Treating Opioid Use Disorder

Opioid use disorder is not 100% preventable, but it is treatable. 

With various treatment options available, it can be hard to know which option is best. Every person has a different set of circumstances and needs, so it is critical to find an individualized path to treatment and through recovery. 

 

The most effective type of treatment for Opioid Use Disorder is Medication-Assisted Treatment (MAT), now known as Medications for Opioid Use Disorder (MOUD)These medications are supported by medical research and have been shown to decrease the chances of dying from an overdose by at least 50%

 

“Medications don’t fix everything, but they’re a big start.” –Dr. Caleb Banta-Green. Along with MOUD, treatment might include brief outpatient, inpatient, and/or residential services. Peer support groups can also be helpful in building relapse prevention skills and developing a support network. 

 

Some people with opioid use disorders can abstain from opioid use without MOUD. However, the scientific data overwhelmingly supports medications as a primary way of avoiding relapse and supporting long-term recovery. Regardless, being supportive of the person’s treatment needs and choice is important and can improve their chance of success. 

Treatment Terms and Types

Treatment Professionals

Many kinds of professionals provide treatment for substance use disorders. In most treatment programs, staff are certified and/or licensed Substance Use Disorder Professionals (SUDPs). Treatment programs are often made up of a team including social workers, counselors, doctors, nurses, psychologists, psychiatrists and/or other support professionals.

Clinical Assessment

If you are an individual interested in pursuing treatment, a clinical assessment will be performed. Clinical assessments help treatment providers determine if you have a substance use disorder, the severity of the disorder, and the best course of action. Treatment providers are trained to work with individuals and design effective treatment plans that accommodate unique lifestyles and needs. It is likely that clinical assessments will continue throughout a person’s treatment to ensure that the best course of action is being taken.

Withdrawal Management or “Detox”

Withdrawal management or “detox” is an important step in transitioning to treatment. Withdrawal management and detox facilities provide services for those suffering from the physical and psychological effects of not using the substance a person is dependent upon. Withdrawing from opioids, benzodiazepines and alcohol without medical assistance is not only uncomfortable, but dangerous. There are different levels of withdrawal management depending on medical needs. Most detox programs provide 24-hour monitoring by professionals who are trained to identify and treat the signs and symptoms of drug or alcohol withdrawal. Successful withdrawal management is not the end goal, but rather the start of successful long-term treatment. In Skagit County, Skagit Community Detox in Burlington provides sub-acute medically monitored care. There are also options in neighboring Whatcom County (Whatcom Community Detox in Bellingham) and Snohomish County (Evergreen Recovery in Everett).

Outpatient Treatment

Outpatient treatment allows individuals to receive treatment during the day without requiring that they remain in the facility overnight. Outpatient treatment is often more affordable and enables a more normal daily routine. Programs can range from several months to one year, depending on the individual’s treatment plan. 

 

Outpatient treatment is offered by a variety of providers throughout Skagit County. *Some programs offer services in the evenings and on the weekends to accommodate work and school schedules. Contact each provider directly to learn more about their programs and services.

Inpatient Treatment (Including Residential)

There are several levels of inpatient treatment. The ASAM Criteria describes inpatient treatment as a continuum marked by five levels of service. The following ASAM levels all fall under the category of inpatient treatment:

  • ASAM Level 3.1 – Clinically Managed Low-Intensity Residential Services
  • ASAM Level 3.3 – Clinically Managed Population-Specific High-Intensity Residential Services
  • ASAM Level 3.5 – Clinically Managed Medium-Intensity Residential Services
  • ASAM Level 3.7 – Medically Monitored High Intensity Inpatient Services for adolescents and Medically Monitored Intensive Inpatient Services Withdrawal Management for adults
  • ASAM Level 4 – Medically Managed Intensive Inpatient Services 

About Residential Programs: 

Residential programs provide a sober living environment while incorporating treatment services. Several models of residential treatment— such as therapeutic communities exist. Residential treatment programs last from several weeks to months, with few lasting six months or more. Residential programs can be helpful in allowing individuals to step away from familiar settings and gain fresh perspectives. Families are often encouraged to participate as much as able. There are two residential treatment programs in Skagit County: Pioneer Center North in Sedro-Woolley and Evergreen Treatment Services Legacy Lodge in Mount Vernon. Female youth ages 13-17 can receive residential treatment services at the Sea Mar Visions program in Bellingham. There are other residential programs throughout the state, and it is not unusual to travel outside of one’s community to attend a residential program.

 

About Intensive Inpatient Treatment: 

Inpatient treatment requires individuals to stay in a facility for a designated set of time. While inpatient treatment can be more expensive and time intensive, higher rates of success are observed. Inpatient treatment often offers 24-hour medical and emotional support and is designed to treat serious addictions. 

 

Patients utilizing Medication-Assisted Treatment can be successful starting outpatient treatment. However, inpatient treatment is provided in special units of hospitals or medical clinics and may be recommended since it offers both detoxification and treatment services for those who need the stabilization and higher levels of support. Because of changes in insurance coverage, inpatient treatment is no longer as common as it used to be.

Medications for Opioid Use Disorder

Medications for Opioid Use Disorder (MOUD), formerly known as Medication-Assisted Treatment (MAT), is the standard of care for individuals with an opioid use disorder. Providers and Opioid Treatment Programs (OTPs) follow federal regulations, which often includes additional certifications and accreditations, to ensure the safety and efficacy of treatment. MOUD programs are clinically driven and tailored to meet each patient’s unique needs. 

 

There are currently three types of medications that have been approved by the Food and Drug Administration (FDA) to treat opioid use disorder:

TREATMENT MEDICATIONS
MethadoneBuprenorphine
(Suboxone™ and others)
Naltrexone
(Vivitrol™)
Opioid EffectA full opioid MedicationA partial opioid medicationNone. An opioid blocker
Typical FormDaily oral medicationDaily oral medication (implant or injection possible)Monthly injection
Visit Frequency6 days a week to start; can decrease over timeVaries from daily to monthlyVaries from weekly to monthly
Cravings and WithdrawalManages cravings and withdrawal by binding to opioid receptorsManages cravings and withdrawal by binding to opioid receptorsCan manage cravings for some people
CounselingCounseling and regular urine drug tests are requiredRequirements varyRequirements vary

The Substance Abuse and Mental Health Services Association (SAMHSA) states that all prescribed medications used for treatment of opioid use disorder work to normalize brain chemistry, block the euphoric effects of alcohol and opioids, relieve physiological cravings, and normalize body functions without the negative effects of the abused drug. It is important to note that MOUD is most successful when used in combination with counseling and behavioral therapies. 

 

The goal of MOUD is recovery, including the ability to live a self-directed life. This treatment approach has been shown to:

  • Improve patient survival
  • Increase retention in treatment
  • Improve social, emotional, and behavioral functioning (decrease illicit opiate use and other criminal activity)
  • Increase patients’ ability to gain and maintain employment
  • Improve birth outcomes among women who have substance use disorders and are pregnant
  • Lower the risk of contracting HIV and Hepatitis C
  • Reduce risk of potential relapse

 

Find a MOUD program by visiting the Resources tab or using the Washington Recovery Help Line’s MOUD Locator. Some programs may refer to themselves as offering MAT. MOUD and MAT are the same. 

 

If opioids are not the primary substance(s) used, check out “What is Substance Abuse Treatment? A Booklet for Families” by the Substance Abuse and Mental Health Services Association (SAMHSA)

 

What is Substance Abuse Treatment? A Booklet for Families

If you need help navigating treatment and recovery services or don’t know where to start, call the 24 hour, Washington Recovery Help Line at 1-866-789-1511. The Washington Recovery Help Line provides emotional support and connects callers with local treatment resources and community services.

Treating Stimulant Use Disorder

There are several treatment approaches that can help people quit or cut back on their stimulant use. Treatment happens in many places, such as: a medical clinic, a mental health program, or inpatient and outpatient addiction treatment programs.

Counseling and Behavior Change Treatments

Counseling and other treatments that focus on behavior change are currently the most effective treatments for stimulant use disorder. One such method, contingency management, gives patients tangible rewards for positive behaviors, aiding their efforts to stop using stimulants. Cognitive behavioral therapy, which helps to identify and modify damaging thinking and behavior, can also help people overcome their addition. For individuals with early or less severe disorders, motivational interviewing can be effective. More information – from Learn About Treatment – is listed below!

 

In Contingency Management a person gets small rewards for reaching goals. For example, a person might receive a gift card for attending a clinic visit or get a chance to win a bigger prize for a negative urine drug test result. Research shows that contingency management is one of the most effective treatments for stimulant use disorder (Ronsley et al., 2020).

 

In Motivational Interviewing, a counselor works with individuals to explore why a person uses stimulants, why they are ambivalent or motivated to change behaviors around stimulant use, and how  the individual might make behavior changes successfully.

 

Cognitive Behavioral Therapy (CBT) helps identify patterns of thoughts, behaviors, and emotions. People learn skills to change unhelpful patterns, cope with cravings, or problem solve “high risk” situations to use.

 

Community Reinforcement Approach helps increase positive activities that compete with drug use. Similar to CBT, it helps a person build skills to cope, problem solve, and improve relationships.

 

Mental health counseling can help with issues such as depression, anxiety, trauma, and other issues that are often seen with stimulant use. Learn more about different types of counseling here.

Medications for Stimulant Use Disorder 

There are still no FDA-approved medications to treat stimulant use disorder. There is some evidence, however, that some mental health medications can be helpful for some people. These medications may not be right or helpful for everyone, so talk to your health care provider.

Withdrawal Management (“Detox”) 

Some people need a structured break from stimulants for a few days to get through early withdrawal.  While this can help the brain and body start to work better, detox is not considered “treatment.” Most people will need ongoing help to cope with cravings and learn new behaviors.

Other Approaches to Help People 

Some people use stimulants to help them manage other areas of their life. Addressing those challenges or needs could help reduce stimulant use. For example, someone may want help with:

  • Housing
  • Employment
  • Connecting with others/finding community
  • 12-step support (e.g., Crystal Meth Anonymous)
  • Health issues

There is also some evidence that exercise can help reduce stimulant use and improve health.

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