April 2006 GCR Newsletter - Heroin Drug Treatment

Philosophical polar opposites, there are two general strategies for heroin drug treatment; methadone maintenance or detox and therapy.

Long running programs of methadone substitution therapy spare recovering addicts the pains of withdrawal, and allow for better participation in society without intoxication. Alternatively, heroin drug treatment may involve supervised detoxification, followed by psychosocial therapies for relapse avoidance and pharmacological interventions. Both philosophies have certain advantages, and addictions professionals remain divided over which therapy offers the greatest benefits.

The primary advantage of methadone (or buprenorphine) opiate substitution programs is that they transition addicts off of a harmful and dangerous abuse of heroin onto much less dangerous and non intoxicating opiates of substitution. Using opiate substitution for heroin drug treatment, recovering addicts are encouraged to gradually reduce the dosage of the substitute opiate until they can transition completely off of opiates...never having had to undergo the intensity of "cold turkey" heroin withdrawal. Heroin addicts may participate less reluctantly in heroin drug treatment that does not requires of them to painfully detox off of heroin.

Opiate substitution programs remain controversial, and some medical professionals argue that although methadone is not intoxicating, it creates an addiction even stronger than heroin and that ultimate cessation of opiates is made more difficult through participation in methadone maintenance therapy. Additionally, because recovering addicts undergoing heroin drug treatment using methadone remain opiate addicts, considerable effort and time remains focused on drug taking behaviors.

Advocates of abstinence based heroin drug treatments argue that recovery is far better achieved through a safe and medically supervised detoxification, followed by an intense participation in the therapies and counseling of a drug treatment rehab. Although detox is painful, once complete addicts are no longer physically dependent, and have an excellent opportunity to integrate the therapy and training of rehab to stay completely opiate free for life. Relapse prevention strategies generally include full participation in aftercare therapy, and make use of drugs such as naltrexone to reduce the likelihood of further abuse.

A philosophical divide between the long and (relatively) painless and the uncomfortable but quick for heroin drug treatment.