Heroin Addiction Treatment: Settings, Therapy, and Benefits

Heroin is a highly addictive, illicit opioid made with morphine extracted from the opium poppy plant. Chronic use of this drug can lead to addiction. However, heroin addiction treatment is available to help you make a positive change in your life. Various types of heroin addiction treatment centers exist for you to explore.

In this article:

• Heroin Addiction Treatment Settings
• Therapies for Heroin Addiction
• Benefits of Attending Heroin Addiction Treatment
• Choosing the Right Heroin Addiction Treatment Center
• How to Find a Heroin Addiction Treatment Program

Heroin Addiction Treatment Settings

Heroin addiction treatment can occur in several different settings. The setting most appropriate for you depends on the severity of your heroin addiction symptoms and other needs. Treatment levels are on a continuum; inpatient care is the most intensive and standard outpatient care is the least intensive. Many patients start with inpatient care and step down to outpatient care to receive ongoing support as they return home after rehab.

Inpatient Heroin Addiction Treatment Center

An inpatient treatment setting is appropriate for someone who has:^{1, 2}

• Severe heroin addiction or opioid use disorder (OUD)
• Mental health conditions such as an anxiety disorder
• Medical conditions such as chronic pain or a heart condition
• Easy access to heroin in their living environment

Inpatient treatment is very distinct from other treatment settings. You will live at a substance use or mental health treatment facility, receiving care and monitoring 24 hours per day. It is common to stay at the facility for six to 12 months.

The types of services that a heroin inpatient facility typically offers include:

• Medical detox
• Medication maintenance treatment (MMT)
• Individual therapy
• Group therapy
• Family therapy
• Treatment for co-occurring mental health conditions
• Treatment of medical conditions
• Case management
• Education and support for patients and their families

A multidisciplinary team provides these services. Such a team consists of psychologists, counselors, psychiatrists, nurses, and doctors.

Partial Hospitalization

A partial hospitalization program (PHP) is less intensive than inpatient treatment. It also occurs in a facility specifically for substance use or mental health conditions. However, it is done on an outpatient basis. This means you do not live at the facility; rather, you commute there daily, five or more days per week, and stay for appointments for about four to eight hours. The total duration of a PHP is about four to six weeks.²

This type of treatment program is intended for someone who:²

• Has a severe heroin addiction
• Completed inpatient treatment and needs a step-down program before starting outpatient treatment
• Has a solid social support system
• Needs to work while receiving treatment—evening programs may be available
• Has the ability to travel to appointments

PHPs develop a treatment plan that is tailored to meet your particular needs. As with inpatient treatment, PHPs have multidisciplinary teams. These address mental health and medical conditions in addition to addiction.²

Intensive Outpatient

Intensive outpatient programs (IOPs) are less intensive compared to PHPs. They can function as a step down from a PHP to transition you to standard outpatient treatment.²

Services in IOPs typically last three to four hours per day, about three times per week. Services can include individual and group therapy. The typical duration of IOPs is two to four weeks.²

Intensive outpatient treatment would be is meant for persons who:³

• Do not require detox or 24-hour supervision
• Need more care than standard outpatient treatment
• Completed a higher level of care and need additional help transitioning to standard outpatient care

Standard Outpatient

Standard outpatient treatment is a fit for you if you have a less severe OUD or if you have completed higher levels of treatment. This level of treatment is ideal for those who:¹

• Have completed inpatient, partial hospitalization, or intensive outpatient treatment
• Have a less severe OUD
• Have few additional mental health or medical conditions
• Have a supportive living environment

Standard outpatient treatment typically occurs once weekly and can involve individual therapy, group therapy, or both.¹

Therapies for Heroin Addiction

There are different styles of evidence-based therapy for heroin addiction. Most therapists integrate a few different types depending on your needs. These different evidence-based therapies include:^{4, 5}

• Cognitive behavioral therapy (CBT): CBT examines how your thoughts, feelings, and behaviors influence each other. Your therapist helps you change unhelpful thoughts into ones that can reduce emotional distress, encouraging healthy behaviors.
• Dialectical behavior therapy (DBT): DBT helps you better regulate your emotions and productively deal with relapse. This means accepting relapse as part of the process and brainstorming plans to help prevent relapse moving forward.
• Motivational enhancement therapy (MET): MET helps you sort through your conflicting thoughts and emotions regarding heroin use. Likely, there is a part of you that wants to continue to use and a part of you that wants to stop. Your therapist helps you weigh the costs and benefits so you can seek healthy changes.
• Contingency management (CM): In CM, your therapist uses positive reinforcement to encourage abstinence from heroin. For example, they might establish a reward system, which can redirect your brain’s reward circuit away from heroin use.

Medications for Heroin Addiction

Medication often is vital to long-term treatment. When you have a physical dependency on heroin, your brain becomes used to it and needs the substance to function. Medications similar to opioids can satisfy this neurochemical need for heroin, all while reducing cravings and heroin addiction symptoms associated with withdrawal.⁶

Available medications for heroin addiction treatment include full and partial opioid agonists, as well as opioid antagonists. These include:^{6, 7}

• Methadone: Methadone is a full opioid agonist and is the most widely used medication to treat heroin addiction.
• Diamorphine: Diamorphine also is a full opioid agonist. Providers may prescribe diamorphine if methadone does not work for you. This could be due to the lack of efficacy of methadone or intolerable side effects.
• Buprenorphine: Buprenorphine is a partial opioid agonist. It has lower risks for overdose compared to other medications. This would be a fit for someone who has overdosed before.
• Suboxone: One novel brand of buprenorphine that is taken orally and used in heroin addiction treatment is Suboxone. It is combined with the opioid antagonist naloxone which reverses the effects of an overdose on heroin or other opioids. Naloxone is included to avoid misuse; it prevents the buprenorphine present in Suboxone from satisfying the cravings of a user. If it is injected illicitly to achieve a high, opioid withdrawal will be the result.
• Naltrexone: Naltrexone is an opioid antagonist used to treat alcohol use disorder (AUD) and OUD. It blocks the opioid receptors in your brain, which reduces heroin cravings. Naltrexone is not addictive. For OUD, prescribers inject an extended-release formulation of the drug every four weeks.

Benefits of Attending Heroin Addiction Treatment

Research has discovered many benefits of heroin addiction treatment. Individuals who remain in treatment show significant improvements compared to those who drop out of treatment. These improvements can include:^{8, 9, 10, 11}

• Reduced use of heroin
• Lower addiction severity to opioids and other drugs such as cocaine and benzodiazepines
• Lower severity of psychiatric conditions
• Fewer health problems
• Fewer legal problems

In addition, retention in medication-assisted treatment increases the likelihood of better outcomes. Research has found that behavioral therapy helps with retention in medication treatment.¹²

Choosing the Right Heroin Addiction Treatment Center

No universal treatment strategy exists because the needs of each person are different. You want to consider your own needs, resources, and goals for treatment when choosing a treatment center.

The factors to consider when choosing an addiction treatment program are:

• Location
• Costs
• What your insurance plan covers
• Services offered by the program (individual or group therapy, case management, etc.)
• Treatment philosophy of the program
• Features and amenities
• Patient-to-staff ratio

How to Find a Heroin Addiction Treatment Program

For help locating a heroin addiction treatment program, please call 866-968-5444Who Answers? for assistance from a specialist. They will help you narrow your options and direct you to an appropriate heroin addiction treatment center.

Resources

1. National Institutes of Health. (2014). Treatment settings.
2. Madakasira, S. (2022). Psychiatric partial hospitalization programs: What you need to know. Current Psychiatry, 21(2), 28-32.
3. McCarty, D., Braude, L., Lyman, D. R., Dougherty, R. H., Daniels, A. S., Ghose, S. S., & Delphin-Rittmon, M. E. (2014). Substance abuse intensive outpatient programs: Assessing the evidence. Psychiatric Services, 65(6), 718-726.
4. National Institutes of Health. (2019). Treatment approaches for drug addiction.
5. Dimeff, L. A., & Linehan, M. M. (2008). Dialectical behavior therapy for substance abusers. Addiction Science & Clinical Practice, 4(2), 39-47.
6. Bell, J. (2012). Pharmacological maintenance treatments of opiate addiction. British Journal of Clinical Pharmacology, 77(2), 253-263.
7. S. Department of Health and Human Services. (2022). Naltrexone.
8. Fareed, A., Casarella, J., Amar, R., Vyalapalli, S., & Drexler, K. (2009). Benefits of retention in methadone maintenance and chronic medical conditions as risk factors for premature death among older heroin addicts. Journal of Psychiatric Practice, 15(3), 227-234.
9. Strang, J., Metrebian, N., Lintzeris, N., Potts, L., Carnwatch, T., Mayet, S., Williams, H., Zador, D., Evers, R., Groshkova, T., Charles, V., Martin, A., & Forzisi, L. (2010). Supervised injectable heroin or injectable methadone versus optimised oral methadone as treatment for chronic heroin addicts in England after persistent failure in orthodox treatment (RIOTT): A randomised trial. The Lancet, 375(9729), 1885-1895.
10. Blanken, P., Hendriks, V. M., Van Ree, J. M., & Den Brink, W. V. (2010). Outcome of long-term heroin-assisted treatment offered to chronic, treatment-resistant heroin addicts in the Netherlands. Addiction, 105(2), 300-308.
11. Strang, J., Groshkova, T., Uchtenhagen, A., van den Brink, W., Haasen, C., Schechter, M. T., Lintzeris, N., Bell, J., Pirona, A., Ovidedo-Joekes, E., Simon, R., & Metrebian, N. (2015). Heroin on trial: Systematic review and meta-analysis of randomised trials of diamorphine-prescribing as treatment for refractory heroin addiction. The British Journal of Psychiatry, 207(1), 5-14.
12. Timko, C., Schultz, N. R., Cucciare, M. A., Vittorio, L., & Garrison-Diehn, C. (2016). Retention in medication-assisted treatment for opiate dependence: A systematic review. Journal of Addictive Diseases, 35(1).