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Suboxone treatment - how can you make sure it works for you?

Suboxone and the Need for Addiction Treatment

Quitting opioids? Then you’re probably at least considering Suboxone... and why not, after all, Suboxone and methadone increase your odds of long-term recovery while also reducing withdrawal discomfort.1

So if considering Suboxone, you might wonder why you also need to bother with addiction treatment – if a daily pill takes away your cravings and withdrawal symptoms… what’s left to worry about?

But the truth is, by combining medication with psychosocial therapies you greatly increase your odds of lasting success.

Without addressing your addictive tendencies and without learning compensatory strategies to manage the brain changes associated with addiction, you’ll likely relapse once off Suboxone – or if you stay on Suboxone over the long-term, you’ll just get addicted to something else (cocaine, alcohol, etc.)

Read on to learn more about:

  • Why you need counseling as well as medication – and what you can expect to learn from counseling and other behavioral therapies
  • Why you don’t just ‘trade addictions’ when initiating Suboxone therapy
  • The long-term risks associated with cold-turkey opioid detox
  • How to get the most out of your Suboxone therapy
  • Your eligibility for Suboxone

If Suboxone alone could do the job, you wouldn’t likely see the manufacturer (Reckitt Benckiser) recommending Suboxone as only one part of a complete treatment plan that should also include counseling and behavioral therapy.2

6 Essential Benefits of Addiction Treatment

Why medication alone isn't enough...

Medications can reduce cravings and withdrawal symptoms to a manageable level. They help you stabilize and focus and they greatly increase your odds of lasting change - but as powerful as medications like Suboxone are, they're not a magic cure; you'll still need to work very hard.

Addiction causes brain changes that lead to compulsion and poor impulse control.3 These brain changes are lasting or permanent and they cause functional changes to the way you think and feel. Fortunately, by learning coping strategies, such as those taught in an addiction treatment program, you can learn to manage your impulses and minimize your risks.

Whether you get intensive rehab care or join an intensive outpatient group, most addiction treatment programs are designed to help you make difficult changes and to provide you with certain necessary skills - here's a list of 6 essential benefits of participation:4

1. Sustaining Motivation

It’s normal to feel somewhat ambivalent about major life change and to find that motivation waxes and wanes over time.

  • But when a temporary motivation dip can lead to relapse and lasting consequences, it’s important to prepare for down-turns and make certain that your long-term goals drive your day-to-day behaviors.

Motivational enhancement therapies help you overcome drug ambivalence, identify personally relevant goals (what’s important to you – not anyone else) - and teach skills that keep you focused on your long-term objectives.

2. Increase Relapse Prevention Skills

Long-term goals are only as useful as your ability to manage immediate impulses and cravings. Therefore, virtually all addiction treatment programs teach relapse preventions skills, such as:

  • Looking back at past relapses - identifying behavior patterns associated with relapse.
  • Identifying the people, places and things that you associate with using/drinking.
  • Learning to identify warning signs of imminent relapse (such as overconfidence, isolation, deception, etc.)
  • Learning relapse prevention coping strategies, such as distraction techniques, mindfulness and scheduling.
  • Writing a recovery plan for high-risk situations.

3. Replacing Negative Activities with Constructive Habits

If you take Suboxone but continue to engage in all the same negative or risky behaviors of active addiction you are likely to fall back to getting high.

  1. Your environment, behaviors and thoughts all influence your ability to maintain recovery. 
  2. You need to identify negative habits and make a plan to replace these with more productive activities.

For example, you are more likely to maintain recovery by getting out of the house and working/volunteering/going to school than you are by hanging around all day with old drug-using friends.

4. Improve Frustration Tolerance and Problem Solving Ability

By letting small problems build into overwhelming obstacles you increase the amount of frustration in your life. In the past you turned to drugs or alcohol as a way to cope with frustration, what will you turn to now?

By learning better problem solving skills and by learning to handle frustration and other negative emotions you increase your chances of lasting recovery.

5. Build and Sustain Healthy and Supportive Relationships

Most people in active addiction behave in ways that diminish the trust and solidity of important relationships. In addiction treatment you may receive couples or family counseling to help repair past damage and to rebuild healthier systems that support recovery.

You’ll also develop new sober friendships to replace the relationships you lose when changing your lifestyle.

6. Improve Your Community Functioning

Through addiction treatment programs you gain access to volunteer, educational and vocational programs that get you out into the community in a positive way.

Suboxone: 5 Secrets to Success

Research shows that opioid substitution therapy (methadone and Suboxone) is superior to all other forms of detoxification on outcomes such as decreasing drug use and sticking with treatment, but still, not everyone finds what they need from Suboxone therapy.1 Here are some steps you can take to improve your odds of success. 

Beyond getting addiction treatment you can also improve your odds of success with Suboxone by:5

  1. Committing to comprehensive treatment (some combination of medication and counseling/behavioral therapies) for an adequate and appropriate length of time. There are no quick fixes to addiction, and though you may choose to skip counseling and taper off Suboxone quickly, this approach increases your risks of relapse.
  2. Getting your family and other supportive loved-ones involved in your treatment process.
  3. Spending some time once stabilized on Suboxone also dealing with other physical or mental health disorders requiring treatment. Unmanaged illness increases your relapse risk. 
  4. Committing to a program that uses drug testing. Drug screening gets you help fast after a slip-up and provides you with extra motivation to remain abstinent.
  5. Avoiding other drugs and alcohol - It’s too easy to simply transfer your addiction.

Aren’t You Just Switching Addictions?

No, though you will remain physically opioid-dependent, most people who initiate Suboxone therapy see a significant decline in behaviors typically associated with addiction, such as:6

  • Reduced or eliminated physical withdrawal symptoms (on short-term opioids, you might experience a daily cycle of intoxication/withdrawal).
  • An end to compulsive or out of control use.
  • An end to drug seeking behaviors (this allows you the time and energy needed to start rebuilding your life).
  • Reduced or eliminate opiate cravings. 

Shouldn't You Feel Some Pain?

  1. Detox pains don’t help people avoid relapse.
  2. Extreme withdrawal symptoms can predispose you to mental declines down the road.

Some people wonder if using Suboxone to avoid/delay and minimize opiate withdrawal symptoms is akin to running from the consequences of your actions – sort of like cheating.

  • Don’t you need to suffer a bit through withdrawal so you won’t fall back into old habits – doesn’t the memory of all that pain help you stay on the straight and narrow?

OK, here the thing about addiction and brain diseases – things that sound good and make sense aren’t necessarily true or effective. While the idea of negative reinforcement makes intuitive sense, there is overwhelming evidence against its effectiveness as a deterrent – and you can see how poorly unassisted detox worked by looking at the relapse rates of those put through cold-turkey detoxes at federal hospitals through the mid part of last century – close to 100% relapse rates.7

So withdrawal discomfort does not help people maintain abstinence. The forces that lead to relapse emerge out of addiction-caused changes to brain structure and to diminished impulse control, memory and planning. Discomfort isn’t teaching, it’s just unpleasant.

So there’s no real benefit to enduring opioid withdrawal discomfort, but according to research presented this month (November 2013) difficult opioid withdrawal symptoms may cause long-term harm.

Researchers at Georgetown University Medical Center studied the brains of animals either maintained on morphine or maintained on morphine and then forced into withdrawal.8

The Results

They found that animals forced through opiate withdrawal had higher levels of neurotoxic cytokines and less of neuroprotective proteins, like CCL5. Cytokines cause brain inflammation and impaired thinking and are linked to conditions like Alzheimer’s and Parkinson’s.

  • Based on their findings, the researchers conclude that cold-turkey withdrawal may be a causative factor in mental decline.

Take-Home

  1. Cold-turkey withdrawal is unpleasant.
  2. It does not help you maintain abstinence. It is actually associated with significantly higher relapse rates.
  3. Withdrawal may be toxic to the brain and may contribute to mental declines.

Are You Eligible to Take Suboxone?

Suboxone combined with counseling and behavioral therapies offers you an excellent chance at building long-term recovery, but are you eligible to take this medication?

Suboxone might be right for you if:

  • You are opioid dependent
  • You are willing and able to follow dosing directions and other instructions
  • You are able to understand an informed consent document and willing to sign
  • You have no serious psychiatric illness that might compromise your ability to comply with treatment directives
  • You are not allergic to buprenorphine or naloxone
  • You have no serious liver dysfunction, paralytic ileus or acute respiratory distress
  • You are not pregnant (though pregnant women may be able to take other substitution opiates, like methadone or Subutex)

The following factors may affect eligibility:

  • The concurrent abuse of other drugs or alcohol, particularly a severe dependence on sedating drugs like benzodiazepines and alcohol
  • Chronic pain
 
 
 
References
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Page last updated Oct 13, 2014

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