please note that improper use of Suboxone, whether by improper technique, dose or duration, achieves the same end result, likely relapse.  Statistically, rapid Suboxone detox programs are no better than going cold turkey and almost always lead to relapse.
2.  Insight therapy and habit modification are required for long term and permanent success

Even if Suboxone is used properly and until the brain is totally healed, it is essential to engage in insight-oriented therapy to understand the true unavoidable consequences of opiate use (addiction, withdrawal, tolerance, destruction of interpersonal relationships, etc.) and learn the necessary behaviors to cope with the unavoidable stresses of life.  Since all opiate users have customized needs, it is critical for the individual to insure they have truly gained the necessary understanding about the impact of opiate use on them and the ability to use the best coping skills.  Merely “going to therapy” does not produce this necessary end result.

  3. There needs to be some ongoing process to remind the individual that they are forever changed and can never use opiates safely again

For many regular 12 Step Programs are the best method to remember one’s vulnerabilities and “keep the grass green”.  Even occasional meetings are better than none.