Opioid Recovery Takes the Whole Village
By Kevin Coughlin, PhD
Transformed Lives MD
Addiction has been defined by the Surgeon General as the most severe form of substance use disorder, associated with the compulsive or uncontrolled use of one or more substances. The newer term in favor is Opioid use disorder – this is a chronic brain disease that has the potential for both recurrence (relapse) and long term recovery.
The latest research in neuroscience suggests that development of opioid use disorder is a multi-stage cycle starting with binge and intoxication, then withdrawal and negative effect, and preoccupation and anticipation. The cycle can become more severe over time with continued use and abuse of the substance. Continued misuse of substances causes progressive changes in the structure and function of the brain, these are called neuroadaptations. These changes in the brain remain even long after the individual stops using substances.
Scientific data shows that short-term treatment only for opioid use disorder is not effective. So short term treatment, or detox without potential for long term medication assisted treatment, will not work for the majority of patients. Data suggests that even with the best inpatient treatment, 80% of patients with opioid use disorder will relapse if they don’t have the potential to get medication assisted treatment.
There are many paths to recovery, and not one way to get there. Some patients do well with an abstinency-only model of recovery, but this is not the majority. There is a saying in the rooms of twelve-step recovery programs, “The definition of insanity is doing the same thing over and over and expecting different results!”
Today’s science supports medication assisted treatment for opioid use disorder, which could include treatment with buprenorphine (suboxone or other formulations), extended release naltrexone, or methadone. We incorporate these science-based treatments into our approach for patients with opioid use disorder.
Above and beyond that, we pull in other resources and try to coordinate care. I heard someone say the other day, “It takes a village” to help the addicted to recover. That village may include the patient’s family, local community, and healthcare team including primary care, psychiatry, and counselors.