Suboxone Addiction

Rehabilitation specialists prescribe Suboxone as drug replacement therapy, or DRT, for the treatment of opioid dependency or addiction. Suboxone contains buprenorphine, a mild opioid, which reduces withdrawal symptoms associated with opioid detoxification but this drug does not cause euphoria like other opioid. Because it contains the opioid buprenorphine, it is possible to become physically dependent or addicted to Suboxone.

The definition of addiction

Using Suboxone for a long time, as in DRT, can result in physical dependence or addition, two separate and independent medical conditions.

Addiction is a chronic, primary condition. This means addiction is not the result of other illnesses and that the individual will need long-term treatment. Addiction is a neurobiological disorder, which means that this disease affects the cells of the central nervous system. Genetic, psychological, social, and environmental factors influence the development of opioid addiction and these same factors influence the ways addiction affects each individual. No two addictions are alike.

Specialists characterize addiction by various behaviors, such as being unable to control Suboxone use, compulsive use of this medication and cravings.

Addiction is closely associated with dependence, but there are distinct differences between the two disorders.

The Definition of Dependence

Physical dependence on Suboxone means the body needs to maintain a certain level of buprenorphine to feel normal. If the level of opioids drops below that level, the opioid-dependent body struggles to regain chemical balance. The individual feels this battle for chemical stability through uncomfortable, flu-like withdrawal symptoms.

Medical professionals diagnose a patient as being physically dependent on buprenorphine if he suffers symptoms once levels of this opioid drops. This decline in opioids levels happen either by not taking the opioid or through the administration of certain drugs, such as naloxone.

Suboxone contains a 4:1 ratio of buprenorphine and naloxone. The naloxone reduces opioid levels and acts as a deterrent by causing unpleasant withdrawal symptoms if the individual takes other opioids.

Addiction versus Dependency

Dependence is a state where a person's body needs a drug in order to feel normal, whereas addiction is the compulsive use of a drug. Addiction and dependence on drugs such as Suboxone are separate and independent from one another: you can be physically dependent on a drug without being addicted to it and vice versa. For example, a person may need anti-hypertensive medication to keep her blood pressure at safe levels; if she were to stop taking the drug, her body would struggle to maintain blood pressure but she would not experience cravings for the medicine.

Conversely, you can be addicted to cocaine without physical dependence. A person addicted to cocaine will crave more once he runs out, but the drop in cocaine levels will not result in physical withdrawal symptoms.

Both addiction and dependence cause real changes to the brain and body, but Suboxone addiction and dependence manifest themselves in unique ways.

Addiction: What Family Members Should Know

Addiction is a disease. Addiction is not an indicator of low moral character. In fact, a person may become addicted to Suboxone while using it as prescribed by a doctor.

Like other chronic diseases, addiction affects the entire family. Researchers believe addiction may be hereditary, at least in part, passed from one generation to the next. Environmental factors within the family unit, such as marital stress, financial difficulties and other relationship problems, increase the risk for addiction for all family members.

Family members should be aware that opioid addiction causes collateral damage within the home. Legal issues, expenses, loss of income, relationship breakdowns and other problems frequently develop as the result of addiction.

Addiction is a negative influence but recovery can have a positive effect on a family. Adversity strengthens the bond between individuals. Each member is a valuable partner the supportive family network.

The family plays a vital role in recovery from opioid and Suboxone addiction. Much of the time, a family member is the first to bring up the issue of addiction and encourage the addicted individual to seek and complete treatment. Frequently, the family locates the facility where the addicted person eventually seeks treatment.

Do not let your loved one hit "rock bottom" before helping. Early treatment reduces the risk for health hazards associated with addiction, such as hepatitis, AIDS, infections and more.

It is possible to arrest the disease's progression at any time. As long as the individual is still alive, he can still work towards recovery.

Recovery begins when the individual recognizes the problems his addiction brings, including failed relationships, legal problems, financial difficulties and poor health. While it is tempting to shield a loved one from the ravages of his disease, it is critical that the addicted individual be aware of the pain his addition causes. Family members must strive to support a loved one without enabling him to continue using opioids.

Drug replacement therapy and recovery from subsequent Suboxone addiction works best when the addicted individual feels physically, emotionally and spiritually safe in his home environment. Family members should recognize addiction as a disease and avoid blaming the individual for his illness.

Family members should know that opioid addiction affects every member of the household. Researchers think that addiction is hereditary, passed from one generation to the next; young family members should recognize an increased risk for addiction if one or both parents suffer from addiction.

Caring for a Family Member with an Addiction

Addiction is extremely difficult for every member of the family but it is important to remember that your loved one relies on support for a successful recovery. The family can work together to develop a treatment plan, with every member playing a role in recovery. The family unit should meet frequently, with or without the addicted individual, to discuss progress.

Learn everything you can about addiction, Suboxone and the treatment for Suboxone addiction. Visit websites, ask questions and seek referrals from other people who have supported a loved one battling this disease.

It is okay to talk about addiction, within the home and with people outside the family unit. Encourage communication between family members, even before the addicted person is ready to talk about his disease. Start a conversation with another member of the family. Shared common emotions and experiences can unite family members and help them forge a common path to recovery. The support and guidance of a strong family unit is a powerful asset when battling Suboxone addiction. Trained counselors can show family members how to open lines of communication between themselves and the addicted individual.

Signs of addiction: For those around

Addiction changes a person's behavior, thinking patterns, emotions and interactions with others. These changes may or may not be obvious to those around. Addiction to drugs such as Suboxone changes the way a person thinks in a way that causes the person to have trouble perceiving, learning, controlling impulses and making rational decisions.

A friend or co-worker may notice changes in a person addicted to opioids, including:

  • Excessive Painkiller Prescriptions for Self and/or Family
  • Frequent Emotional Crisis
  • Prioritizing Activities Involving Opioids
  • Arguments or Violent Outbursts
  • Withdrawal from Relationships, Family or Friends
  • Child Neglect
  • Abnormal, Illegal or Anti-Social Actions
  • Separation or Divorce
  • Unexplained Absences from Home
  • Legal Trouble
  • Neglect of Social Commitments
  • Unpredictable Behavior such as Inappropriate Spending

Addiction Symptoms: Physical and Psychological

The disease of addiction makes changes to the brain and body in a way that causes specific physical and psychological symptoms.

Physical symptoms of drug addiction include:

  • Unexplained Weight Gain or Weight Loss
  • A Change in Sleep Patterns
  • Deteriorating Physical Appearance - Looks Sickly
  • Nagging Cough
  • Diminished Hygiene Care
  • Body or Clothing May Have an Unusual Odor
  • Bloodshot Eyes with Large or Small Pupils
  • Tremors
  • Slurred Speech

Addiction to Suboxone and other opioids causes "hard-wired" changes in the reward circuit of brain. These changes are responsible for the uncontrolled, compulsive behaviors associated with addiction.

A psychological reward is something that reinforces certain behaviors. Rewards cause animals to repeat behaviors more often and with more intensity. Natural rewards, such as eating or mating, ensure the success of a species by encouraging them to do something that might be otherwise boring or unsavory.

The change in the reward circuit causes the addicted individual to incorrectly associated opioids with a rewarding experience. This incorrect reward pattern causes the individual to lose interest in things he used to find pleasurable and focus solely on opioid abuse.

Alterations in the reward circuit cause psychological symptoms in the addicted individual. Psychological symptoms of addiction to opioids include:

  • Inability to Abstain Consistently
  • Impairment in Behavioral Control
  • Cravings for Drugs or Intense Reward Experiences
  • Diminished Capacity to Recognize Significant Personal or Relationship Problems
  • Dysfunctional Emotional Response

Behavioral, Cognitive and Emotional Changes

Suboxone addiction alters the way a person acts, thinks and feels. These changes may come on slowly or appear abruptly and may last long after the individual has stopped using opioids. Left untreated or poorly treated, these changes increase the risk for returning to opioid abuse after the individual has successfully stopped using Suboxone.

A person with a Suboxone addiction may take higher doses of his medication or take it more frequently than he intends. As his disease progresses, he loses interest in things he used to be passionate about; eventually, he only cares about taking Suboxone. It may seem that he lacks the interest or ability to quit using Suboxone or other opioids permanently.

Opioids change the way a person thinks and, since doctors prescribe Suboxone as drug replacement therapy, it may be difficult for the individual to see that she has merely traded one addiction for another. She may blame all her problems on other people or events, rather than as the consequence of her Suboxone addiction.

Addiction and gender: how women and men are affected differently

Results from the 2010 National Survey on Drug Use and Health show more males over the age of 12 use illicit drugs, such as marijuana and cocaine, than females of the same age. Females between the ages of 12 and 17 years, however, were more likely to abuse pain relievers than males in that same age group.

Many studies reveal women are more likely to abuse prescription drugs, such as opioid painkillers. Females are also more likely to abuse multiple substances than are males.

Treatment options

Suboxone is normally the treatment for opioid addiction but it is possible to become addicted to Suboxone itself. Rehabilitation specialists will need to plan treatment options carefully for those addicted to Suboxone.

The American Society of Addictive Medicine warns that addiction can cause "disability or premature death, especially when left untreated or treated inadequately." This is even true for Suboxone addiction. Almost 15,000 people die in the United States every year from overdoses on prescription painkillers. Countless more suffer physical, emotional, social, economic and criminal affects from opioid addiction and many do not get adequate treatment for their disease.

According to the National Institute on Drug Abuse, more than 23 million people in the United States over the age of 12-years needed treatment for alcohol or substance abuse in 2010; of these, only about 11 percent received treatment at a specialty facility. Some receive Suboxone to help them recover from opioid dependence. Just over 5 percent of admissions to publicly funded substance abuse programs were for treatment of opioid abuse; because patients can take Suboxone therapy as an outpatient, they do not need to be admitted to an inpatient facility.

After they successfully quit other opioids, the individual must then wean himself from Suboxone. Many individuals try to quit alone, a procedure called self-detoxification, without the help of medicine to reduce withdrawal symptoms because they feel they have gained everything possible from the professionals. This is commonly known as "going cold turkey," named for the cold, clammy, bumpy and pale appearance the skin takes on during detoxification.

During self-detoxification, uncomfortable withdrawal symptoms, such as diarrhea, abdominal pain, cold sweats and muscle pain can last for several days to two weeks. Without proper medical assistance, the addicted individual may suffer dangerous complications. For example, she can vomit and inhale stomach contents, a complication known as aspiration. Aspiration may result in pneumonia or lung infections. The Suboxone addict also faces dehydration from excessive vomiting and diarrhea. The complications and overwhelming symptoms of withdrawal cause many people who attempt self-detox to return to Suboxone.

Other people reduce the withdrawal symptoms during self-detoxification by using a variety of products. Once such homemade treatment plan is The Thomas Recipe, in which a person takes Xanax or some other medication to reduce anxiety and induce sleep, medicine to ease diarrhea plus vitamins and supplements to soothe muscle aches and fatigue.

While these remedies may reduce withdrawal symptoms, the person may suffer the same dangerous complications as he would without medication. Furthermore, self-detoxification addresses only the physical aspects of Suboxone addiction; self-detox does not address the behavioral aspects of opioid addiction. This lapse in the treatment plan increases the risk for relapse.

Relapse is the largest complication associated with quitting Suboxone. Someone who has recently tried detoxification is at a greater risk for overdose, as the detoxification process lowers the body's tolerance to opioids. This means she can accidently overdose on a lower dose than she used to take before she attempted detoxification.

Overdose requires emergency, sometimes lifesaving treatment. Doctors administer naloxone and other medications to reduce opioids to safe levels quickly. Once the patient's Suboxone levels are within safe levels, she may continue her behavioral therapy program as an outpatient.

Doctors regularly prescribe Suboxone as part of outpatient drug replacement therapy, or DRT. Other DRT medications include methadone or buprenorphine. These drugs bind to the same opioid receptors within the body as opioids and Suboxone do; this reduces withdrawal symptoms. DRT medications including Suboxone last longer than other opioids, such as oxycodone or codeine, and do not produce the euphoric effects. DRT medications allow addicted individuals to participate in treatment without a hospital stay.

Supporters of using Suboxone as DRT recognize the flexibility of outpatient treatment while opponents say it is merely trading one addiction for another. After Suboxone helps the patient overcome his initial addiction, the individual must address his need for Suboxone.

After the individual changes the behaviors associated with his initial addiction, he weans himself from Suboxone. Some patients struggle with their Suboxone for years, unable to free themselves from drug addiction.

Medication-Assisted Treatment, or MAT, refers to any substance abuse treatment plan that includes pharmacological intervention, including the use of Suboxone. According to the Substance Abuse and Mental Health Services Administration, or SAMSA, Suboxone or DRT intervention:

  • Improves Survival Rates
  • Increases Retention in Treatment Programs
  • Decreases Illicit Opioid Use
  • Decreases the Risk for Hepatitis and HIV
  • Decreases Criminal Activities
  • Increases Employment
  • Improves Birth Outcomes for Pregnant Women Battling Addiction

Inpatient MAT programs use medicine that ease withdrawal and facilitate detoxification from Suboxone use. During detoxification, physicians administer some medications to decrease the level of Suboxone, plus other drugs that relieve the resulting symptoms of withdrawal. Medical personnel observe patients for dangerous complications, such as dehydration or aspiration, and take lifesaving measures whenever necessary. While detox eases the physical aspects of addiction, individuals must still endure the demoralizing process of detoxification.

Rapid detox is the most humane method of detoxification from Suboxone addiction. During rapid detox, board-certified anesthesiologists administer standard detoxification and anti-withdrawal medications alongside anesthesia and sedatives so that the patient rests in a comfortable "twilight sleep" rather than face painful withdrawal symptoms. When the patient awakens, he will have no recollection of the grueling and demoralizing detoxification and withdrawal period. She can now complete the rehabilitation process.

Rehabilitation

Although medical treatment and behavioral modification are independently useful, addressing both the physical and behavioral aspects of opioid addiction offer the best hope for recovery. Behavioral therapy may take place at an inpatient or outpatient facility. To offer the best chance of success, it is important to match the type of facility to the individual's personal needs. Both pharmacological and behavioral treatments work to restore normalcy to those brain function and behavior. These treatments also aim at improving employment rates, reducing relapse and lessening side effects associated with opioid addiction.

After successful detoxification or drug replacement therapy, patients may participate in drug rehabilitation treatments offering behavior modification techniques designed to change the behaviors that caused physical dependence or improve the environmental factors that led to the initial dependence on drugs and reduce the risk for relapse. Rehabilitation may be inpatient or outpatient, and programs can be as short as 28 days or as long as 6 months or a year.

New behavioral therapies show particular promise in the treatment of opioid addiction. Contingency management therapy is a voucher system in which a patient earns points for negative drug tests. He may redeem these points for items that enhance a healthy lifestyle.

Cognitive-behavioral interventions modify a patient's expectations and behaviors related to opioid addiction and give him new tools to deal with stresses that may cause relapse.

Long-term recovery from opioid withdrawal depends on success during both the detoxification and rehabilitation phases. A significant number of individuals suffer relapse, especially those who engage in self-detoxification or do not participate in rehabilitation.

The American Society of Addictive Medicine states that recovery from addiction is "best achieved through a combination of self-management, mutual support, and professional care provided by trained and certified professionals." Rehabilitation can take place in an outpatient clinic, or at a short-term or long-term residential facility. Professional treatment programs include personal, family and group counseling; each addresses a specific aspect of opioid addiction. These programs include behavior modification programs and provide peer support.