Psychosocial and pharmacological treatments versus pharmacological treatments for opioid detoxification

People who abuse opioid drugs and become dependent on them experience social issues and health risks. Medications such as methadone and buprenorphine are substituted to help dependent drug users detoxify and return to living drug free, by reducing physiological withdrawal symptoms (pharmacological detoxification). Yet psychological symptoms can occur during detoxification and may be distressing. It is often a personal crisis that led to a drug user deciding to detoxify. Furthermore the psychological reasons why a person became addicted are important. They may not be able to cope with stress and have come to expect that using mood modifying illicit substances helps. Even after successful return to a drug-free state, many people return to heroin use and re-addiction is a substantial problem in rehabilitation. The physiological, behavioural and social conditions in an individual's life that made them an opiate addict may still be present when physical dependence on the drug has been eliminated, which makes psychosocial therapy important. Psychosocial treatments include behavioural treatments, counselling and family therapy.
The review authors searched the medical literature and found evidence that providing a psychosocial treatment in addition to pharmacological detoxification treatment to adults who are dependent on heroin use is effective in facilitating opioid detoxification. This conclusion is based on eleven controlled studies involving 1592 adults. The addition of a psychosocial treatment to substitution detoxification treatment improved the number of people who completed treatment (relative risk (RR) 1.47), reduced the use of opiate (RR 0.82), increased abstinence from opiate at follow up (RR 2.43) and halved the number of failures to attend clinic absences (RR 0.48). The findings of an improved rate of clinical attendance may help in suppressing illicit drug use and provides clinical staff with more opportunities to counsel patients in psychiatric, employment and other drug and non-drug related areas. Variations in the populations who are substance users and use of a wide range of different psychosocial interventions means that it is difficult to single out particular therapeutic interventions.