Drug addiction is a vicious, unrelenting hunter. Cunning and craft, it's a carnivore that never ceases stalking its prey. Drug addiction is a hardened killer laying silently in the tall grass, belly-all-a-grumble, studying your every move, learning your every weakness, and waiting to pounce. Drug addiction is a meat-starved coyote.
In 2017, more than 70,000 people died from drug overdoses, and in 2018, it killed more than 67,300 Americans. These shocking numbers make it a leading cause of injury-related death in the United States, and more shocking still, sixty-eight percent of those deaths involved a prescription or illicit opioid. The path to drug addiction begins with taking drugs voluntarily, but the power of choice soon ends. Over time, seeking and taking the drug becomes compulsive, because addiction affects parts of the human brain involved in reward and motivation, learning, memory, and behavior control. As humans, we are (unfortunately) uniquely vulnerable to addiction; it's an inherent fault in the way we are wired. The coyote has always followed us, you see. A coyote runs at a top speed of roughly 43 mile per hour; we will never be able to outrun our addiction, so we have to outsmart it.
We can help. You can overcome drug addiction and have a better life than you ever thought possible!
Addiction is a chronic disease characterized by the compulsive, uncontrollable seeking of the very same substances that slowly killing a person. It's a vicious foe because even the strongest of people, without proper assistance, are incredibly prone to relapse. Coyotes never quit coming, ever. When hungry enough, they will stalk their prey for weeks, waiting for the perfect moment to go in for the kill. Most patients need long-term or repeated care to stop using completely and recover their lives. We are all human, and we all deserve a chance to fight the coyote head on. There are two main types of relapse, the first being "Traditional Relapse, which is when someone intentionally returns to using drugs or alcohol. The second is called a "Freelapse," which refers to someone accidentally ingesting drugs or alcohol, having no intention to actually do so.
People who relapse often face risk factors in the days, weeks, or months leading up to the actual act of relapsing. These can be considered warning signs if we become familiar enough with them and sensitive enough with them to recognize what's coming. Risk factors usually come in the form of difficult feelings or experiences that challenge their ability to cope with their addictions without their substance of choice. And, the greater the number of risk factors, the higher your risk for relapse.
There are three main stages to relapse:
Since we cannot outrun the coyote, we have to outsmart him, and that requires hacking our very own human brain wiring. We have to make our human nature work FOR us rather than FOR the drugs. Thankfully, we have tools at our disposal for battling addiction, and with help from others and a dogged commitment to getting clean, it is possible to beat it for good. Any decent treatment program must address and include the following: behavioral counseling, medication (if needed), medical devices used to treat withdrawal symptoms, training, evaluation and treatment for co-occurring mental health issues such as depression and anxiety and plans for long-term follow-up to prevent relapse.
Based on drug abuse research started in the mid-1970s and continued to present day, there are some key principles that should form the basis of any effective treatment program.
One of the biggest hurdles to beating drug addiction is the managing of the withdrawal symptoms that occur during detox. Withdrawal can be incredibly painful, because your body has adapted to the presence of the drugs in your system and when you abruptly stop using drugs after long-term use, your body is thrown into a kind of panic-mode. You can become violently ill and produce a range of withdrawal symptoms as your body tries to adapt to the sudden absence of drugs. Withdrawal symptoms from drugs or alcohol vary depending on the type of substance you become dependent on. Stimulants like methamphetamine normally produce psychological symptoms, while alcohol, prescription drugs, and heroin can cause a range of physical and psychological symptoms. Drug withdrawal can last anywhere from a day or two to several weeks. Common drug withdrawal symptoms include: sweating, tearing eyes, runny nose, hot and cold flushes, nausea, vomiting, diarrhea, muscle cramps, muscle aches, tremors, significantly increased appetite, dehydration, elevated heart rate, elevated blood pressure, poor concentration and memory, insomnia, restlessness, irritability, agitation, anxiety, depression, hallucinations, delirium and seizures.
It is definitely not advised to try to go through detox alone. The symptoms of withdrawal can be painful and often life-threatening. Your best bet is a medical detox, which allows you to recover from drug dependence while receiving medical care and supervision, and often involves the use of certain medications that can help to relieve and reduce symptoms. Detoxification is not in itself "treatment," but only the first step in the process. Patients who don't receive any further assistance after detoxification overwhelmingly tend to resume their drug use.
Studies done by SAMHSA in 2014 found that medications were necessary and used in almost 80 percent of detoxifications. People who suffer from heroin and painkiller addiction can receive medications in drug detox that relieve the opioid withdrawal symptoms and also help to lessen and manage the cravings for the drugs. Methadone, buprenorphine, and naltrexone are FDA-approved medications for opioid addiction, and these drugs can be prescribed as part of medical detox or medication-assisted treatment (which is drug therapy combined with counseling and behavioral therapy.) Those who suffer from addiction to prescription drugs like benzodiazepines, amphetamine, and sleep aids can be put on "tapering schedules" to avoid withdrawal. Tapering is when doctors slowly reduce doses of these drugs gradually over a period of time until patients are no longer using these medications. They "ween them off" a little bit at a time to reduce the severity of the withdrawal symptoms. Tapering schedules and medication management are included as part of drug detox, and people who use more than one drug, (which is extremely common) require careful, considered treatment that addresses all of the substances they use.
Opioid detox: Methadone, buprenorphine, and naltrexone are used to treat opioid addiction. Acting on the same targets in the brain as heroin and morphine, methadone and buprenorphine mitigate and suppress withdrawal symptoms, while also giving a small "fix" or relieve cravings. (Naltrexone blocks the effects of opioids at their receptor sites in the brain and should be used only in patients who have already been detoxified.) All these medications help patients reduce drug seeking and related criminal behavior and help them become more open to more behavioral-focuses treatments. A NIDA study found that once treatment is initiated, both a buprenorphine/naloxone combination and an extended release naltrexone formulation are similarly effective in treating opioid addiction. Because full detoxification is necessary for treatment with naloxone, beginning treatment among active users was difficult, but once detoxification was complete, both medications had similar effectiveness.
Tobacco: Nicotine replacement therapies have several forms, including the patch, spray, gum, and lozenges. (These products are all available over the counter.) The U.S. Food and Drug Administration (FDA) has approved two prescription medications for nicotine addiction: bupropion and varenicline (also known as Chantix.) They work differently in the brain, but both help prevent relapse in people trying to get off nicotine. The medications are more effective when combined with behavioral-focused treatments, such as group and individual therapy as well as telephone "quit lines."
Alcohol: Three medications have been FDA-approved for treating alcohol addiction and a fourth, topiramate, has shown promise in clinical trials. Naltrexone blocks opioid receptors that are involved in the rewarding effects of drinking and in the craving for alcohol. It reduces relapse to "heavy" drinking and is highly effective in some patients. (But it should be noted that genetic differences may affect how well the drug works in certain patients.) Acamprosate may reduce symptoms of long-lasting withdrawal, such as insomnia, anxiety, restlessness, and dysphoria (which is a general feeling unwell or of being unhappy). It may be more effective in patients with severe addiction. Disulfiram (also known as Antabuse) is a drug that interferes with the breakdown of alcohol. Acetaldehyde builds up in the body, leading to unpleasant reactions that include flushing (warmth and redness in the face), nausea, and irregular heartbeat if the patient drinks alcohol. Compliance (which means following instructions and taking the drug as prescribed) can be a problem, but it may help patients who are highly motivated to quit drinking.
Sometimes devices can also be used to manage withdrawal symptoms during detoxification, prevent relapse, and treat co-occurring conditions, but they must be used under the direction of a qualified medical professional. In November 2017, the Food and Drug Administration (FDA) granted a new indication to an electronic stimulation device, "NSS-2 Bridge," for use in helping reduce opioid withdrawal symptoms. This device is placed behind the ear and sends electrical pulses to stimulate certain brain nerves.
Preventing relapse is key, or all the pain and struggle of detox has been for nothing. An addict trying to get clean must always remain vigilant, listening for the footsteps of the coyote behind him. If you or someone you love is struggling with alcohol or drug addiction and are ready to seek treatment, the good news is that while we can never outrun the coyote, we are far, far smarter, and we have developed tools to give us the upper hand. We no longer have to be prey. We can shake the predator for good.