Author: Hannah Sumpter

Tramadol is a medication that is prescribed to relieve moderate to severe pain. Although it has lower rates of addiction than other leading opioid medications, it is still a controlled substance that carries the risk of addiction.¹ If you or a loved one develops a dependence on tramadol, a variety of tramadol addiction treatment options are available to support long-term recovery.

In This Article:

• About Tramadol
• Signs You May Need Tramadol Addiction Treatment
• Types of Treatment for Tramadol Addiction
• Therapies for Tramadol Addiction Treatment
• Recovery Support After Treatment

About Tramadol

Introduced in 1995, tramadol was available as a non-controlled prescription.² However, after being linked to opioid addiction and overdose, tramadol was placed on the U.S. Drug Enforcement Administration’s schedule of controlled substances in 2014  as a Schedule 4 substance.²  Misuse of a Schedule 4 drug, although considered less dangerous and with a lower potential for abuse or addiction, still carries a risk with use. ¹

Tramadol is formulated differently from other opioid medications. It combines less potent opioid properties with the properties of a serotonin-norepinephrine reuptake inhibitor (SNRI). As an SNRI, it has antidepressant effects that may counteract the typical sedative effects of opioid medications.²

Unlike other stronger opioid medications such as oxycodone and hydrocodone, tramadol does not adversely affect respiratory or cardiac function when used as prescribed.³ However, there are other side effects that anyone using the medication should be aware of.

Tramadol can also interact with medications, including other narcotic pain relievers, antidepressants and nonsteroidal anti-inflammatory drugs. When combined with drugs such as alcohol or benzodiazepines, tramadol can cause seizures, breathing problems and overdose.⁴

Signs You May Need Tramadol Addiction Treatment

While tramadol carries a low risk of addiction, cases of tramadol dependence have been reported in patients with no prior history of substance misuse.⁵ Like other opioid drugs, tramadol increases endorphins, dopamine, and serotonin levels in the brain, potentially causing a sense of euphoria.⁶ If you take tramadol for an extended period of time, you may experience withdrawal symptoms if you try to stop using it. This is a sign of dependence.

Even if you take tramadol as directed by your doctor, you may develop dependence on this medication. Dependence can develop into an addiction, known clinically as an “opioid use disorder” (OUD), when using tramadol becomes a central obsession in your life.

According to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), an OUD diagnosis requires at least two of the following symptoms during a 12-month period:⁶

• Taking tramadol in larger amounts or for longer than you’re meant to
• Wanting to reduce or stop using tramadol without success
• Spending a lot of time getting, using or recovering from the use of tramadol
• Experiencing cravings and urges to use tramadol
• Not managing to do what you should at work, home or school because of tramadol use
• Continuing to use tramadol, even when it causes problems in relationships
• Giving up important social, occupational or recreational activities because of tramadol use
• Using tramadol in dangerous situations
• Continuing to use tramadol even when you know you have a physical or psychological problem that could have been caused or made worse by the drug
• Needing more tramadol to get the effect you want (i.e., developing tolerance).
• Developing withdrawal symptoms, which are relieved by taking more of the drug

An OUD diagnosis is ranked by severity and according to the number of symptoms a person has of those listed above. Having 2-3 symptoms indicates a mild addiction, 4-5 symptoms indicate a moderate addiction and 6 or more symptoms indicate a severe addiction.⁶

Types of Treatment for Tramadol Addiction

If you need tramadol addiction treatment, knowing what to expect can make it easier to seek the support you need.

Tramadol rehab typically begins with detoxification, followed by inpatient treatment, outpatient treatment and ongoing aftercare.

Detox

Detoxification, is the process of ridding the body of a substance or drug while managing physical and emotional symptoms that occur when use is stopped. During detox, individuals who have become dependent on tramadol with experience withdrawal. These withdrawal symptoms are similar to those experienced when discontinuing any other type of opioid.⁷

Opioid withdrawal symptoms may include:⁷

• Bone pain and muscular aches/spasms/tension
• Changes in body temperature
• Chills and goosebumps
• Hyperalgesia (enhanced pain sensitivity)
• Insomnia
• Tearfulness
• Drooping eyelids
• Pupil dilation
• Stomach cramps, nausea, vomiting or diarrhea
• Heart rate and blood pressure changes
• Teeth chattering
• Weakness
• Yawning
• Anxiety
• Emotional pain
• Irritability
• Loss of motivation for natural rewards
• Malaise
• Stress

In addition to the typical opioid withdrawal symptoms, some people may experience withdrawal symptoms specific to tramadol. These include:⁸

• Anxiety
• Paranoia
• Depersonalization (feeling like you’re observing yourself from outside your body)
• Psychosis
• Auditory hallucinations

Withdrawal symptoms from tramadol dependence may be uncomfortable, but are usually not life-threatening and can be managed with medical care. This includes standard medications that are used to treat opioid withdrawal and addiction, such as methadone, buprenorphine and naltrexone.⁹ Other medications that are helpful in tramadol withdrawal include clonidine, lorazepam, baclofen and ibuprofen.^5,10

Studies show that not only do the leading withdrawal management medications limit withdrawal symptoms, but many of them can also diminish cravings. This is ideal for long-term recovery from tramadol dependence, as cravings can be a significant factor for relapse.¹⁰

Due to the risks that accompany withdrawal symptoms, your medical provider may recommend that you taper off your tramadol use gradually. This way, you will experience fewer and less severe withdrawal symptoms.  Tapering off of tramadol can take several weeks or up to a month.¹¹

Inpatient Rehab

After completing detox, you will most likely continue your addiction recovery journey with inpatient treatment.

If you received medical detox in a hospital setting, you may continue your treatment in the same setting that you completed detox or transferred to another hospital-type setting, where you will begin 30 to 90 days of residential addiction treatment. ¹²

With inpatient tramadol rehab, you live among others in recovery who are also seeking long-term sobriety. Inpatient treatment services typically include individual therapy, group therapy, family therapy, continuous addiction recovery education and an introduction to 12-step meetings.¹²

During residential treatment, a doctor and clinical staff provide medical oversight and prescribe any necessary medications to support your recovery.¹²

Outpatient Treatment

Outpatient addiction treatment for tramadol rehab is offered in a variety of settings, including partial hospitalization treatment (PHP) and intensive outpatient treatment (IOP).

People enrolled in a PHP live at home or in a sober living community and return to the residential treatment setting several times per week for individual and group therapy sessions.¹³

Intensive outpatient treatment is very similar to PHP. Whether at home or a sober living community, you still live within the community and return throughout the week for individual therapy and group therapy sessions.¹³

Both PHPs and IOPs offer similar addiction treatment, but vary depending on the frequency of attendance. PHPs offer more frequent visits, possibly two to three times a week for several hours, while IOP attendance is less frequent, usually once or twice a week.¹³

Outpatient treatment is an essential step for lasting recovery. Residential treatment helps you establish the stability you need to return to the community safely. Re-engaging in the community can really challenge your recovery, especially during the first year.  Outpatient treatment helps you to maintain recovery and further develop healthy coping skills to help you combat cravings and triggers.

Therapies for Tramadol Addiction Treatment

During tramadol rehab, psychotherapy (talk therapy) is an evidence-based approach that supports successful addiction treatment.  Some leading types of talk therapy that are used in addiction treatment include motivational interviewing, cognitive behavioral therapy and solution-focused therapy.¹²

Motivational interviewing involves working with your therapist to develop strong personal motivation to succeed in recovery. Cognitive behavioral therapy helps you to identify maladaptive thinking patterns and responses that have contributed to your addiction and helps you to develop healthier ways of interpreting your experiences and responses.

Another commonly used approach is solution-focused therapy, this type of talk therapy help you identify cravings and triggers that could contribute to relapse. Solution-focused counseling is important to help you develop a comprehensive relapse prevention plan to meet your unique needs.¹⁴

Along with individual counseling, tramadol addiction treatment may include group counseling sessions to help you build rapport and mutual support with others seeking long-term sobriety. This is especially important because research has shown that a network of support is essential for lasting recovery.¹⁴ 

During individual and group sessions, you learn ways to strengthen your coping skills, identify relapse triggers and continue working on a long-term sobriety plan.¹³

Holistic Interventions

Holistic therapeutic approaches are also helpful during addiction treatment. These interventions,  shifts from focusing on medically managing the symptoms of addiction to supporting the whole person—mind, body, and spirit—in recovery.¹²

Holistic treatment still incorporates counseling and group therapy, but it also includes supplemental treatments such as:¹⁵

• Yoga
• Tai chi
• Guided meditation
• Equine therapy

Holistic rehab therapies work to complement traditional methods of recovery by treating both the physical and emotional symptoms of addiction and withdrawal.¹⁵ These interventions, along with psychotherapy and medication, offer support that focuses on the whole person.¹⁵

Recovery Support After Treatment

Once you have completed outpatient treatment, aftercare provides ongoing support to help you maintain your sobriety.

A key part of aftercare is having ongoing support that keeps you motivated and committed to maintaining your sobriety over time. One component of aftercare typically includes attending 12-step meetings, such as Narcotics Anonymous (NA), or other recovery support groups, which help many people stay on the path to recovery.

Additionally, finding a sober living community can be critical if your current living environment is not supportive of your sobriety and recovery. Sober living communities are useful for people who otherwise would not have a drug-free place to reside. In a sober living community, you live among others who are also in recovery, providing peace of mind in knowing that drugs are not readily available. While living in a sober community, you can also build friendships and mutual support with others who are also rebuilding their lives in recovery.¹⁷

A variety of approaches are available for tramadol addiction treatment, and can be individualized to meet each person’s unique needs. To speak with a treatment specialist concerning your needs for tramadol rehab, call 800-934-1582(Sponsored) at any time.

 References

1. Drug Enforcement Administration. (2020). Drugs of Abuse: A DEA Resource Guide/2020 Edition. U.S. Department of Justice.
2. Fagan, T.C., & Kogan, F.J. (2018, July 6). Tramadol: An Emerging Drug of Abuse. The Arizona Pulse.
3. Scott, L. J., & Perry, C. M. (2012, September 17). Tramadol: A Review of its Use in Perioperative Pain. Drugs, 60, 139-176.
4. S. National Library of Medicine. Tramadol. MedlinePlus.
5. Ojha, R., & Bhatia, S. C. (2010). Tramadol Dependence in a Patient With No Previous Substance History. Primary Care Companion to the Journal of Clinical Psychiatry, 12(1).
6. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.).
7. McDiarmid, T., Mackler, L., & Schneider, D. M. (2005). Clinical inquiries. What is the addiction risk associated with tramadol? The Journal of Family Practice, 54(1), 72–73.
8. Sidana, A., Domun, I., & Arora, P. (2019). Tramadol withdrawal psychosis. Indian Journal of Psychiatry, 61(6), 655–656.
9. Vandergriendt, C. (2018, June 27). How to Recognize and Treat Tramadol Addiction. Healthline.
10. Ahmadi, J. (2015, October 28). Tramadol Dependency Treatment: A New Approach. Journal of Addiction Medicine and Therapeutic Science, 1(2): 041-043.
11. National Library of Medicine. (2003). Withdrawal syndrome and dependence: tramadol too. Prescrire International, 12(65), 99–100.
12. Weinstein, Z. M., Wakeman, S. E., & Nolan, S. (20 Addiction 18). Inpatient addiction Consult Service: Expertise for Hospitalized Patients with Complex Problems. Medical Clinics of North America, 102(4), 587-601. A
13. Allison, M., & Hubbard, R.L. (1985). Drug Abuse Treatment Process: A Review of the Literature. International Journal of the Addictions, 20(9), 1321-1345.
14. Wakeman, S. E., Metlay, J. P., Chang, Y., Herman, G. E., & Rigotti, N. A. (2017). Inpatient Addiction Consultation for Hospitalized Patients Increases Post-Discharge Abstinence and Reduces Addiction Severity. Journal of General Internal Medicine, 32(8), 909-916.
15. Breslin, K.T., Reed, M.R., @ Malone, S.B. (2011, September 11). An Holistic Approach to Substance Abuse Treatment. Journal of Psychoactive Drugs, 35(2).
16. Gossop, M., Stewart, D., & Marsden, J. (2008). Attendance at Narcotics Anonymous and Alcoholics Anonymous meetings, frequency of attendance and substance use outcomes after residential treatment for drug dependence: a 5‐year follow‐up study. Addiction, 103(1), 119-125.
17. Polcin, D. L., & Korcha, R. (2015, September 11). Motivation to maintain sobriety among residents of sober living recovery homes. Substance Abuse and Rehabilitation, 6, 103-111.

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