Author: Hannah Sumpter

Tramadol is a medication that relieves moderate to severe pain. Although it has lower rates of addiction than other leading opioid medications, it is still a controlled substance that carries risk of addiction.¹ If you or a loved one does develop a dependence on tramadol, a variety of tramadol addiction treatment options are available for successful 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 originally 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 2014.² It is listed as a Schedule 4 drug. Misuse of a Schedule 4 drug can lead to physical or psychological dependence.¹

Tramadol is formulated differently than 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 heart function when used as prescribed.³ However, there are other tramadol side effects, including several that are specific this medication.

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 Tramadol misuse led to a 250% increase in emergency department visit from 2005 to 2011.²

Signs You May Need Tramadol Addiction Treatment

While tramadol has 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 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), if 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 but not managing to
• 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 according to the number of symptoms a person has of those listed above. Having 2-3 symptoms indicates a mild addiction, 4-5 symptoms indicates a moderate addiction, and 6 or more symptoms indicates a severe addiction.⁶

Types of Treatment for Tramadol Addiction

If you are in need of 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. These stages of recovery can be customized to your individual situation, personality, and needs.

Detox

Detoxification, also called withdrawal, begins when you stop taking the drug. Withdrawal symptoms, when overcoming tramadol dependence, 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, diarrhea
• Heart rate 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  may be uncomfortable, but they are usually not life-threatening and can be managed with medical care. Standard medications used to treat opioid withdrawal and addiction include methadone, buprenorphine, and naltrexone.⁹

Other medications used to treat tramadol withdrawal include clonidine, lorazepam, baclofen, and ibuprofen.^5,10

Studies show that not only do the leading withdrawal management medications limit withdrawal symptoms, many of them also can 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, you can expect your doctor to  gradually taper you off your tramadol use. This way, you will experience fewer withdrawal symptoms and an easier withdrawal experience. 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 be transferred to another hospital-type setting, where you will begin 30 to 60 days of residential addiction treatment. Or you may continue your treatment in a residential rehab setting where you completed your detox.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 help you through recovery.¹²

Outpatient Treatment

Outpatient addiction treatment for tramadol rehab is offered in various ways, 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 once or twice a 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 you reconvene 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 two hours, while IOP attendance is less frequent at once or twice a week for two hours.¹³

Outpatient treatment is an essential step for lasting recovery. Residential treatment helps you establish stability to return to the community safely, but once you re-engage in the community, your recovery is challenged in new ways. This is especially true during the first year of recovery. Outpatient treatment helps you further develop strong coping skills for cravings and triggers.

Therapies for Tramadol Addiction Treatment

During tramadol rehab, psychotherapy (talk therapy) is highly recommended as a proven method for successful addiction treatment. Leading types of talk therapy 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 identifies maladaptive thinking patterns and responses that have contributed to your addiction. You then learn healthier ways of interpreting your experiences and responding.

Related to this approach is solution-focused therapy, where you identify cravings and triggers that could contribute to relapse. Solution-focused counseling helps you set up a relapse prevention plan.¹⁴

Aside from individual counseling, tramadol addiction treatment may include group counseling sessions to help you build rapport and mutual support with others seeking long-term sobriety. A network of support is essential for lasting recovery.¹⁴

Individual and group sessions will help you strengthen your coping skills, identify relapse triggers that may occur in the community, and continue working on a long-term sobriety plan.¹³

Holistic Interventions

Holistic therapeutic approaches are a new addition to addiction treatment. With holistic interventions, treatment 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 can work together with psychotherapy and medication to support long-term tramadol rehab.¹⁵

Recovery Support After Treatment

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

An important part of aftercare is continuing your motivation to maintain sobriety. Attending 12-step meetings, such as Narcotics Anonymous (NA), or other recovery support groups helps many people stay on the path to recovery.  These peer support programs prove highly successful in their ability to promote motivation and coping skills for sobriety.¹⁷

Additionally, finding a sober living community is 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 pursue recovery. 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 rebuilding their lives in recovery.¹⁷

A variety of approaches are available for tramadol addiction treatment, and they can be individualized for each person’s unique needs. To speak with a treatment specialist concerning your needs for tramadol rehab, call 800-934-1582(Who Answers?) 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.