Non-Pharmaceutical Options
As well as medication-assisted withdrawal, other options can help you through the withdrawal process. These treatments aim to make the withdrawal more manageable and comfortable for you and to teach you positive coping strategies. This is often known as psychosocial treatment, which can be defined as, “including cognitive and behavioral approaches and contingency management techniques”.
Assistance with social needs
Many people who are struggling with opioid addiction may find it hard to engage with ‘normal’ daily life. Chronic pain itself can be a barrier enough to daily functioning, but when you combine that with dependence on opioids, things can get tough. A vital part of opioid withdrawal treatment should be assistance with social needs to help patients regain their quality of life and access the support they need.
Employment - Many people with chronic pain and opioid dependency are out of work or struggle to keep up with the demands of a job. Help to get back to work can include providing hope for the patient about other effective chronic pain treatments to enable them to increase their levels of functioning, as well as vocational training. Vocational training centers around educational and training programs to help you find work and be realistically able to maintain your job. This can include, “skills training, sheltered work environments, and monitoring of drug use during employment.”
Housing - Whether an individual is homeless, not inappropriate housing, or in a housing situation that is detrimental to their physical and mental well-being, housing assistance services can be useful. This may involve finding temporary accommodation, assisting you with getting the right benefits and financial help if you’re out of work, and finding more permanent accommodation which meets your needs. Being in the right environment is vital to manage opioid withdrawal, reduce the risk of relapse, and enable you to manage your chronic pain effectively.
Food - As with housing, patients must have access to the nutrition they need to maintain their physical health both during and after withdrawal. This might involve pinpointing you to food banks if resources are stretched, providing nutritional guidance about a balanced diet, or teaching cooking skills.
Self-help groups - Self-help groups can focus on chronic pain specifically, to give you the ongoing support and advice you need moving forward. Alternatively, they can focus on opioid withdrawal to support you through the process both during and after withdrawal if you feel you need it.
Self-help groups tend to be small, face-to-face groups with other people who are going through similar struggles. Sometimes being around other people who really ‘get it’ can be invaluable. Self-help can also be part of 12-step programs for addiction, which have a set structure patients work their way through to help them sustain their withdrawal.
The WHO guidelines explain that support groups, “often provide both material assistance and emotional support, and promulgate an ideology or values through which members may attain a greater sense of personal identity.”
Activities and hobbies - Finding purpose, distraction, and things you enjoy is one of the biggest motivators for both opioid withdrawal and chronic pain recovery. You may receive help to access leisure activities and hobbies, as well as support with setting goals going forward.
Building social skills - Social isolation is very common in those with chronic pain for many reasons, as well as for those with opioid dependence. When you’re not interacting socially you can lose social skills which may have come naturally previously. It can also feel anxiety-inducing to be in social situations when you have become used to being isolated. Providing social skills training can enhance confidence and equip patients with the tools they need to rebuild their social life.
Spiritual support - For those who are religious or have spiritual beliefs, providing access to this type of support is vital during withdrawal and recovery. This can enable them to feel more hopeful, strong, and determined.
Cognitive Behavioral Therapy (CBT)
CBT works based on replacing negative thought patterns and behaviors with more positive, helpful ones. CBT for opioid withdrawal focuses on changing addictive behaviors and learned patterns of behavior. A big part of CBT during withdrawal should be educating patients about other ways to manage their chronic pain and providing hope for the future.
For example, during CBT a patient going through withdrawal may be taught how to change dependent thinking such as ‘I need opioids or I’m never going to be able to manage my pain’, to more positive thought patterns such as ‘I can manage my pain without opioids’. They will be taught to break the association between chronic pain and the immediate need for opioids, and instead learn that chronic pain can be reduced with other natural methods.
The World Health Organization (WHO) guidelines for opioid withdrawal state that, “Cognitive approaches primarily aim to change addictive behaviors by changing faulty cognitions that serve to maintain behavior, or by promoting positive cognitions or motivation to change behavior.”
The aim of CBT is not only to help the patient through the withdrawal process, but to educate, prepare and equip them for the future managing their chronic pain without the use of opioids. The tools they learn through CBT can be carried forward and applied in their day-to-day life to reduce the chances of relapse.
Mindfulness
Mindfulness centers around being present at the moment, not allowing worries from the past or about the future to concern you. Mindfulness practices provide a deep sense of grounding, stress relief, and relaxation. Mindfulness can be incredibly useful during withdrawal to help patients cope, to help them relax and provide comfort, and to enable them to sleep more deeply.
The process of mindfulness can enable patients to make more helpful choices, aiding in breaking the addiction cycle. Learning mindfulness tools can enable you to maintain a greater sense of emotional control moving forward.
Mindfulness is also very helpful in treating chronic pain, helping to break the stress and pain cycle and easing muscle tension. This equips patients with the tools to manage their chronic pain after withdrawal and to reduce the risk of relapse.
Mindfulness techniques will often be combined with medication-assisted withdrawal to bring optimal results for patients. One study found that “those who received methadone and a mindfulness training-based intervention were 1.3 times better at controlling their cravings and had significantly greater improvements in pain, stress, and positive emotions”.
Psychotherapy And Counselling
Structured counseling may be used to help patients through the experience of withdrawal and to help them gain greater coping skills for the future. Psychotherapy may also be used which is a very structured approach to dealing with problems and emotions. These talking therapies can help you to express what you’re going through and find better ways to deal with your problems.
Family Therapy
Often families attend counseling together to help resolve issues that could be adding to the stress. During family therapy, your loved ones may learn how to support you while you withdraw from opioids and learn to help you cope with your chronic pain moving forward. This can be useful to create a healthy, adaptive family dynamic for the patient.
Precision Pain Care and Rehabilitation has two convenient locations in Richmond Hill – Queens, and New Hyde Park – Long Island. Call the Queens office at (718) 215-1888 or (516) 419-4480 for the Long Island office to arrange an appointment with our Interventional Pain Management Specialist, Dr. Jeffrey Chacko.
