Treatment Center Baltimore | Opiates, Opioid Addiction| Blog

February 28, 2020

Opioid Addiction: Why Do Users Have Cravings?

Addictions to anything-drugs, alcohol, sex, gambling-are quite serious. Every addiction has its own craving.

When it comes to opioid users, their cravings are massive and control their lives. In order to understand what opioid users go through, we must first define a “craving.”

According to Frontiers in Psychiatry, a craving:

“ is an overwhelmingly strong desire or need to use a drug, is a central component of OUD and other substance use disorders.”

Opioid Use Disorder (OUD) is sweeping the country. Whether the opioid is used for treatment or as an illicit drug, the craving for it is overpowering. The opioid user has a focused compulsion to use the drug as the euphoria and emotional response that it gives is motivational to continue the opioid addiction. This craving is long-lasting and cannot be filled unless the opioid is used. (Craving is included in the definition of opioid dependence in the International Classification of Diseases, Eleventh Revision.)

Addiction is, however, a chronic relapse based on the brain. There are many theories as to why someone would risk their health, reputation, occupation, and family to use opioids. One theory, known as “Opponent Theory,” proposes that the opioid user’s euphoria masks the pleasant or unpleasant sensations. Thus, they have the moment of enjoyment then come down, only to feel bad later. A short time later, the craving hits again, and the opioid addict returns to the drug.

Does this really explain the intense cravings experienced by opioid users? Do cravings ever go away?

Even in recovery, cravings may not disappear completely. But to say they “never go away” is both inaccurate and discouraging. An opioid user need not believe cravings will dominate their life forever.

Coping techniques, medications, and other forms of ongoing treatment can be of great help to the person in recovery. Recovery may follow them through life, but they also should know that cravings may fade with time.

What is needed to help break the addiction is the commitment of the opioid user in recovery to remain in treatment and learn coping mechanisms. As recovery moves into six months and beyond, cravings are less powerful. Opioid users even begin to master the craving control techniques they have learned in recovery.

Sobriety is the goal, and that comes with complete abstinence to the drug. Typically, this comes after six weeks in rehabilitation. There is no clear “rehabilitated” moment for every user. It is different for everyone.

It’s realistic, even after years of being sober, that former opioid users will have cravings from time to time. They may even be tempted to visit the places where they purchased the drug and used it. This is very normal and is reported by many former opioid users long after recovery and rehab.

However, these cravings are less of a desire to do the drug again and more of an annoyance. The psychological triggers to use opioids have passed, and now they can use the coping mechanisms they learned in treatment.

The bottom line is this: Opioid cravings are not something that “enslave” a person all their lives. Treatment, medications, behavioral therapy, and a healthy support system of family and friends can help a person overcome and even end opioid use for a lifetime.

If you have cravings for opioids, consult an expert. The Concerted Care Group of Central Baltimore, MD, and Brooklyn, MD, has a compassionate Behavioral Health team which includes therapists, a psychiatric nurse practitioner, a nurse practitioner, and a psychiatrist. Services include individual and family therapy for adults and adolescents. Group therapy and psychiatric services are available for adults.

For more information on opioid cravings, see this link.

January 30, 2020

by Concerted Care Group

What is Behavioral Therapy?

Addiction Treatment

Treatments for people addicted to drugs vary in scope and focus.

One type of treatment that has several types of therapies is known as “Behavioral Therapy”***. Addicts need incentives to reduce and end their dependence on the drug(s). Behavioral therapies accomplish this on several levels:

It helps the addict develop life skills that help them handle stressors that once caused them to resort to the addiction.
Cravings are blunted by redirecting environmental cues that make them desire the drug.
Drug abstinence is incentivized through newly learned behaviors.

Behavioral therapy intimately involves the patient in changing their behavior and moving forward, addiction-free and permanently changed. There are several types of behavioral therapy that are used for addicts and, specifically, opioid users:

Contingency Management (CM) is a popular behavioral therapy. It reinforces positive behaviors. Abstinence is the focus. This is used in methadone programs and has been shown to promote abstinence and increase treatment retention.
Voucher-Based Reinforcement (VBR) is for opioid abusers, mainly heroin, and cocaine users. The patient gets a “voucher” when their urine is tested and it’s drug-free. That voucher can then be used to purchase food, tickets, or other valuable items the patient can use. The vouchers start at a low value and increase in value as the patient successfully passes each urine test. If the patient has a positive urine test, the voucher values are reversed. Vouchers are an effective method of incentivizing opioid and cocaine users to stay clean.
Prize Incentives (PI) is similar to the vouchers but actually uses cash prizes as an incentive to stay abstinent. During a three-month period, the patient participates in breath tests or urine tests. If they are clean, their name is entered into a bowl for prizes worth $1-$100. Additionally, the patient may also get extra draws for attending counseling sessions or accomplishing goal-related activities. (This method has been criticized for promoting gambling though studies have shown that it does the opposite.)
12-Step Facilitation Therapy: Once again, abstinence is focused on utilizing 12-step self-help groups. From the patient’s daily or weekly attendance, they agree that their addiction is overwhelming and that they have absolutely no control over it. They cannot overcome their craving and dependence on it by themselves. So, they must surrender to a “Higher Power”. The patient then seeks the fellowship of other recovering addicts. The patient’s commitment to regular attendance and participation in the meetings has been shown to keep them abstinent and sustain recovery.
Family Behavior Therapy (FBT): Bringing a spouse, parent or significant other into the treatment has been shown also to be quite effective in leading the patient into positive behavior reinforcement. Opioid abuse is addressed along with other issues such as depression, unemployment, and abuse. Family Behavioral Therapy combines behavioral contracting with contingency management. The patient and family members apply the strategies and skills to improve their home life. Patients use new behaviors to stop opioid abuse. CMS (Contingency Management System) is used as an incentive when the behaviors are demonstrated. At the session, behavioral goals are reviewed. Rewards are given as goals are met. Patients can choose interventions from a menu.

This is not a complete list of behavioral therapies. There are other therapies that we will focus on in a future blog. If you or a family member have an opioid addiction, please contact a drug treatment center immediately.

Concerted Care Group of Central Baltimore, MD, and Brooklyn, MD, has a compassionate Behavioral Health team which includes therapists, a psychiatric nurse practitioner, a nurse practitioner, and a psychiatrist. Services include individual and family therapy for adults and adolescents. Group therapy and psychiatric services are available for adults.

***Click here for more information on behavioral therapy.

November 30, 2019

by Concerted Care Group

Outpatient Drug Rehab vs. Inpatient Treatment

Addiction Treatment, substance abuse treatment

Drug and alcohol rehabilitation programs were developed to meet the immediate needs of the substance abuser. Lodging Homes and Homes for the Fallen, known as “inebriate homes,” were opened in Boston in the 1850s to treat alcoholics.

In the 1920s, “Morphine Maintenance Clinics” were opened to treat people with morphine addiction. Halfway Houses began in the 1950s for drug and alcohol addicted persons – designed to be safe, recovery-focused homes.

From these homes and many other treatment advances came the modern outpatient drug rehabilitation and inpatient drug rehabilitation programs. These rehabilitation programs have helped millions of addicts recover from their drug addiction to lead normal, sober lives.

Outpatient drug rehab and inpatient drug rehab have both similarities and significant differences. Let’s look at how each one works for the patient.

Outpatient Drug Rehab

This type of rehab is a part-time program that does not require the recovering user to stay in a clinic full-time. Outpatient rehab allows the patient to go home or to school during the day.

The patient typically attends rehab programming 10-12 hours a week over 3-6 months, up to 12 months when needed. Sessions focus on drug abuse education, individual and group counseling, and learning how to cope with the challenges of life without taking the drug(s).

Outpatient drug rehab allows patients to remain in their home environment while benefiting from a structured therapeutic program. Clinicians assess their progress every week.

Outpatient drug rehab programs do not isolate them from people and situations which could negatively impact their recovery. Because patients still live in their own homes during treatment, they have to be genuinely motivated to refrain from drug abuse.

Support systems in their network, such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), provide group counseling and encouragement off-site. Thus, no patient will be recovering alone. Sponsors and peers are ready and willing to stand with them through every step of their recovery.

Many individuals in a long-term program may utilize outpatient drug rehab. Outpatient drug rehab can be effective for patients with mild or strong drug addictions.

Finally, outpatient care relies significantly on the involvement of the patient’s family. Unwavering family support and encouragement are crucial to the patient’s success in recovering from drug addiction.

Inpatient Drug Rehab

Individuals in a recovery program may also benefit from inpatient drug rehab. It is different in structure from outpatient drug rehab, but its goals are the same.

Inpatient drug rehabs are held in hospitals or residential substance abuse facilities. Both options require patients to live there 24-hours a day – completely removing the patients from their regular lives and peers. Thus, there is less temptation and opportunity to use drugs. In inpatient drug rehab, the patient’s entire focus is on detoxing from all addictive substances, getting sober, and learning how to stay sober.

Treatments times vary from 30, 60, or 90 days up to a year (or longer, depending on the progress made). Clinicians keep patients on strict schedules for medications, meetings, treatments, counseling, and other addiction care.

Inpatient drug rehab teaches patients to focus all their time and effort on taking personal responsibility for their lives while addressing the negative behavior which led to addiction. They also learn to develop positive habits that will help them stay sober. Their relationships, career, and community are tied to their recovery. Patients also receive recommendations for relapse prevention and sobriety support groups to join when treatment ends.

Outpatient vs. Inpatient

Both types of drug rehab options are beneficial, depending on the patient’s needs. A healthcare team will make a recommendation for each patient. If you or a loved one has a drug addiction, please consult a physician immediately.

Concerted Care of Central Baltimore and Brooklyn, MD, has an intensive outpatient drug rehab treatment program that allows clients to get the steady ongoing support they need for difficult periods in their recovery. It includes both individual and group sessions with qualified professionals who help guide individuals through challenging periods in their recovery. IOP is not intended to be a long term solution, but a bridge to stable maintenance.

Call Concerted Care at (833) 224-5483 for a consultation. We serve the Central Baltimore, MD, and Brooklyn. MD areas.

November 30, 2019

by Concerted Care Group

Opioid Addiction Treatment: Methadone vs. Buprenorphine

methadone treatment, Opiate Addiction, Opioid Treatment

Opioid addiction is increasing as millions of American citizens are using it to alleviate pain. According to US drug overdose statistics:

The death rate from drug overdoses more than tripled between 1999 and 2017, and that death rate from opioid overdoses increased almost six-fold during the same period. More people in the United States died from overdoses involving opioids in 2017 than from HIV- or AIDS-related illnesses at the peak of the AIDS epidemic.

As a result, new treatments for treating opioid addiction have been developed to help opioid addicts. Two of the most common drugs used are Methadone and Buprenorphine. There are two separate camps that believe that one is better than the other. We will examine both.

Methadone Treatment

One of the main goals in treating opioid addiction is reducing the craving for it. Methadone is a proven and effective synthetic opioid that reduces the craving. It has a long history of effectiveness as it was developed by German physicians during World War II and later used by US physicians to treat extreme pain. (Addiction was accurately portrayed by Frank Sinatra in the film, “The Man with the Golden Arm”. It is heralded as educating the public on the dangers of heroin.)

Methadone can be distributed as a liquid, powder, or tablet. It requires a prescription and must be monitored closely by a doctor. Methadone changes the way the brain and nervous system respond to pain. For pain, physicians typically prescribe methadone following surgery or in treatment from an injury or a chronic illness.

Additionally, methadone treatment is helpful in eliminating addiction to other opioids. Known as “replacement therapy”, this treatment replaces the opioids in your system with somewhat milder effects. Relief comes slowly as it blocks the high that comes from drugs like oxycodone, hydrocodone, morphine, heroin, and codeine.

Methadone treatment is most effective when supplemented with individual or group counseling. Opioid addicts are referred to drug counselors, social services, or medical personnel trained in opioid addiction counseling. Many companies offer these services under their medical benefits packages.

Buprenorphine Treatment

Buprenorphine is an opioid medication that is also used to treat opioid addiction. It is dispensed in a physician’s office. It can also be taken at home as a prescription.

Buprenorphine is known as “partial opioid antagonist,” meaning it may decrease physical dependence on opioids. Buprenorphine’s potential for misuse is lower than that of full opioids, and it also can reduce the craving for them.

Buprenorphine is still an opioid, however, so its side effects can be problematic. It is known to cause euphoria and respiratory depression in some patients. In low doses, buprenorphine can produce a basic agonist effect to reduce cravings and withdrawal symptoms. It can, however, reach a “ceiling effect” when increasing doses of the drug begin to reach a plateau. At this point, buprenorphine may no longer be effective for the individual.

Conclusion

Both methadone and buprenorphine have been proven to be effective treatment options for opioid addiction. Methadone, however, may be the most effective for long-term treatment.

If you or a loved one are battling opioid addiction, consult a physician immediately. They can recommend licensed drug addiction treatment centers suited to your needs. Opioid addiction cannot be treated alone. A team of medical personnel and addiction specialists are needed to help the addicted individual overcome this painful situation.

Concerted Care of Central Baltimore and Brooklyn, MD, Methadone Maintenance Treatment (MMT) utilizes methadone as one element in a comprehensive treatment program in which methadone replaces opiate drugs, including heroin and oxycodone. Call (833) 224-5483 or email info@concertedcaregroup.com for an immediate consultation.

March 27, 2018

by Concerted Care Group

Drug Addiction Help for a Loved One: How You Can Support Them

drug addiction recovery Concerted Care Group

Addiction Treatment

“Rock bottom became the solid foundation on which I rebuilt my life.”

~ J. K. Rowling

Sometimes, a person has to hit the bottom in their drug addiction before they can get help. Recovery is rarely a thought for them when they are intoxicated.

So, when they do hit rock bottom, like Rowling did, their loved ones need to be there to help them get treatment and help them, if possible, every step of the way to recovery.

February 27, 2018

by Concerted Care Group

Ron Shelley: Methadone Maintenance Treatment and The Step Up Program

methadone treatment

Ron Shelley is the chairman of the Concerted Care Foundation, a non-profit organization under the Concerted Care Group (CCG). The Concerted Care Foundation focuses on rehabilitating the community and servicing the needs of its clients and others in the Baltimore community; their focus is career development and education.

February 27, 2018

by Concerted Care Group

Treating the Whole Person: Methadone Maintenance Treatment and The Step Up Program

methadone treatment

Drug addiction recovery has been compared to a ladder leading out of a deep, dark hole. As the substance abuser climbs each rung up the ladder, they are closer to recovery. They never, ever want to fall back into the abyss as it will be even more difficult to climb out of it.

No recovering opioid addict wants to slip back into his or her destructive ways; they would rather get off the drug now and forever. This isn’t easy, even with the many benefits of methadone maintenance treatment. In fact, it could be a life-long battle.

February 20, 2018

by Concerted Care Group

Coming to Grips with It: Methadone Maintenance Treatment

coming to grips with it MMT Concerted Care Group

methadone treatment

“Speaking as somebody who’s been in the drug scene, it’s not something you can go on and on doing, you know. It’s like drink or anything, you’ve got come to grips with it.”

~ John Lennon

January 31, 2018

by Concerted Care Group

Doug Rashid, Board Member: Our Methadone Maintenance Treatment Strategy is Working

methadone treatment

Doug Rashid became a board member for Concerted Care Group soon after it opened. He serves on the board as a communications consultant for the board, as he is experienced in doing publicity and public relations for businesses in the Washington, D.C. area. Doug was also a pharmaceutical salesman for several years, which gives him a knowledge of medications.

December 31, 2017

by Concerted Care Group

Opioid Addiction: Ten Red Flags that Someone Has It

Opioid Treatment

Have you seen some strange behavior recently?

Have you wondered if they are addicted to some substance?

These are serious questions to ask yourself if you believe that your loved one, friend, classmate, co-worker, spouse or neighbor may have an opioid addiction.

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