The Science Of Suboxone (Buprenorphine)

How does Suboxone treatment work, and what are its effects?

We’ve talked extensively about Suboxone, including its history and its role in medication assisted treatment for opioid addiction. If you’ve read some of these articles, you know that Suboxone is an opioid that eases withdrawal symptoms.

But what exactly is going on in your brain when you take Suboxone — is it different from what happens with other opioids? For those of you who want to delve a little more into the nitty gritty of why and how Suboxone works, here is some more information about its neurological effects.

First of all, what happens in your brain when you take opioids?

There are molecules in your brain called neurotransmitters that carry information between neurons (i.e. brain cells). Different types of neurotransmitters attach to different receptors on the neurons.

One type of receptors is called the opioid receptors. We have many of these opioid receptors in an area called the locus coeruleus in the brainstem. Whenever the right kind of molecules attach to the opioid receptors in this area and activate them, this prevents the release of noradrenaline – a neurotransmitter which stimulates alertness and blood pressure. Preventing noradrenaline from being released causes the opposite symptoms: drowsiness, slowed respiration (breathing), and analgesic (pain relieving) effects. Another effect of opioid receptor activation is the release of another neurotransmitter called dopamine into the nucleus accumbens, which is a brain region implicated in reward processes. This reaction causes feelings of pleasure.

The above process can occur with neurotransmitters that naturally exist in your body called endogenous opioids (like endorphins, which make you feel good when you exercise).

But chemicals that you ingest can also attach to the opioid receptors. When you take full agonist opioids like heroin and oxycodone, they copy the actions of endogenous opioids and attach to opioid receptors – causing even stronger pleasurable effects like euphoria.

“Although opioid use may be pleasurable at first, eventually these neurological changes induce physiological dependence – opioids become a necessity to function in daily life.”

However, if you take a lot of full agonist opioids for a long time, your brain notices the influx of opioids and “turns off” some receptors. This means that you eventually need more opioids to achieve the same effect (tolerance). In addition, when you stop taking opioids and there are not enough of them in the receptors, you release more noradrenaline than usual, causing highly unpleasant side effects like vomiting, anxiety, jitters, and pain (withdrawal). Although opioid use may be pleasurable at first, eventually these neurological changes induce physiological dependence – opioids become a necessity to function in daily life.

In the worst-case scenario, high levels of opioid use will slow down the respiratory system enough to dangerously lower the amount of oxygen reaching the brain, causing brain damage or even death (overdose).

What does Suboxone do to help?

Suboxone is the brand name for buprenorphine and naloxone.

Buprenorphine is also an opioid that attaches to opioid receptors. It has strong binding ability, replacing and blocking other opioids so that they become ineffective. It is a partial agonist instead of a full agonist, meaning that it causes limited pleasurable effects, just enough to stop withdrawal symptoms. People report feeling “normal” rather than high when on a regimen of buprenorphine. In addition, there is lower propensity for tolerance because buprenorphine takes longer to dissipate, creating a steadier effect on the receptors.

“People report feeling “normal” rather than high when on a regimen of buprenorphine.”

Essentially, taking buprenorphine substantially reduces one’s need to turn to other, more dangerous opioids in order to maintain the status quo of an opioid-dependent brain. It thus allows the individual to function on a day-to-day basis experiencing neither withdrawals nor highs. There is also the possibility of lowering dosage over time to return the brain to its pre-dependence state (tapering).

Suboxone has a few advantages over other medications used to treat opioid addiction, such as methadone. Buprenorphine is thought to have less respiratory effects (and even cause withdrawal symptoms) at high doses, reducing the risk of overdose. Like methadone, it can still be misused by being diverted (i.e. used to get high, although it is reportedly difficult), which is why naloxone is added. Naloxone, an antagonist, attaches extremely strongly to the receptors and completely blocks other opioids. However, it does not have any effects of its own, doing nothing to prevent withdrawal symptoms. If Suboxone is injected instead of taken orally, the naloxone kicks in, blocks the buprenorphine, and causes withdrawal. This combination helps ensure that people use Suboxone as directed.

Workit Health offers treatment for opioid use disorder using a novel combination of Suboxone and personalized online therapy. If you’re interested in Suboxone as a possible treatment option, why not check us out?


References

Buprenorphine Treatment. (2015). Retrieved from http://www.naabt.org/education/buprenorphine_treatment.cfm

Koob, G. F. (2011). Neurobiology of addiction. Focus, 9(1), 55-65.

Kosten, T. R., & George, T. P. (2002). The Neurobiology of Opioid Dependence: Implications for Treatment. Science & Practice Perspectives, 1(1), 13-20.

How Does Cognitive Behavioral Therapy Help with Addiction?

How does Cognitive Behavioral Therapy work? And can it help treat addiction?

As human beings, we encounter thoughts, feelings, and behaviors almost constantly without taking the time to reflect on them. Cognitive Behavioral Therapy (CBT) works on the principle that thoughts, feelings, and behaviors are all interconnected.

According to CBT, identifying and changing the links between thoughts/feelings/behaviors helps modify unwanted elements, such as being too sad (a feeling) or overeating (a behavior). It’s an extremely common and effective therapy for many psychological disorders, like depression. What you may not know is that it’s also a great option for people struggling with addiction.

So what happens in Cognitive Behavioral Therapy for addiction?

An important step in using CBT to reduce your addictive behaviors is recognizing the precursors or “triggers” to those behaviors.[1] For instance, many people report wanting to reduce their drinking, a classic unwanted behavior. What are the triggers — thoughts, feelings, situations, people — that lead to them to crave a drink? One person’s trigger may be wanting to be more outgoing at a party; another’s may be feeling exhausted after a long day at work. Most individuals, by going through Cognitive Behavioral Therapy, can identify patterns in their life that are directly associated with their addictive behaviors.

Once you know what those patterns are, CBT clinicians help break the connection between a trigger and an addiction behavior through a myriad of activities, homework, and lessons. For example, if you find that you tend to drink because it helps you relax when you’re stressed, the clinician may teach you alternative ways to wind down. If you’re experiencing unhelpful thoughts surrounding your drinking (“I’ve been drinking for 20 years, I’ll never be able to stop!”), the clinician will help train your mind to think in more productive ways.

Another great aspect of Cognitive Behavioral Therapy is that the skills you learn to manage your addiction can be applied to a range of problems. Almost 20% of people with addictions also struggle with depression.[2] By engaging in CBT, you can essentially kill two birds with one stone — reduce your addictive behaviors and get rid of the unpleasant thoughts and feelings that come with depression.

What does the evidence say about Cognitive Behavioral Therapy for addiction?

Many studies have been conducted to test the effectiveness of CBT for addiction. One meta-analysis showed that CBT had a statistically significant treatment effect looking at 53 controlled trials of CBT for alcohol and drug users.[3] Furthermore, CBT has been shown to have long-term positive effects. One study with cocaine users in methadone treatment found that 60% of CBT patients were clean at a 52-week follow-up.[4]

Although Cognitive Behavioral Therapy has been shown to be effective for many individuals with addiction issues, there are many options which you may want to consider. It is common to use medications, such as antidepressants, in conjunction with psychotherapy. There exist countless types of psychotherapies, including mindfulness, narrative therapy, and motivational interviewing, although few with as much evidence behind them as CBT. In practice, clinicians are likely to “mix and match” skills from a variety of psychotherapies depending on your needs.

Where can I get Cognitive Behavioral Therapy for addiction?

Most if not all psychotherapists (psychologists, social workers, counselors, etc.) are likely to be familiar with CBT. However, it may be helpful to seek clinicians who specialize in addiction or substance use disorders. If you don’t seem to connect with the first clinician you meet, don’t give up – it can take some “shopping around” to find somebody who matches your personality and needs.

An increasingly popular option due to its convenience is online CBT, which can consist of video or phone meetings with a clinician, text messaging, and/or web-based coursesWorkit Health offers addiction treatment with all of these features and more.

How Can I Find a Doctor to Prescribe Vivitrol (Naltrexone)?

You’re ready to start Vivitrol treatment. What doctors prescribe it, and how can you get started?

You may have heard of an alternative to methadone and Suboxone for opioid addiction treatment: Vivitrol. It’s actually not a replacement for methadone or Suboxone, as it does something entirely different.

Vivitrol is an injectable form of naltrexone, an opioid antagonist which blocks the effects of opioids such as heroin and prescription painkillers, thus preventing them from causing highs, and also reducing cravings. [1] It is a good choice for people who are strongly motivated to quit use of all opioids, including Suboxone. For example, it can be used as a “stepping stone” for patients who are ready to taper off of their Suboxone regimen.

Interested in quitting opioids but not sure which treatment option will work for you? Check out our comparison of Suboxone vs. Vivitrol.

You may know that Suboxone and methadone are highly regulated, and thus only available from approved treatment programs and providers. On the other hand, Vivitrol is not an opioid, and can be provided by any doctor who is licensed to prescribe medication.

Try these few steps to ensure that the process of receiving Vivitrol goes smoothly for you:

1. Find a doctor who can provide Vivitrol.

Try calling your primary care provider to see if they can offer Vivitrol injections. Even if your primary care doc doesn’t prescribe the Vivitrol shot, they may be willing to prescribe naltrexone pills, to help you begin your treatment as you find a doctor for Vivitrol treatment.

Alternatively, use the Vivitrol website to find a provider in your area. If you’re leaving inpatient treatment, or involved in an outpatient program, your counselor may have a list of providers in your area that offer Vivitrol.

2. Set up an appointment in advance.

It is important to tell your doctor that you are interested in Vivitrol well in advance of when you actually want the injection, so you’ll have ample time to quit using opioids and the doctor will be sure to order and receive a shipment of the medication.

In order to take Vivitrol safely, it is necessary to stop use of opioids (including Suboxone) 7 to 10 days prior to the injection. The Vivitrol website has more helpful tips on what you can ask your doctor prior to starting treatment.

3. Follow your doctor’s instructions to abstain from opioids.

Clearly state what opioids you are taking as this affects the length of the withdrawal process. Your doctor may be able to prescribe some non-opioid medications that will help make the transition more comfortable for you.

4. Communicate with your doctor after receiving your injection.

Although Vivitrol is not specially regulated, there are some risks involved – namely that there is potential for overdose if you resume taking opioids, due to your lowered tolerance. [2] Stay in touch with your doctor to ensure that Vivitrol continues to be the right treatment for you.

Here at Workit Health, we have started to offer Vivitrol alongside Suboxone as an option for opioid use treatment, with an online counseling and medication management program to help keep you on track. Check us out if you are located in Michigan or the Bay Area of California.


References

[1] https://www.asam.org/resources/publications/magazine/read/article/2015/12/15/ask-the-pcss-expert-does-evidence-show-naltrexone-reduces-cravings[2] https://www.asam.org/resources/publications/magazine/read/article/2015/12/15/ask-the-pcss-expert-does-evidence-show-naltrexone-reduces-cravings

 

Workit Health’s Online Addiction Courses: The 6 Core Sections

Boost your body, mind, heart, spirit, and tribe in Workit Health’s online addiction courses.

Wish you could address your addiction without dedicating your time to inpatient rehab or making to in-person sessions every couple days? Online addiction treatment is one way to do just that. Workit Health’s programs all include an online curriculum of courses available 24/7 from the comfort of your home.

The online courses are personalized to your needs, and include information about addiction as well as activities built from evidence-informed treatments for mental health and substance use disorders.

The courses are broken up into six main modules, or sections, each addressing a fundamental aspect of addiction:

1. My Mission

My Mission sets the stage by documenting your path to addiction and your mission for recovery. In addition, we make sure that you walk away with the ability to identify your triggers and cravings, a skill which will be focused in the modules coming ahead.

2. Body

Body is, as you might expect, a module about the physical side of addiction. Here, you will address your self-care needs and external triggers (such as HALT, Hungry-Angry-Lonely-Tired). We also provide ample information about the neuroscience of addiction.

At Workit, when we say we’re Working Body, we’re focusing on physical self-care, whether that is exercise, drinking enough water each day, scheduling overdue medical care, or checking our HALT.

3. Mind

In Mind we deal more with the risky and unhelpful thought processes that lead to engagement in addiction. Based on Cognitive Behavioral Therapy, we will explain and practice ways in which you can stop troublesome “auto-thoughts” in their tracks.

When someone on the team or one of our Workit members is Working Mind, we know they’re focused on recognizing negative thought patterns and focusing on what we call their antidotes, or alternative thoughts. They might bust out an Auto Thought Card Deck to change negative thought patterns.

4. Heart

In Heart we’ll discuss emotion regulation, which is fundamental to Dialectical Behavior Therapy. We will walk through the process of coping with difficult, triggering emotions. Using the principles of Positive Psychology, we will also encourage self-compassion and gratitude.

When Workit Heart, we’re healing. Each section of Workit builds off each other, and healing can truly begin once we’ve established self-care in Body and begun to change our thinking in Mind. Examining tough stuff, especially in our history or low self-esteem, can be difficult, but doing the work to get through it is so worth it.

“I like to work tribe or body more than heart, but Working Heart is really rewarding,” Kali Lux, Workit’s Head of Marketing says about her own experience with Working Heart. “Workit has helped me realize it’s a lot easier for me to focus on my external stuff, like self-care, exercise, or relationships, than look internally at my own negative self-talk or negative thought patterns. At 9 years sober, there’s always more exploration and work to do!”

5. Spirit

Spirit is all about Mindfulness – learning acceptance, practicing breathwork, and more. In accordance with Existential Therapy, you will also get a chance to explore the meaning and purpose of a life free from addiction.

At Workit, when we say we’re Working Spirit, we’re focused in on mindfulness. We’re trying to center ourselves and develop a daily practice of mindfulness. That looks different to everyone, and the Spirit section acts as an introduction to mindfulness in recovery.

Workit Health counselor Brooke Houser says, “I’ve always connected with nature so I use that for a lot of my spiritual needs. One of my favorite parts of the Spirit section is choosing your spirit soother. Mine is an image of a sunny lake. I like to picture it and take a deep breath when I’m getting stressed.”

6. Community

Finally, Community is a module that centers around relationships. Taking hints from Family Systems Therapy and Interpersonal Psychotherapy, we provide opportunities to examine the relationships and communities in your life, and whether they serve as triggers or supports.

Working Community means focusing on your relationships. Whether its building in boundaries with friends and family members, or finding your tribe in addiction recovery, connection is a huge part of recovery and Community helps you get there.

In addition to the six main modules, your personal coach or counselor can give you access to many of the hundreds of additional courses we have on a variety of topics: how to deal with grief, how to get better nutrition, how to establish work-life balance. We want you to walk away with concrete, applicable skills that you can use in your journey to recovery.

 Bracelets for each section of the program. Bracelets for each section of the program.

Are you a Workit member already doing the online courses? What section is your favorite to work on? Need some of our Workit Health bracelets to remember which section you’re working on? Let us know in the comments!

Depression After Opioid Use

It may come as no surprise that opioid use and depression often come together as a package.

People who use opioids for nonmedical purposes are 3.1 times more likely to have depression than those who do not [1]. Conversely, people who have depression are 2.8 times more likely to use opioids [1]. In this article we will examine why opioid use and depression are likely to co-occur and what that means for your addiction care.

What does it mean to have depression?

Depression, or Major Depressive Disorder, is a psychiatric condition characterized by sad mood and/or lack of interest in previously enjoyable activities [2]. Beyond just feeling down, individuals with depression have difficulty functioning on a daily basis due to these symptoms and other emotional/physical changes (such as irritability and tiredness). Depression is a common yet debilitating disorder, experienced by around 7% of US adults yearly [2].

What is the link between opioid use and depression?

Using opioids has been linked to subsequent depression, and depression has been associated with longer periods of opioid use [3]. Why are the two so tightly linked?

Although there are many possibilities, one important link is the negative impact of opioid misuse on many aspects of life: difficult relationships and financial stress, for example, can be catalysts for depression.  Another possibility is that individuals with depression use opioids to “self-medicate” their psychological pain. The link also exists on a neurological level: researchers speculate that some of the same neural pathways are involved in both depression and addiction, such that one condition increases the risk for the other [4].

Because the relationship between depression and opioid use is bi-directional, it is possible for the two to create a positive feedback loop such that the presence of one worsens the other. For this reason, it is often recommended to address depression and opioid use at the same time.

Quit opioids with online help from Workit Health.

Since buprenorphine is an opioid, will using it make my depression worse?

Buprenorphine (the main ingredient in Suboxone) is commonly used to treat opioid use disorder, and it is indeed an opioid. However, it does not have the same chemical properties and neurological effects as commonly misued prescription opioids and illicit opioids. In fact, buprenorphine is now being researched as an experimental treatment for depression [5]. Which is not to say that one should use buprenorphine as an antidepressant – at least until further research is conducted – but it is not scientifically linked to worse depression.

What should I do if I have opioid use disorder and depression?

It is possible and recommended to treat opioid use and depression simultaneously. Integrated treatment programs that treat both conditions together are thought to be particularly effective. Many antidepressant medications are safe to take with Suboxone. Some psychotherapies, such as Cognitive Behavioral Therapy, teach skills that are relevant for both depression and substance use [6].

Workit Health provides a convenient Medication Assisted Treatment program with Suboxone and online counseling. Because counseling is integrated into the program, Workit can provide strategies and resources for dealing with co-occuring depression and opioid use disorder.


References
[1] Martins, S. S., Keyes, K. M., Storr, C. L., Zhu, H., & Chilcoat, H. D. (2009). Pathways between nonmedical opioid use/dependence and psychiatric disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Drug and Alcohol Dependence, 103(1-2), 16–24.
[2] American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
[3] Scherrer, J. F., Salas, J., Copeland, L. A., Stock, E. M., Ahmedani, B. K., Sullivan, M. D., … & Lustman, P. J. (2016). Prescription opioid duration, dose, and increased risk of depression in 3 large patient populations. The Annals of Family Medicine, 14(1), 54-62.
Sullivan, M. D. (2016). Why does depression promote long-term opioid use?. Pain, 157(11), 2395-2396.
[4] Lalanne, L., Ayranci, G., Kieffer, B. L., & Lutz, P. E. (2014). The kappa opioid receptor: from addiction to depression, and back. Frontiers in psychiatry, 5, 170.
[5] Fava, M., Memisoglu, A., Thase, M. E., Bodkin, J. A., Trivedi, M. H., De Somer, M., … & Ehrich, E. (2016). Opioid modulation with buprenorphine/samidorphan as adjunctive treatment for inadequate response to antidepressants: a randomized double-blind placebo-controlled trial. American Journal of Psychiatry, 173(5), 499-508.
[6] Kelly, T. M., & Daley, D. C. (2013). Integrated Treatment of Substance Use and Psychiatric Disorders. Social Work in Public Health, 28(0), 388–406.

 

Suboxone And Heroin: What You Need To Know

Is Suboxone Treatment Effective for Heroin Addiction?

Medication Assisted Treatment with Suboxone (or methadone) is commonly thought to the gold standard treatment for treating addiction to opioid. Taking Suboxone (buprenorphine/naloxone) helps individuals reduce or quit their use of opioids without having to experience withdrawal symptoms. Suboxone is used to treat addiction to prescription opioids, such as oxycodone and morphine.

What about heroin – is Medication Assisted Treatment with Suboxone helpful for people who use heroin?

Although use of prescription painkillers is more common, heroin is especially dangerous for a couple of reasons. Because it is an illegal drug, users can never be sure of its purity, leading to a greater risk of overdose. In addition, there is the possibility that it is contaminated with other dangerous drugs, like fentanyl, another extremely strong opioid. [1] Heroin overdose deaths are increasing at a greater rate than deaths from opioids such as oxycodone and morphine. [2] This is possibly because people using prescription opioids for medical or non-medical purposes often switch to heroin as it is easier to find, and more cost-effective. [3]

Get help for heroin addiction today.

What does the research say?

Research clearly shows that yes, Suboxone treatment is effective for treating heroin addiction. One review found that treatment with buprenorphine (i.e. the active ingredient in Suboxone) significantly improved retention in treatment and reduced heroin use compared to a placebo (i.e. inactive treatment). [4] A recent randomized controlled trial compared heroin dependent patients on Suboxone treatment versus a waitlist with no treatment. They found that the patients in the treatment group reduced their use of heroin across 12 weeks; they also had greater improvements in quality of life, mental health, and engagement in criminal activity compared to the waitlist group. [5] Taken together, this evidence suggests that Medication Assisted Treatment for Suboxone is a useful treatment option for heroin use, not just prescription opioid use.

Which is better, methadone or Suboxone?

One study comparing buprenorphine with methadone treatment long-term, demonstrated that they were equally effective in reducing heroin use, as well as improving mental health, social adjustment, and general quality of life. [6] So both medications are effective for treating heroin use disorder. Read our contributor’s personal comparison of buprenorphine and methadone.

When can I start Suboxone?

Before starting Suboxone for any type of opioid use disorder, one must have stopped taking opioids for a certain length of time to make sure that they don’t experience precipitated withdrawal, i.e. even more severe withdrawal symptoms (read more here). Ask your provider for more details on when to stop taking heroin before starting Suboxone.

Where can I find Suboxone for treating heroin use disorder?

Workit Health offers treatment for opioid use disorder (including addiction to heroin) using a novel combination of Suboxone and personalized online therapy in Michigan and California. If you aren’t in those states, you can check out Suboxone.com to find a provider near you.


References
[1] Voklow, N.D. (2014, May 14.) America’s Addiction to Opioids: Heroin and Prescription Drug Abuse.”National Institute on Drug Abuse. Retrieved from https://www.drugabuse.gov/about-nida/legislative-activities/testimony-to-congress/2016/americas-addiction-to-opioids-heroin-prescription-drug-abuse
[2] Rudd, R. A., Aleshire, N., Zibbell, J. E., & Matthew Gladden, R. (2016). Increases in drug and opioid overdose deaths—United States, 2000–2014. American Journal of Transplantation, 16(4), 1323-1327.
[3] Compton, W. M., Jones, C. M., & Baldwin, G. T. (2016). Relationship between nonmedical prescription-opioid use and heroin use. New England Journal of Medicine, 374(2), 154-163.
[4] Sung, S., & Conry, J. M. (2006). Role of buprenorphine in the management of heroin addiction. Annals of Pharmacotherapy, 40(3), 501-505.
[5] Dunlop, A. J., Brown, A. L., Oldmeadow, C., Harris, A., Gill, A., Sadler, C., … & Hinman, J. (2017). Effectiveness and cost-effectiveness of unsupervised buprenorphine-naloxone for the treatment of heroin dependence in a randomized waitlist controlled trial. Drug & Alcohol Dependence, 174, 181-191.
[6] Maremmani, I., Pani, P. P., Pacini, M., & Perugi, G. (2007). Substance use and quality of life over 12 months among buprenorphine maintenance-treated and methadone maintenance-treated heroin-addicted patients. Journal of substance abuse treatment, 33(1), 91-98.

 

What Science Says About Inpatient Vs Office-Based Suboxone Treatment

For a long time, the idea has been to go to inpatient treatment to quit opiates. But is it really necessary for Suboxone treatment?

Suboxone is one of the few medications approved by the FDA to aide individuals who are trying to reduce or quit their use of opioids. A notable feature of Suboxone is that unlike methadone (another medication which is more strictly regulated), Suboxone can be prescribed by any doctor who receives qualification through the Substance Abuse and Mental Health Services Administration (SAMHSA). This makes office-based outpatient treatment using Suboxone more feasible, but Suboxone and other medications can also be used in inpatient settings. What’s the difference?

Comparing inpatient and outpatient treatment using Suboxone

Inpatient programs involve living within a facility for the duration of the treatment. These programs usually last between 28-90 days and are highly structured. The aim is usually not maintenance but detox: to get the patient to completely withdraw from, and abstain from, opioid use quickly [ASAM]. During an inpatient detox program, patients receive constant professional support and medical supervision, with no access to drugs. Medications such as Suboxone are used to ease the discomfort of the withdrawal process.

On the other hand, outpatient programs seek to integrate treatment in general medical care. In office-based Suboxone treatment, individuals are prescribed medication to take on their own and may have to visit the physician on a regular basis for drug testing and medication management services. In addition, the physician is required to refer the patient to additional psychosocial services such as counseling. Although outpatient treatment programs can also aim for rapid withdrawal (i.e. detox), oftentimes the goal is to maintain functioning with consistent Suboxone use for months or years, with the possibility of eventually tapering. This latter model of care is called Medication Assisted Treatment (MAT).

Is inpatient Suboxone treatment really better than outpatient?

Many believe that people suffering from addiction can only succeed through inpatient programs, which have the advantage of completely removing the individual from environments that are directly linked to their addictive behaviors. It should be noted that if detox is indeed the goal, inpatient detox programs have been found to be more effective (in terms of program completion) than equivalent outpatient programs – unsurprisingly, as detox can be highly uncomfortable even with the help of medications. However, office-based Medication Assisted Treatment is beneficial compared to (even inpatient) detox, for a couple reasons that we will discuss here: Effectiveness, safety, and access.

Research shows that detox programs are more likely to result in relapse than MAT. In one Irish study, 94% of the patients relapsed within 36 months of an inpatient residential program. Inpatient programs are more likely to be successful if they are intensive and followed up with long-term services.  In contrast, reviews have shown that MAT reduces mortality, risk of HIV infection, criminal activity, and illicit opioid use, with the caveat that one must maintain medication use for extended periods of time. One paper recommends that detox only be considered for individuals who are exceptionally well functioning both physically and psychologically, with a strong social support network.

Both detox and MAT (as well as drug use) come with safety risks – for instance, methadone used for MAT can be “diverted” and then result in overdose (Suboxone is less risky in this regard). However, in the event of relapse, there is greater risk of overdose for detox than for MAT. This is because of the loss of tolerance that occurs once opioids have been completely withdrawn. In addition, ultra-rapid inpatient detox programs, in which withdrawal is completed over a period of hours to days sometimes under anaesthesia, have been associated with potentially life-threatening side effects. Furthermore, although not risk-free, MAT is the recommended treatment for pregnant mothers, because detox during pregnancy can result in miscarriage.

Finally, outpatient methods may simply be a more accessible model of treatment for many. Office-based programs are easier to access while maintaining commitments to family and work; they further allow the patient to avoid the stigma of substance use treatment and receive more tailored services. For these reasons, office-based treatment can be a generally more practical choice than inpatient detox.

Interested in outpatient MAT? Workit Health provides office-based treatment for opioid use disorder using Suboxone and a personalized online program.


Sources: Sullivan, L. E., & Fiellin, D. A. (2008). Office-based buprenorphine for patients with opioid dependence. Annals of internal medicine, 148(9), 662.Ducray, K., Darker, C., & Smyth, B. P. (2012). Situational and psycho-social factors associated with relapse following residential detoxification in a population of Irish opioid dependent patients. Irish Journal of Psychological Medicine, 29(2), 72-79.DuPont, R. L., McLellan, A. T., Carr, G., Gendel, M., & Skipper, G. E. (2009). How are addicted physicians treated? A national survey of physician health programs. Journal of Substance Abuse Treatment, 37(1), 1-7.Kleber, H. D. (2007). Pharmacologic treatments for opioid dependence: detoxification and maintenance options. Dialogues in clinical neuroscience, 9(4), 455.van den Brink, W., & Haasen, C. (2006). Evidence-based treatment of opioid-dependent patients. The Canadian Journal of Psychiatry, 51(10), 635-646.Strang, J., McCambridge, J., Best, D., Beswick, T., Bearn, J., Rees, S., & Gossop, M. (2003). Loss of tolerance and overdose mortality after inpatient opiate detoxification: follow up study. Bmj, 326(7396), 959-960.Luty, J., Nikolaou, V., & Bearn, J. (2003). Is opiate detoxification unsafe in pregnancy?. Journal of substance abuse treatment, 24(4), 363-367.Fiellin, D. A., & O’connor, P. G. (2002). Office-based treatment of opioid-dependent patients. New England Journal of Medicine, 347(11), 817-823.

 

Why Online Addiction Treatment Is Chill

Harness the power of the web on your path towards addiction recovery.

There are a lot of addiction treatment programs out there. But wouldn’t it be great if you could access treatment (even partially) in the comfort of your home? Online treatment creates that possibility. But what does it look like in practice – and does it even work?

Get started at home today.

What does online treatment entail?

Online treatment for mental and behavioral health uses digital technology as a means of delivering and/or enhancing psychotherapy (and perhaps even pharmacotherapy). Technology can be incorporated into treatment programs in different ways:

Therapists and medical professionals can meet with patients over remote video or phone calls instead of seeing them in person. This approach is called telemedicine or tele-psychology.

Digital programs can provide all the steps of a therapy through guided, sometimes interactive curriculums, with little to no involvement from a human provider. This is called computerized therapy.

Treatment programs can combine a more traditional mode of therapy with smartphone apps, text messaging, or other types of digital technology. This is called computer-assisted or web-assisted treatment.

These approaches are not mutually exclusive, and often mixed and matched to suit the goals of the program.

Learn about the 6 sections of Workit Health’s online program.

Is online treatment useful for people struggling with substance use?

Yes – or rather, promising evidence is starting to accumulate for some types of online treatment. Online treatment has been implemented in countless different ways. This means that some models may be more or less effective than others, and more or less appropriate for your specific needs and preferences.

With that being said, some online approaches like computerized therapy and videoconferencing have strong evidence for their effectiveness as mental health treatments. [1] In the realm of substance use disorders, several studies of online treatments have found that they can effectively help reduce addictive behaviors. [2]

For example: One methadone treatment regimen that incorporated an online interactive tool was found to reduce opioid use more than standard treatment. [3]

Participants in a study who used a self-help computerized cognitive-behavioral therapy program significantly decreased their alcohol use compared to those who received an educational brochure. [4]

Learn about Workit’s online Suboxone program.

What are some advantages of online therapy?

1. Cost

In comparison to the hefty price tag often associated with in-person psychotherapy, some forms of online therapy like smartphone apps or text-based counseling can provide more affordable options. Computerized therapy has been found to be a cost-effective addition to traditional treatment for substance use, for both the provider and the patient. [5]

2. Accessibility

There tends to be high demand for in-person treatment programs and not enough supply. It can thus be easier to get started with online treatments. Furthermore, many people find that online therapies more convenient in terms of scheduling and traveling.

3. Options

What if you live in an area where there simply aren’t many providers, and you’ve tried them all? Online treatments can give you diverse options beyond those in your immediate vicinity.

4. Privacy

Online treatments are relatively discreet, especially if the online portions mostly or completely replace in-person sessions.

5. Engagement

Online treatment does not have to be an inferior substitute for in-person treatment – it can make creative usage of technology to engage patients in ways that simply would not be possible in traditional modalities (such as by utilizing fun apps, or providing 24/7 support).

Workit Health provides interactive, evidence-based online addiction treatment that is personalized to your specific goals. We have an online curriculum available 24/7, and licensed coaches and counselors who can support you via text, phone, or video chats. We also provide a Medication Assisted Treatment program for opioid use disorder that is mainly delivered online.

If you’re interested in online addiction treatment, why not check us out?


References
[1] Vallury, K. D., Jones, M., & Oosterbroek, C. (2015). Computerized cognitive behavior therapy for anxiety and depression in rural areas: a systematic review. Journal of medical Internet research, 17(6).
Backhaus, A., Agha, Z., Maglione, M. L., Repp, A., Ross, B., Zuest, D., … & Thorp, S. R. (2012). Videoconferencing psychotherapy: A systematic review. Psychological services, 9(2), 111.
[2] Gainsbury, S., & Blaszczynski, A. (2011). A systematic review of Internet-based therapy for the treatment of addictions. Clinical psychology review, 31(3), 490-498.
[3] Marsch, L. A., Guarino, H., Acosta, M., Aponte-Melendez, Y., Cleland, C., Grabinski, M., … Edwards, J. (2014). Web-based Behavioral Treatment for Substance Use Disorders as a Partial Replacement of Standard Methadone Maintenance Treatment. Journal of Substance Abuse Treatment, 46(1).
[4] Riper, H., Kramer, J., Smit, F., Conijn, B., Schippers, G., & Cuijpers, P. (2008). Web‐based self‐help for problem drinkers: a pragmatic randomized trial. Addiction, 103(2), 218-227.
[5] Olmstead, T. A., Ostrow, C. D., & Carroll, K. M. (2010). Cost-effectiveness of computer-assisted training in cognitive-behavioral therapy as an adjunct to standard care for addiction. Drug & Alcohol Dependence, 110(3), 200-207.