Rehabilitation of Opioid (opium) Dependency

The basic strategy of opium rehabilitation is detoxification and the establishment of realistic goals for abstinence and improvement of life functioning. A long term commitment by the patient to maintain a lifestyle without illicit substances is essential for preventing relapse. Patients are educated about their responsibility for improving their lives. Motivation for abstinence is increased by providing information about the medical and psychological problems that can be expected if dependence continues. The dependent person is also advised to establish a drug-free peer group and to participate in self-help groups such as Narcotics Anonymous or Alcoholics Anonymous. Patients and families are encouraged to establish an opioid-free lifestyle by learning to cope with chronic pain and develop realistic vocational planning. An important treatment component is relapse prevention aimed at identifying triggers for a return to drugs and developing appropriate coping strategies. Advice and counseling can be given by the doctor by referring patients to formal drug programs, including methadone maintenance clinics, programs using narcotic antagonists, and therapeutic communities. Long-term follow-up of treated patients indicates that approximately one-third becomes completely drug free, and 60% no longer use drugs.

Whether carried out in inpatient, residential, or outpatient settings, patients usually do not receive maintenance medications. Many opioid-dependent individuals enter treatment programs that are based on the cognitive behavioral approaches of enhancing commitment to abstinence. Main aim of treatment is helping individuals to rebuild their lives without substances, and preventing relapse. A variation of this approach can be used for these patients. The basic elements of treatment are incorporated into long-term (some times more than one year) residence in a therapeutic community. Other individuals at various stages of recovery become the primary support group. By observing and getting advice from the persons recovering from drug dependence themselves is the most motivating factor. Advice and a drug-free atmosphere, in which the opioid-dependent person progresses through ever-increasing levels of independence is provided. Assuming a job outside the therapeutic atmosphere is part of the rehabilitation. Treatment of all substance abuse disorders, it is likely that counseling, behavioral treatment, and relatively simple approaches to psychotherapy add significantly to a positive outcome. Teaching the drug abusers to cope with stress, enhancing their understanding of personality attributes, teaching better cognitive styles, and, through the process of relapse prevention, issues that might contribute to increased craving, easy access to drugs, or periods of decreased motivation. A combination of these therapies above appears to give the best results.

It is important to discuss prevention. Doctors should carefully monitor opioid drug use in their patients, keeping doses as low as is practical while still controlling pain, Doctors also must be vigilant regarding their own risk for opioid abuse and dependence, never prescribing these drugs for themselves. For intra venous drug–dependent person, all possible efforts must be made to prevent AIDS, hepatitis, bacterial endocarditis, and other consequences of contaminated needles both through methadone maintenance and by considering needle-exchange programs.

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