Why do so many opiate addicts relapse within the first year after completing treatment?

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Answered by: Eliza, An Expert in the Addictions - General Category
Statistics show that 90% of opiate addicts will relapse within the first year after completing a traditional treatment program. The numbers look grim, but understanding the mechanics of opiate addiction can help make sense of this statistic. Furthermore, understanding the way opiates affect the brain over time can expand treatment options for those in need.

Opiate addiction varies from other addictions, especially in the way it affects the brain. We all have naturally occurring opiates in our brains, which regulate things like mood, motivation, and pain. Our brain releases these chemicals when we need them, helping to elevate our mood if we are having a bad day, or motivating us to get the housework done, or taking away pain from minor injuries. These naturally occurring opiates are found in each one of our brains, and they are essential to our daily function.

When one takes opiates daily for a length of time, these naturally occurring chemicals are altered in their brain. Over time, the brain quits making its own opiates, as the user is supplying more than the brain needs to function normally. When one quits taking these opiates, the brain is suddenly completely devoid of these essential chemicals, which causes the symptoms of withdrawal.

Without any opiates, many opiate addicts suffer from nausea, vomiting, diarrhea, cold chills, muscle aches, insomnia, and various other symptoms. Many opiate addicts claim that the first three to five days of withdrawal are hell, and many of these opiate addicts do not even make it through those initial stages of withdrawal, as the brain reels from complete lack of opiates. After a week or less, these excruciating symptoms will subside.

The opiate addict's brain, however, takes months and even years to return to its normal functioning. During this time, these opiate addicts experience extreme fatigue, lack of motivation, depression, and sensitivity to pain. This period of withdrawal is referred to as Post Acute Withdrawal Syndrome, known as PAWS in the addiction world.

These Post Acute Withdrawal Symptoms can vary in severity and length, depending on the opiate addict's level of use. The opiate addict who has used for more than a year will often experience PAWS for many months, or longer. Also, the opiate addict who used more of the substance, with less breaks in using, will experience this long-lasting withdrawal for longer. Furthermore, intravenous opiate addicts will experience PAWS even longer. It is during these months, or even years, following the initial harsh withdrawal, that many of these opiate addicts relapse. It seems that the long-lasting effects of PAWS often sends opiate addicts back to their drug of choice.

Many opiate addiction experts advocate for the use of replacement therapy during the first two years of recovery. Traditionally, methadone was used as a replacement for drugs like heroin and oxycontin, allowing the patients to stave off withdrawal while working to improve other areas of their life. Methadone is often thought to come with another list of problems, including addiction to another substance.

The opiate addict must attend the methadone clinic everyday for quite some time, which often ties them to the clinic, and does not allow them to break their daily habit of procuring their fix. Furthermore, over the years, many of these methadone clinics have failed to provide the counseling support these opiate addicts need to remain clean. In recent years, though, statistics have shown that with proper counseling and support 60% of methadone patients who get off methadone after at least two years of treatment remain clean for at least five years.

With the knowledge of this valuable statistic, some methadone providers began to provide this much needed counseling and support. In addition, the introduction of Buprenorphine has revolutionized treatment for opiate addiction. Buprenorphine is a low-level opiate that has quite an affinity for the opiate receptor, meaning that this drug fills all the opiate receptors, which will not allow other opiates to bond to these receptors.

If the opiate addict uses other opiates, he or she will not feel the effects of these drugs. Because Buprenorhine is not a strong opiate, like methadone, many of the opiate addicts who choose this new drug will not feel any of the euphoric effects that many opiates can cause. Buprenorphine is provided in a doctor's office, and the opiate addict is generally given a month's prescription for the drug, freeing them of the daily obligation to a methadone clinic. Unfortunately, most Buprenorhine providers do not provide counseling, so many opiate addicts must seek other treatment options on their own.

No method of opiate treatment is perfect, or even all-encompassing. Opiate addiction is individualized and often complicated. Many experts today recommend a combination of replacement therapy and traditional treatment to give the opiate addict the best chance for remaining clean after treatment is complete.

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