TREATMENT OF ADDICTION TO OPIATES
There are many approaches to the treatment of addiction to opiates. Some of those involve maintenance for opioid replacement therapy which typically utilizes methadone or buprenorphine. Buprenorphine has also been used for many years for detoxification prior to abstinence therapy.(Alan W. Graham, MD, FACP, FASAM, et al, Principals of Addiction Medicine, 3rd Edition, Pgs. 658-663)
Abstinence therapy is usually based in cognitive behavior therapy i.e., counseling, self-help groups, group therapy. More recently CBT is used in combination with medical therapy with an opiate antagonists such as naltrexone.
Abstinence therapy is usually preceded by detoxification from opiates. A variety of methods of detoxification both inpatient and outpatient are utilized by various practitioners. Many different modalities of detoxification are accepted in the field of addiction medicine. It is up to the clinician, based upon his evaluation of the patient and his training and experience as to which modality is indicated in a given situation.
Patients frequently self select for therapy and try many different kinds of therapy. They learn about therapies through word of mouth, the internet and other forms of advertising. Patients therefore present whether to a methadone clinic, hospital, or outpatient addiction treatment center with prior knowledge of the modalities that are used at that location and they are there because they prefer to try that modality at that particular time.