Opioid and Substance Use Disorder Rehabilitation and Maintenance

Rehabilitation programs may be inpatient or outpatient. Both categories of programs facilitate recovery and are designed to treat the whole person, including psychological and social aspects of an individual’s life.

Some rehabilitation facilities follow a model of care that involves pain management. For example, people may be taught how to manage their chronic back pain symptoms without medication during their rehabilitation stay.

See 11 Chronic Pain Control Techniques

Inpatient Treatment Programs

Inpatient treatment refers to facilities that offer housing and support to people seeking help for opioid addiction.

Long-term residential treatment

This type of treatment usually offers 24-hour care in a non-hospital controlled environment for 6 to 12 months. Long-term residential treatment usually serves patients with severe or recurring substance use disorder, including abuse of multiple substances, or those that failed outpatient treatment. It is less commonly used for those with co-morbid chronic pain.

Many programs use the therapeutic community model, which focuses on:

• Developing personal accountability
• Developing responsible daily habits
• Becoming social and productive

Treatment is highly structured and collaborative between participants. The goal is for the participant to leave employed, enrolled in school, or in a training program.

Short-term residential treatment

Short-term programs are typically designed to be between 3 and 6 weeks and involve a modified version of what is provided in long-term treatment. Short-term programs are often more flexible and less expensive than long-term programs.

Short-term programs generally involve outpatient treatment once the residential portion has been completed and may or may not include an additional focus on pain management. Outpatient treatment includes:

• Ongoing use or slowly tapering down of medication assisted treatment, such as methadone or buprenorphine
• Outpatient day or half day treatment
• Continuing care, such as Narcotics Anonymous (NA)
• Individual counseling
• Drug education classes

Continued outpatient therapy helps reduce the risk of relapse and provides ongoing support once a person has left the residential facility.

Outpatient Treatment Programs

Outpatient treatment is a flexible program option. They provide similar support a person would receive in an inpatient facility without the 24/7 commitment.

Day programs

Day programs are the most structured and provide the highest level of care in terms of outpatient treatment. Most suggest a person participate several hours a day, 5 to 7 days a week. Day programs focus on:

• Individual therapy
• Group counseling
• Additional therapeutic techniques, such as art or music

Day programs still require a large time commitment and may make it difficult for a person to attend work or school during the duration of treatment. Integration of pain management interventions may vary based on individual needs and the specific facility’s resources.

Intensive outpatient programs

Intensive outpatient programs (IOPs) require less time than day programs; however, they still offer a range of support services and education. IOPs generally offer:

• Medication Assisted Treatment (MAT)
• individual and group counseling
• Drug use monitoring (i.e. urine and blood testing)
• Relapse prevention training
• Case management
• Community-based support groups

IOPs generally provide access to 24-hour hotlines so that participants are able to access help outside of normal work hours.

Continuing care groups

Continuing care groups, such as Narcotics Anonymous, are a useful resource for recovery. They are readily available and are typically lead by licensed therapists. Some groups may be age or gender specific. Those patients with ongoing pain management needs are co-managed with a pain management specialist or an addiction specialist with pain management training.

Choosing a rehabilitation facility and type of program is a big decision. The Substance Abuse and Mental Health Services Administration (SAMSHA) provides free and confidential referral and information services in both English and Spanish.

Addressing Pain After Opioid Addiction

A common concern during the opioid addiction recovery process is how to address and manage pain.

While some rehabilitation programs integrate pain management interventions and help patients acquire other skills to more effectively manage their chronic pain and related psychosocial problems, this level of integration may vary in traditional addiction rehabilitation facilities. Patient in recovery may need to seek separate pain management treatment with their primary care or pain management provider. Additional resources include:

• Individual or group mind-body therapy
• Smart phone apps and online programs
• Pain management specialists

See Chronic Pain Coping Techniques - Pain Management

A person in recovery from opioid addiction should have a plan in place in the event of a severe injury or scheduled surgery where acute pain management may be needed. There are a number of non-opioid medications and techniques available for acute pain management including the growing field of regional anesthesia. Other multimodal and multidisciplinary treatments can effectively help manage acute pain without the use of opioids.

See Medications for Back Pain and Neck Pain

In closely monitored cases, a patient in recovery can benefit and successfully use time-limited opioids for acute pain. Pain management in these special circumstances needs to be closely monitored by an inpatient pain team, surgeon, pain management, and addiction specialist.

Medication assisted treatment may need to be discontinued or put on hold in the event of an acute injury or surgery. It can be restarted after acute pain management is complete.