Withdrawal and detox
Certain drugs such as Cocaine and Cannabis do not require prescribed medication to help with withdrawal symptoms. Being admitted to a residential drug rehab helps to break the addictive cycle. It provides a place of safety to engage within a daily structured treatment programme.
Heroin detox
However, for a heroin user a residential drug rehab will also be able to offer a medicated detox prescribed by the clinic’s GP. Heroin is a highly addictive substance that can lead to physiological changes in the brain and alterations in behaviour.
Heroin binds to the brain’s opioid receptors and central nervous system activating certain neurons because their chemical structure mimics the body’s natural opioids more commonly known as endorphins. However, heroin also activates opioid receptors in a different way leading to abnormal signals being sent to the brain and the brain stem. The brain will adapt with regular heroin use but higher doses will need to be taken to feel the same effect and dependence on the drug will mean that it will need now to be taken to avoid going into severe heroin withdrawal.
Some heroin users that are admitted to The Haynes Clinic are being seen by their local drug and alcohol team and they are being prescribed Methadone as a daily heroin substitute which acts on the brain in a very similar way. They have, though, been caught out by body tolerance where the body has become used to the daily amount of Methadone and is craving or needing more to get a similar effect. They will then buy heroin and use it on top of the methadone, as they have used their daily dose of methadone and still feel a need for more. This will then get picked up on a drug screen by the drug and alcohol team. If they were in line for a community residential detox they will automatically be put to the back of the queue for misusing heroin with their prescribed methadone. So basically, they have sabotaged any chance of a free detox and will need to look to private treatment to get any immediate help. Usually, those seeking a heroin detox are relatively young as heroin has such a detrimental effect on the body that users rarely get to old age.
A residential drug detox from heroin will usually take up to 14 days and the drug that is used to counter any effects of withdrawal is Subutex (or buprenorphine). Subutex is a controlled drug and is kept away from other medications in a separate locked cupboard and there is even a different coloured GP prescription in order for the rehab to obtain it.
Having been assessed by the GP then a starting dose of Subutex can be administered. This will usually be after about 12 hours from the last time that heroin was used, as it needs to be about the time when withdrawal is starting. If the test dose is not sufficient, then the dose can be slowly increased up to its first day maximum. The dosage is then slowly reduced over the next 10 or so days (depending on individual need). Subutex is an opioid agonist which means it binds to the same brain receptors as heroin. However it has a different result as it eliminates the high or euphoria of heroin use and it also eliminates heroin withdrawal symptoms and reduces any cravings for heroin.
Drug addiction treatment alongside heroin detox
Usually anyone admitted for a heroin detox will be joining the treatment programme within 24 hours of their detox starting. People have this misconception that with a drug detox you are spending time in bed, not able to start engaging and this is simply not true. You should not feel too ill if the medication works as it should and it is important to make the most of each day you spend in drug rehab. 28 days goes quickly (especially after the first week).
Changes required during drug rehab
It is important to be willing to accept that, before coming into treatment, our thinking was flawed. During treatment, we will need to understand the changes that need to be made. We will need to take direction from qualified therapists so we understand what we need to do when we leave.
During treatment, there will the attendance at support groups which will cover addictions other than just our own. For those with a heroin addiction, Narcotics Anonymous will be be most relevant. By initially attending with other members of the group, who are currently also in treatment, it makes it easier and helps with understanding how the support group process works. This, combined with lectures and workshops around the 12 Step programme, starts to help people look at the changes they need to make to their thinking and behaviour in order to get well.
Being in treatment for 28 days is basically just the start of our Recovery and to think that is all that is needed would be very wrong and a relapse waiting to happen. The reason that a drug rehab has a daily structured plan is to try and get us to also to have more of a planned day and to set goals and to have a purpose. Continuing daily structure, when we leave treatment, is critical. At The Haynes Clinic, for those who have been in treatment for 28 days, there is Aftercare, one day a week and this is completely free of charge. You can also attend for as many months as you want to. It is ongoing support, at the clinic, and if you do not live close by then there are Zoom aftercare meetings. This facility is really useful as it enables people to share what is going on in their lives, post rehab, and to get support and direction from therapists that they know and trust.
One of the priority changes that a heroin user needs to make, having left treatment, is to change their mobile phone number. This stops contact with drug dealers or so called using friends. In fact, the other priority is a complete change of the people we used to associate with as really they were not our friends but people we used to mix with that also used heroin. This is where the changes that we have learnt to make in drug rehab treatment are so important because if we go back to a life we used to lead then we will get everything that comes with it, including that relapse.