The rehab process for heroin is similar to the traditional rehab process (shown below), but with the often-added component of medication used to combat heroin addiction.
As with many drug treatments, heroin detox typically includes medication to help offset withdrawal symptoms. Instead of stopping medication after detox, recovering heroin addicts usually continue to use medication-assisted treatment during the therapy and aftercare stages to ensure better recovery outcomes and to help combat cravings.
For more information, read our guide to the rehab process
The different types of rehab facilities fall into two categories or “settings.” The two settings are residential (full-time rehab) and outpatient (part-time rehab). Residential means the client stays overnight and works through each step of the rehab process steps at the facility. Patients who attend an outpatient facility return home after treatment each day and complete the steps of rehab at different facilities. Below is a comparison of the most common program options within those two rehab settings.
|Setting||Type of Treatment||Description||Time Commitment||Duration|
|Residential||Short-term residential||Intensive treatment, sometimes in a hospital setting. Therapies offered are extensive. Typically 3-6 weeks, and often a modified 12-step approach.||Hours per Day: 24||14-30 days|
|Days per Week: 7|
|Long-Term Residential||Intensive treatment in a non-hospital setting, most often a therapeutic community facility with other patients. Therapies offered are extensive, and the focus is on treating the substance use disorder – typically when intensive medical or psychiatric supervision isn’t required.||Hours per Day: 24||3-12 months|
|Days per Week: 7|
|Partial Hospital- ization||Intensive treatment, sometimes in a hospital setting. Patients do not stay overnight. Referred to as “hospitalization” due to the availability of more intensive medical and psychiatric services, and the near full-time commitment every week. Medical treatment is available to those who qualify.||Hours per Day: 6-8||14-30 days|
|Days per Week: 5|
|Outpatient||Intensive Day Treatment||Patients receive the extensive services of a residential program but return home after. After completion, patients often transition to less intensive counseling. Therapies offered are extensive. Medical and psychiatric treatment is often available to those who qualify.||Hours per Day: 2-4||3-4 months|
|Days per Week: 3|
|Counseling||Both individual counseling and group counseling focus on short-term behavioral goals to develop coping strategies. Therapies offered are moderate. Medical treatment is not available.||Hours per Day: 1-2||As long as desired|
|Days per Week: 1-3|
|Support Groups||Self-help groups are recommended to help maintain abstinence after another form of treatment. Typically meet one day a week for 1-2 hours.||Hours per Day: 1-2||As long as desired|
|Days per Week: 1|
Opioids, including heroin, are one of the few groups of drugs with specific treatment programs for them. Most rehab programs treat all drugs, as many of the behavioral therapies remain the same. However, the recent rise in U.S. opioid addiction has spurred specific opioid treatment programs (OTPs) to open around the U.S.
OTPs use medication-assisted treatment, or MAT, to help users overcome addiction. MAT includes prescribed medications as well as support services like therapy. However, to receive these services, patients must be diagnosed with an opioid-use disorder, which a medical professional would determine during the initial assessment process at the OTP.
The Substance Abuse and Mental Health Services Administration (SAMHSA) found that patients who identify heroin as their primary drug of abuse made up 26% of the population in rehab in 2015. Since the National Institute on Drug Abuse estimated that heroin has the fewest overall users in the U.S. (compared to other drugs), the large percentage of heroin users in treatment indicates the severity and danger of heroin addiction.
According to data collected by SAMHSA between 2005 and 2015, the average age of those in treatment is 35 years old, with the average age of first use being 28 years old.
Detox is the first step to recovering from any drug addiction, and it’s especially important for heroin addiction. During this process, the body experiences withdrawal symptoms from heroin that can be difficult to handle alone.
Regularly using heroin leads to dependence, or the brain adapting to the drug and becoming reliant on the drug. When the drug disappears, the brain reacts negatively to the chemical imbalance, leaving the user with the side effects of withdrawal.
Withdrawal begins anywhere from 8-12 hours after the last hit and causes flu-like symptoms. If the user cannot get rid of the withdrawal by using more heroin, they will experience more severe symptoms over the following 2-3 days. Extreme discomfort can last 7-10 days total, with lingering withdrawal symptoms lasting months for heavy users. Because of this long withdrawal period, many doctors and rehabs encourage opioid and heroin addicts to go through a medication-assisted detox.
For more information about withdrawal, read our guide on Heroin Addiction
Withdrawal from heroin itself does not typically put users at a fatal risk. However, when detoxing from heroin, vomiting and diarrhea are common and could cause severe dehydration and possibly even death. Likewise, some of the medications often used to help with withdrawal and detox (like methadone) could cause death from an overdose.
The most important step when searching for detox services is to find a qualified doctor or medical help. Medical personnel can monitor your medication intake as well as your physical well-being to prevent any harm during detox.
Many recovering heroin users say that the psychological effects of heroin withdrawal are far worse than any physical danger. Detoxing in an inpatient facility where mental and emotional support is available from staff and peers can help to lessen the effects and decrease the danger of relapse during withdrawal.
Because opioid and heroin addiction is so prevalent and dangerous, the FDA has approved many types of medications to help with heroin detox and rehab therapy. For many of the available medications, patients use them during detox and afterwards in therapy, slowly tapering their usage as treatment continues. The medication’s purpose is to help addicts remove themselves from heroin over time without having to experience the full weight of long-term physical and psychological withdrawal symptoms.
Information about available medications and how they work is provided in our Medication-Assisted Treatment section below.
Treatment for heroin comes in two forms: medication treatment and behavioral therapy. The most successful approach is medication-assisted treatment (MAT), which focuses on matching people to appropriate medications and uses behavioral therapy as a support service.
Therapy is the third step in the rehab process, sometimes intermingling with the second phase (detox). Therapy deals with the root of the drug addiction and is crucial for long-term success. The National Institute on Drug Abuse suggests no fewer than three months of rehab with therapy for the best chance at recovery. Behavioral therapy involves individual or group counseling, and it equips addicts to overcome their addiction by giving them coping skills and addressing any other mental health needs.
Since MAT traditionally involves methadone, which can be addictive, there has been controversy surrounding medication treatment for heroin abuse. However, recent developments in medicine have produced a wide variety of alternative medications that are less addictive and provide significant benefits for heroin users who are at a high risk of overdose and relapse. Medications for heroin detox and treatment target the same mu-opioid receptors that heroin targets, but they work to lessen the withdrawal symptoms from the drug in three different ways. Healthcare providers choose appropriate medications based on your level of addiction and history with heroin.
|Type of Medication||Drug Name||Benefits||Drawbacks|
|Agonist||Methadone (aka. Dolophine, Methadose)||
|Partial Agonist||Buprenorphine (aka. Subutex, Sublocade)||
|Antagonist||Naltrexone (aka. Depade, Revia, and Vivitrol)||
In 2016, the FDA approved the first buprenorphine implant for treatment of opioid dependence. The hope is that an implant increases the success rate of the medication because users do not need to take a daily dose to be successful. Likewise, scientists are working on developing a heroin vaccine that would prevent heroin from producing pleasurable sensations in the brain.
In a majority of cases when pregnant women use heroin during pregnancy, their fetus is at risk of fetal death, intrauterine growth retardation, and prematurity. One of the best ways to prevent these complications is for the mother to seek medication-assisted treatment (MAT) for heroin addiction as soon as possible. Although more data is available for methadone, the National Institute on Drug Abuse tested buprenorphine and determined it to also be safe for the mother and child.
Infants of mothers who use heroin may also be afflicted with neonatal abstinence syndrome (NAS), which means the baby experiences withdrawal symptoms upon delivery. MAT during pregnancy may also reduce the severity and length of the NAS, but infants still will likely need NAS treatment. While methadone and buprenorphine treatment is better than continuing to use heroin, it can result in a milder form of NAS for the fetus.
Babies that are born with NAS are kept in the hospital and given morphine to gradually wean their bodies off their dependence on heroin.
While medication is often the central piece of many heroin treatment plans, federal law requires behavioral therapy to accompany most medication-assisted treatments to address the social and psychological barriers to a full recovery, a requirement that is backed by scientific studies. Often, substance abuse begins due to other mental or psychological difficulties, and those areas need to be simultaneously addressed during rehab to encourage a successful recovery.
There are no evidence-based combinations of a particular medication with a certain therapy. In fact, few studies demonstrate positive outcomes from using specific behavioral therapies with certain medications. Many behavioral therapies exist, but the National Institute for Drug Abuse only suggests two for heroin addiction (explained below).
|Contingency Management (CM, or “motivational incentives”)||Cognitive-Behavioral Therapy (CBT)|
|Definition||Voucher or prize-based system to reward positive behaviors including abstinence from a drug.||Helps patient acquire skills for identifying triggering situations, avoiding those situations, and coping with any problems brought about by drug use.|
|Used for||Initial abstinence||Relapse prevention|
|Intensity||1 hour per week or less||2 hours per week|
|Analysis||CM has played a positive role in heroin addiction treatment since the 1970s. However, few recent studies support its usage with current medication options. One 2014 study does show that Contingency Management helps for short term goals like getting a Hepatitis B vaccine.||While CBT has been proven to work well for prescription opioid use patients, it has had mixed results with heroin addicts. One 2016 study shows that CBT did not lead to better results for heroin use patients, possibly due to the difference in demographics and how dedicated the participants were to rehab.|
Aftercare, the final step in the rehab process, is a lifelong commitment that can take many forms from counseling to support groups. Aftercare can make a substantial, positive difference on your ability to stay clean. Aftercare for heroin addiction is especially important due to heroin’s abnormally high relapse rates.
Some sources estimate that up to 90% of people in heroin recovery will relapse. While the Substance Abuse and Mental Health Services Administration does not provide any relapse rate percentage, their comprehensive study of substance abuse patients in treatment confirms a higher than average relapse rate. According to their study, almost 78% of patients who went to treatment primarily for heroin abuse reported that they had been in treatment before, and 27% said that had been in treatment at least five times before.
One of the most common forms of aftercare is a support group. Many people are familiar with Alcoholics or Narcotics Anonymous, a 12-step faith-based support group. However, many other options also exist. Support groups are an excellent way to stay accountable to your abstinence goals and continue your recovery process. Regularly attending support groups can also benefit by providing a support system for those with a lack of positive relationships from which to draw encouragement.
You can also check out alternative types of support groups listed in the table below.
|Name||Description||Who They Serve|
|LifeRing Secular Recovery||Secular support groups focused on abstinence and drug recovery. Find a personal account here and meeting information here.||Anyone previously addicted to alcohol or other non-medically indicated drugs, including heroin|
|Heroin Anonymous||12-step spiritual program and support available to anyone trying to overcome drug addiction.||Anyone recovering from heroin addiction or wanting to stop|
|Nar-Anon Family Group||12-step spiritual support group for loved ones of those addicted to drugs.||Family members or friends with loved one who is addicted to drugs|
|Secular Organizations for Sobriety||Comprehensive list of secular support for anyone struggling to maintain abstinence from an addiction. Find meetings here.||Anyone recovering from addiction: eating, drug, sex, etc.|
|Heroin Support Group||Entirely online discussion board to provide support to others who are struggling with heroin addiction.||Heroin addicts, recovering addicts, and loved ones|
Sober living homes (also referred to as recovery residences) are group homes that help recovering addicts transition from treatment facilities to living on their own while maintaining sobriety. They are especially helpful for those who don’t have a supportive and positive environment to live in after rehab.
Residents can stay for a couple of months of for years, as long as they follow the rules and don’t relapse (most homes have a zero tolerance policy for using substances). Other rules usually include completing chores, attending mutual support groups regularly, and paying an equal share of the cost of renting the home.
Some halfway houses are listed in our database, and you can find them by using the appropriate filter in our tool below. Otherwise, head to our guide on sober living homes to learn more about sober living homes, and to find a certified recovery residence near you.
Heroin’s highly addictive nature and the rise of opioid use in the United States has led many researchers to begin studying alternative methods to help addicts successfully get off the drug. New treatments, namely the heroin vaccine, are doing just that.
Switching some therapy time with “screen time” has shown positive results according to two different studies. In one 2014 study, researchers incorporated a web-based behavioral treatment program as a partial replacement for behavioral therapy that led to a slight increase of opiate abstinence among users. In another 2016 study, patients used a smartphone app for self-monitoring, management, and medication compliance with mostly positive results. These studies have not been widely-accepted or proven yet, but remote and online options are starting to increase and could become standardized in the near future.
The heroin vaccine, a new approach to heroin addiction, has been tested on monkeys and shown positive results. Instead of working to inhibit or alter the chemical receptors like current heroin medications do, the vaccine contains part of a heroin molecule. In the study, the vaccine trained monkeys’ immune systems to produce antibodies against heroin. The antibodies neutralized the heroin’s effects and lasted up to 8 months. Researchers think the vaccine could work just as well for humans.
Alternative treatments include any remedies or therapies that are not part of the typical addiction treatment model. They constitute a group of methods that have anecdotal evidence or some scientific studies to support them, but they have not been widely accepted as one of the approved treatments for withdrawal or therapy.
|Loperamide||Used for diarrhea by stopping spasms in the intestinal tract.||Diarrhea, vomiting, abdominal cramping||Over-the-counter medication|
|Ginger||Inhibits enzymes that cause inflammation and pain in joints/body.||Nausea and physical pain||Spice, take as a pill or with tea|
|NSAID||Including aspirin and ibuprofen, these medications help reduce physical pain but sometimes come with severe side effects.||Physical pain||Over-the-counter painkillers|
|Passion Flower||Similar efficacy to clonidine, but should not be taken by pregnant women.||Anxiety, insomnia, and muscle spasms or pain||Plant, ingested|
Mindfulness meditation is designed to focus attention on inner and outer experiences with acceptance, patience, and compassion. Mindfulness practice has proven to be somewhat beneficial for relapse prevention, as it encourages objectively thinking through decisions and not responding to cravings without careful consideration. Likewise, mindfulness has worked well with heroin addicts who also have anxiety.
Another therapy that integrates meditation for therapeutic purposes is Qigong, which intertwines meditation with energy and breathing techniques. Practitioners believe it strengthens and cleanses individuals who use it, and one research team implemented it as detoxification therapy for a group of heroin addicts. The results were positive, but there is little other evidence or studies to recommend the practice.
Acupuncture, a form of alternative medicine that involves inserting thin needles into specific locations on the body, has had inconclusive results from scientific studies that examined its benefit on heroin addiction treatment. One study found that those with lower or more moderate levels of addiction benefitted from the treatment, while those with a stronger addiction did not. Another study revealed a slight advantage to using acupuncture in conjunction with methadone maintenance therapy.
Neurofeedback uses electroencephalography (EEG) to measure brain waves and show brain function to the person wearing the EEG sensors on their scalp. The process, called biofeedback, allows people to see how their brain responds to different stimuli so that they can learn self-regulation and see its effects on their brain in real time.
Similar to acupuncture, neurofeedback is still in the early phase of testing but has yielded promising results. Many of the studies about neurofeedback have combined it with medication therapy. One study combined neurofeedback with Methadone while another combined it with Methadone or Buprenorphine. Both studies showed positive outcomes for less depression, cravings, and withdrawal symptoms.
Our directory of rehab programs includes a comprehensive list of available treatment centers and programs as provided by the Substance Abuse and Mental Health Services Administration (SAMHSA). In the directory, you will find tools to filter the programs by setting, price, and location.
OTPs are not always specific clinics, sometimes they are programs available in hospitals, counseling offices, and correctional facilities. As of 2015, the only states that did not have OTPs were Wyoming and North Dakota. When contacting specific treatment programs, you can ask if they have an OTP or are certified to treat opioid-use disorders. Additionally, you can select the filter “SAMHSA-certified Opioid Treatment Program” underneath “Type of Care” in our directory.
For more information about finding and choosing the best rehab, visit our guide on the subject
Heroin addiction’s high overdose rate and even higher relapse rate make it one of the toughest addictions to overcome – that makes going to rehab crucial to your success. Learn more about what happens in rehab in our guide “The Rehabilitation Process.”
If you are researching for yourself or for a loved one, read more about the chemistry of heroin addiction and how it affects the human body and mind.
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