Author: Ruben Bermea, LPC

When it comes to finding treatment for narcotic misuse, a variety of  therapies for opioid addiction are available.  Choosing an approach that matches your therapeutic needs can improve your motivation for long-term recovery.¹ Various opioid addiction therapies offer the opportunity to develop coping skills, supportive relationships, and the motivation to achieve sobriety and engage in treatment. A combination of evidence-based approaches can help you establish a long-term path to recovery.

In This Article:

• Motivational Interviewing
• Behavioral Therapies
• Mindfulness-Based Interventions
• Contingency Management
• Community Reinforcement
• Family Therapy
• Peer Support Groups
• Medication-Assisted Treatment

Motivational Interviewing

One of the diagnostic criteria for a substance use disorder—the clinical name for addiction—is to continue using a substance like opioids even after it begins to negatively affect your health, interpersonal relationships, work life, or other important areas of your life.² Even though a person may recognize the effects that substance misuse is having in their life, it may not be enough to motivate them to stop.^1,2

A therapist who uses motivational interviewing works to help you identify personal, or internal, motivators to participate in treatment and choose behaviors that put your wellness first.¹ These motivators can be more meaningful and effective than external motivators—such as recommendations from your doctor, ultimatums from family members, or court mandates.

With motivational interviewing, the relationship you have with your therapist can positively influence your openness to change.¹ When you work with someone who helps you feel supported in recovery, you may notice an improved desire to engage in the treatment process.

Some clinicians combine motivational interviewing with other opioid addiction therapies, including behavioral therapy and contingency management.¹

Behavioral Therapies

Many addiction experts believe that people use opioids to cope with different kinds of stress.¹ While many people use opioid medications as prescribed by their doctor to cope with intense or chronic pain, the psychological distress that physical pain can cause may limit their ability to manage other areas of their life.^1,2,5 This can lead people to use opioids as a way to achieve relaxation and relief from emotional as well as physical pain.^1,2 In these circumstances, opioid misuse can become a potentially life-threatening way of coping with stress.^1,4

Opioid addiction therapies can help you develop new methods for dealing with negative emotions, emotional pain, and stress.² Cognitive-behavioral therapy (CBT) offers skills to help you better understand and identify how you currently think, including the thought patterns that lead to specific behaviors. When you become aware of how certain thoughts lead into your actions, you become empowered to make different choices and establish new patterns of behavior. This approach can also help people better respond to triggers that can lead to substance misuse, including chronic pain.^2,5

Behavioral therapies for opioid addiction can help you build various skills to support recovery, including:¹

• Strategies to manage urges and cravings to use substances
• Methods to manage intense emotions and stress
• Relationship and social skills
• Educational or job attainment skills

The skills you develop while participating in opioid addiction therapies should match your needs in recovery and beyond.¹ What you learn in treatment can help you improve your ability to live a valued life.

Mindfulness-Based Interventions

Developing mindfulness skills through meditation practice holds promise for people in recovery.¹ Twelve-step programs such as Narcotics Anonymous (NA) highlight meditation as an opportunity for personal reflection while connecting with feelings of love, forgiveness, and empowerment in recovery.^6,7 Meditation and mindfulness practices can enable you to build lifelong skills that you can use in different areas of your life.

Mindfulness can improve your ability to observe your inner experiences, thoughts, feelings, and physical sensations.¹ Addiction can cause extreme stress and discomfort, especially in early recovery when strong cravings, urges to take opioids, or withdrawal symptoms develop.² With improved observation and acceptance of these experiences, people who practice mindfulness can respond to stress associated with addiction with safer, healthier alternatives to opioid misuse.¹

Studies have shown various benefits of meditation in addiction treatment, including reduction of anxiety, withdrawal symptoms, and drug cravings.¹

Contingency Management

Developed from research on positive reinforcement, contingency management seeks to turn addiction recovery into a rewarding experience.¹

Contingency management offers incentives and rewards to people who participate in recovery-related activities.² The prizes used in this therapeutic intervention are intended to motivate you to meet certain goals associated with your recovery plan.¹

Some examples of prizes used in contingency management include:^1,2

• Food
• Tickets to events
• Movie passes
• Positive messages
• Access to recovery-related activities or other program privileges
• Money

The frequency and size of prizes received may be adjusted depending on your treatment goals.¹ Behaviors that contingency management programs reward include:^1,2

• Maintaining abstinence
• Submitting a drug-free test or urinalysis
• Engaging in a recovery-oriented activity
• Keeping appointments
• Staying in a treatment program for a specified amount of time
• Educational or work-oriented achievements

Community Reinforcement

Therapies for opioid addiction include a community reinforcement approach (CRA) to recovery. Sometimes combined with contingency management, this approach works to make healing more desirable than opioid misuse.¹ CRA analyzes the triggers that lead to substance misuse and the results you hope to achieve in recovery. Your therapist then helps you establish better alternatives to substance misuse by promoting changes within a your environment to support ongoing sobriety.

CRA leverages a person’s relationships, family interactions, hobbies, daily activities, and job skills to reinforce substance use recovery.¹ Therapists who use CRA strive to remain flexible and meet people where they are in their motivation and daily life. Providers work quickly to promote motivation at crucial moments in treatment. They help ensure that an individual’s sober living skills, medication management, relationships, self-care, and job-skills training work together to promote lasting recovery from addiction.

CRA can help people from a diverse set of backgrounds, including adolescents, achieve and maintain sobriety from a variety of substances.⁷ CRA tools have even been translated into several languages, including Dutch, Finnish, German, and Korean.

Family Therapy

Opioid addiction therapies that involve loved ones are considered important components to holistic recovery from substance use.^1,2 For individuals who are connected to their relatives, family members can offer valuable information, perspectives, and feedback about progress during the recovery process.¹ Family or couples therapy can also help your loved ones understand the recovery process so that they can be more patient and supportive during your healing.

Treating addiction often requires adjustments for the person receiving treatment and the people they have relationships with.¹ New patterns of behavior can mean new ways of connecting with others. Therapy can help family members adopt supportive ways of relating to their loved one during the recovery process.

Examples of family or relationship-focused therapies for opioid addiction include:¹

• Behavioral couples therapy
• Community reinforcement and family training
• Brief strategic family therapy focused on adolescent recovery
• Multisystemic therapy, providing intensive treatment for adolescents
• Multidimensional family therapy, offering holistic treatment for adolescents

Each of these therapies focuses on improving family relationships and helping the individual in recovery build a fulfilling life of sobriety.

Peer Support Groups

Peer support groups provide continuing care in the form of mutual support for people recovering from substance use disorders.¹ These groups look different depending on their structure, their philosophical foundation and mission, and the kind of information they use to promote recovery. Some groups may ask you to explore your relationship with spirituality in overcoming addiction. Other groups are dedicated to supporting the family members of people experiencing addiction.

Examples of mutual or peer-led support groups include:¹

• Narcotics Anonymous (NA)
• LifeRing Secular Recovery
• Secular Organizations for Sobriety
• Self-Management and Recovery Training (SMART)
• Women For Sobriety
• Celebrate Recovery

Relationships fostered in these groups, especially in 12-step based programs, will often extend beyond the “walls” of the meeting room.¹ Participants in some groups may offer support to other members after meetings have ended.

Before you choose a recovery group, take some time to research what these groups have to offer. This can help ensure that the group you choose meets your goals and preferences to help you maintain lasting recovery.¹

Medication-Assisted Treatment

Medication-assisted treatment, also known as pharmacotherapy, is a highly effective component of opioid addiction recovery.¹ Medications have different purposes and can support your recovery across all stages of treatment.⁸

Starting with detox, buprenorphine or methadone can help manage undesirable withdrawal symptoms.⁸ Both medications can also support long-term recovery. Some providers may recommend combining buprenorphine with naloxone to reduce the risk of opioid misuse or addiction.

Naltrexone may be used for long-term medication-assisted treatment.⁸ This medication can help you maintain sobriety, though it is not recommended if you recently used opioids, as naltrexone is known to trigger severe withdrawal symptoms.⁸

Medication-assisted treatment also helps manage the risks of overdose in early or long-term recovery.⁸ Without medication, you may be at a higher risk of opioid use relapse due to strong cravings. Because a person’s drug tolerance drops rapidly after stopping opioid use, relapse can lead to an increased risk of overdose, especially immediately following withdrawal.⁸

If overdose does occur, naloxone is a life-saving medication that can restore a person’s breathing. Injected or consumed as a nasal spray, naloxone reverses the effects of opioid overdose.⁹

Getting matched with the right program, provider, and level of care requires careful consideration of your needs, preferences, and the impact of substance use on your health.¹ Insurance providers, case managers at a hospital, and other community case management resources can guide you through the process of receiving therapies for opioid addiction.

If you would like to learn more about treatment options available to you, call 800-934-1582(Who Answers?) to speak with a treatment specialist today.

References

1. Miller, W. R., Forcehimes, A. A., & Zweben, A. (2019). Treating Addiction: A Guide for Professionals. The Guilford Press.
2. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).
3. National Institute on Drug Abuse. (2020, June 3). Evidence-based Approaches to Drug Addiction Treatment. Principles of Drug Addiction Treatment: A Research-based guide (Third Edition).
4. S. Drug Enforcement Administration. (2020). Drugs of Abuse: A DEA Resource Guide, 2020 Edition. U.S. Department of Justice.
5. American Psychological Association. (2011). Coping with chronic pain.
6. Alcoholics Anonymous World Services, Inc. (1976). Alcoholics Anonymous: Big Book, 4th Edition.
7. Meyers, R. J., Roozen, H. G., & Smith, J. E. (2011). The community reinforcement approach: an update of the evidence. Alcohol Research & Health, 33(4), 380–388.
8. (2021, August 5). Opiate and opioid withdrawal. U.S. National Library of Medicine.
9. National Institute on Drug Abuse. (2021). Naloxone DrugFacts.