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Vicodin Addiction Explained

What Is Vicodin?

Vicodin is a powerful prescription medicine commonly used to manage critical pain that can only be mitigated by an opioid. It is commonly used when treatments like non-opioid pain medicines fail to relieve pain.

Vicodin is composed of acetaminophen and hydrocodone. Hydrocodone is both a narcotic and an opioid pain medication, while acetaminophen is a minor pain reliever that helps increase the effects of hydrocodone.

Hydrocodone is known by the brand name Vicodin and is a narcotic analgesic agent as well as a cough suppressant used to relieve moderate to severe pain. Medical research has shown that the psychoactive drug is more effective compared to codeine when administered for cough suppression purposes and is almost equal to morphine when used for pain relief.

Hydrocodone bitartrate is classified as an opioid analgesic and appears as light, colourless crystals or as a pellucid powder that is affected by light. Persons using hydrocodone bitartrate are likely to become addicted even if they take the dose correctly as prescribed by a physician. Hydrocodone bitartrate and acetaminophen may be accessible in tablet form for oral administration.

Available forms of Vicodin

Vicodin is available in both oral and tablet forms.

Tablets: Vicodin tablets are mainly composed of hydrocodone bitartrate and acetaminophen. However, these three elements come in different proportions to form different types of tablets. For instance, USP 5mg/300mg tabs are composed of 5 milligrams of hydrocodone bitartrate and 300 milligrams of acetaminophen. There are also USP 7.5 mg/300mg as well as USP 10mg/300mg tablets. (1)

Additionally, each tablet contains several dormant elements such as colloidal silicon dioxide, magnesium stearate, crospovidone, povidone, stearic acid, microcrystalline cellulose and pregelatinized starch. (1)

Oral Solution/Elixir: The oral solution may contain (7.5mg/325mg)/15ml, (10mg/300mg)/15ml, or (10mg/325mg)/15ml. This is the ratio of hydrocodone bitartrate to acetaminophen in relation to the overall volume of the solution. (2)

Vicodin brand and street names

All types of drugs, from prescription medications to illegal substances, have street names. People refer to drugs by their slang names as a way to conceal their substance dependence from their loved ones. Some of the street names used to refer to Vicodin include tabs, lorries, Watsons, hydros. 357s, vikes, fluff, vics, scratch, vicos and idiot pills. (3)

Brand names for Vicodin include Zolvit, Xodol, Hycet, Lortab, Anexsia, Norco, Stagesic, Zamicet, Lorcet Plus, Verdrocet, Zydoen, Vicodin ES, Maxidone and Vicodin HP. (3)

Medical Uses of Vicodin

Vicodin is usually prescribed by physicians to alleviate moderate to severe pain because of its hydrocodone and acetaminophen components. Hydrocodone acts as a narcotic pain reliever and cough suppressant. It functions by obstructing nerve cell receptors in the brain responsible for detecting pain.

Acetaminophen functions as a pain reliever and fever reducer due to its non-narcotic analgesic and antipyretic nature, respectively. It lowers fever by acting on the thermo-regulating part of the brain. In many cases, hydrocodone and acetaminophen are used simultaneously for pain relief.

However, Vicodin is not prescribed to children younger than 6 because of the increased risk of serious side effects like shallow or slow breathing.

Legal Status (UK)

One of the key reasons for the United Kingdom Misuse of Drugs Act 1971 was to control the supply and possession of many registered drug substances. The act, however, authorizes the use of some controlled drugs by diverse classes of people, e.g., licensed physicians acting in their professional capacity. In medical practice, this usually applies to the prescription of strong opiates to patients suffering severe pain.

Hydrocodone is a controlled substance both under the Misuse of Drugs Act 1971 and the Misuse of Drugs Regulations 2001.

Routes of administration

Hydrocodone bitartrate and acetaminophen tablets are medically prescribed for oral use only. They may pose a risk of overdose and death when administered differently. Oral administration is the only medically prescribed way of administering hydrocodone. However, individuals who abuse hydrocodone use other routes like snorting or injection.

Medical studies revealed that the majority of the users abuse hydrocodone products by intranasal (snorting) and oral routes. The substance is mostly abused through the oral routes through cutting, chewing or crushing, which ultimately changes the rate of drug release.

Most individuals abusing hydrocodone orally tend to do it in combination with alcohol.

Pharmacological Actions of Vicodin

Hydrocodone applies its fundamental pharmacological effects via agonistic binding to opioid receptors. It attaches itself to the mu-opioid receptor found in the central nervous system and activates it to produce both antitussive and analgesic effects. The attachment of hydrocodone to the CNS receptors also produces effects like respiratory depression, physical dependence, analgesia, decreased gastrointestinal motility, euphoria and physical dependence.

Researchers have yet to establish the accurate mechanisms of hydrocodone that produce the analgesic reaction. However, some scientists suggest that certain CNS opioid receptors that conduct opioid-like activities can be pinpointed across the brain and spinal cord and may be responsible for the analgesic effects of hydrocodone.

Vicodin Addiction and How It Develops

Drug addiction is a collection of physiological, cognitive and behavioural events that occur due to continued substance use. The user develops a powerful desire to take the drug frequently and finds it difficult to control its use, leading to increased tolerance.

Vicodin addiction develops when the drug is misused or abused. The drug alters a person’s perception of response to pain and emotions. The fact that it produces feelings of light-headedness and euphoria in the user makes it highly addictive and has resulted in the extensive misuse of the drug nationally.

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Hydrocodone is similar to opioids like morphine, oxycodone, fentanyl, oxymorphone, hydromorphone, methadone and tapentadol. All these substances have the tendency of being misused and are even used for criminal diversion purposes in some cases.

Hydrocodone bitartrate and acetaminophen tablets expose users to the risks of opioid addiction, abuse and misuse. When the drug is taken repeatedly, the user becomes more resistant to the drug’s effects, and as the tolerance rises, so does the individual’s risk for Vicodin addiction.

Why Is Vicodin Addictive?

Vicodin contains hydrocodone, which is used for opioid medication, and acetaminophen, which boosts the hydrocodone’s effects. This is what makes Vicodin extremely addictive to its users, despite its efficiency in pain management. (1)

In most cases, users develop substance dependence on their prescription only to realize their addiction after they stop taking it. It is this dependence that causes the user to develop a compulsive urge, regardless of the drug’s negative consequences, which leads to addiction. Moreover, the addiction escalates even more when the user starts developing withdrawal symptoms and responds by taking more Vicodin to relieve them. (1)

Causes & Risk Factors of Vicodin Addiction

Before issuing Vicodin to patients, doctors are required to assess every person’s risk for opioid misuse, addiction and abuse. Healthcare providers are also required to monitor all clients receiving the psychoactive drug for the development of any addictive behaviours or conditions.

Some of the risk factors include a personal or family history of substance abuse such as drug or alcohol addiction, as well as a mental illness like depression.

Common causes and risk factors for Vicodin addiction include genetic, psychology, environment and brain chemistry. Additionally, individuals at high risk can be prescribed Vicodin, but they may have to undergo thorough counselling about the correct usage and risks associated with this psychoactive drug.

Common Drug Combinations with Vicodin

Vicodin tablets pose a risk of overdose that may be fatal in some instances. The risk is usually higher when the psychoactive drug is abused with alcohol and other central nervous system depressants like marijuana, drugs for sleep such as alprazolam, lorazepam and zolpidem or muscle relaxants like carisoprodol and cyclobenzaprine.

Drug combinations usually alter how the medicine works and may even raise the risk for serious after-effects. Products that may be positively combined with Vicodin include certain pain medications mixed with opioid agonists like pentazocine, nalbuphine, butorphanol or naltrexone.

The user may experience side effects such as severe drowsiness or shallow breathing upon complementing the medicine with other substances. That is why it is advisable for users to tell their physician or pharmacist whether they are taking other drugs.

Co-Occurring Disorders with Vicodin Addiction

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A co-occurring disorder happens when a mental health disorder and substance abuse or addiction occur simultaneously, e.g., drug abuse and depression or alcoholism and anxiety.

In most cases, substance abuse usually coexists with a mental health condition. Vicodin addiction may be accompanied by co-occurring disorders such as anxiety, bipolar, post-traumatic stress and depressive disorders, as well as schizophrenia. (3) A mental health disorder may precede the development of addiction in many people abusing Vicodin. In some clients, the mental disorder could even be triggered or worsened by a Vicodin addiction.

Signs and Symptoms of Vicodin Addiction

Individuals may experience different symptoms of Vicodin addiction. Some may be short-term symptoms, while long-term effects may be experienced by individuals who have used the psychoactive drug for a long period.

Some of the common signs and symptoms of Vicodin addiction include anxiety, doctor shopping, constipation, constant headaches, lack of concentration, reduced heartbeat, ear discomfort, negative mood changes, loss of memory, theft, nausea and vomiting and so on. These symptoms can be classified into some of the categories that follow.

Mood symptoms

Patients using Vicodin for medicinal purposes or individuals misusing the drug may experience mood swings. However, some people, especially teenagers, have been noted to abuse the drug to remove the pain of uncontrollable mood changes caused by depression.

Vicodin functions by affecting brain pain receptors, relieving pain and producing emotions of serenity and jubilation. It can affect a person’s mood because it heightens certain emotions and reduces others. Some of the mood symptoms to look out for include;

  • Euphoria
  • Anxiety
  • Severe mood swings

Behavioural symptoms

Vicodin addiction results in an abrupt change in the behaviour of the user, especially when used for a long period. The person may exhibit several behavioural changes since drug addiction needs more money, energy, time and attention. Consequently, this may lead to theft and even poor concentration since the individual will mostly be thinking about how they can acquire more of the drug.

Some of these behaviours are difficult to control, since the individual may not have the willpower to control themselves. The changes worsen in time as the person becomes more dependent on Vicodin. Listed below are some of the frequent behavioural signs associated with Vicodin abuse or addiction:

  • Memory problems
  • Doctor shopping
  • Stealing

Physical symptoms

When Vicodin is abused by snorting or mixing it with substances like alcohol, it enters the body and connects to opioid receptors in the brain, gastrointestinal tract, spinal cord and several other organ systems.

This releases opiate effects that are easily manifested physically, especially when a person consumes more than the prescribed amount. This results in laboured breathing and a slower heart rate, causing oxygen insufficiency in the brain and other vital organs. The following are some other physical symptoms that indicate a serious dependence on Vicodin.

  • Inability to focus
  • Weakness
  • Dizziness
  • Slow heartbeat
  • Drowsiness
  • Nausea and vomiting
  • Itching
  • Seizures
  • Headache
  • Ringing in the ears
  • Constipation
  • Constricted pupils
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Psychological symptoms

Psychological dependence is a condition that develops when a person is regularly exposed to psychoactive substances. Due to Vicodin’s addictive hydrocodone components, a person becomes mentally dependent when they use the substance for a long period.

This leads to psychological symptoms, which may start appearing due to the changes occurring in the user’s brain. Most individuals are driven to Vicodin addiction by pain, stress and life pressures. Compared to physical symptoms that appear instantaneously, psychological symptoms may take time before they are even noticed because they surface slowly.

  • Obsession with obtaining more Vicodin
  • Hallucinations
  • Confusion

Possible Consequences of Vicodin Addiction

Once a person becomes addicted to Vicodin, the substance alters the part of the brain responsible for pain perception and emotional response. Vicodin addiction may cause the user to develop more tolerance towards the drug, increasing the level of dependency.

People suffering from Vicodin addiction are highly vulnerable to long-term mental disorders such as depression. Such individuals risk damaging their relationships and health and foregoing primary responsibilities to fulfil their urges.

The drug is highly dangerous because the patient may still become addicted to the drug despite adhering to the doctor’s prescription. Teenagers, however, may be more susceptible to Vicodin consequences than adults because their brains are still developing.

  • Liver damage or failure
  • Urinary system issues
  • Relationship problems
  • Financial issues
  • Performance issues at work or school
  • Incarceration
  • Social isolation
  • Neglect of family
  • Coma
  • Death

The Impact of Long-Term Vicodin Abuse on the Brain

Individuals who become addicted to Vicodin suffer serious after-effects after abusing the drug for a long period. Hydrocodone may be dangerous, and substantial doses of acetaminophen may also cause serious harm.

The following are the major long-term effects of Vicodin use;

  • Hearing Loss: Long-term Vicodin abuse has been linked to hearing loss that may even be irreversible. A medical report noted that 15 to 75 Vicodin tablets per day may cause a user to suffer minor to complete hearing loss.
  • Chronic Constipation: Most opioid drugs have been found to cause constipation. This condition may take some time to develop or may begin as soon as the user starts the medication. Constipation is, however, treatable if it occurs consistently due to Vicodin abuse.
  • Liver Damage: This is the most long-term effect experienced by Vicodin abusers. It occurs because of the acetaminophen added to the hydrocodone.
  • Kidney Failure: Kidney failure is mostly caused by the acetaminophen present in Vicodin. A 2001 medical report noted that 8-10% of people who took acetaminophen regularly suffered kidney damage.
  • Reproductive Problems: Vicodin and other opioid narcotics have been found to affect hormone levels and has been associated with erectile dysfunction and low testosterone levels.
  • Cardiovascular Damage
  • Brain Damage

Vicodin Overdose Explained

An overdose of Vicodin may result in toxicity due to the presence of both hydrocodone bitartrate and acetaminophen in the tablet or solution. The user may end up suffering severe liver complications even with minimal use because each Vicodin pill has over 300 mg of acetaminophen. (1)

Clinical studies show that acute overdoses of hydrocodone bitartrate and acetaminophen tablets are characterized by muscle flaccidity, constricted pupils, respiratory depression, cold, clammy skin and somnolence progressing to stupor or coma. (1)

A user may experience hepatic necrosis, which may be fatal. This usually results due to acetaminophen overdosage. Hypoglycaemic coma, renal tubular necrosis and coagulation defects may also occur.

Signs and Symptoms of Vicodin Withdrawal

Most Vicodin addicts find it difficult to stop using the drug because of withdrawal symptoms. Users may experience these even when they use the drug as prescribed by the physician.

Vicodin withdrawal symptoms are unpleasant, but they aren’t life-threatening. The user may experience initial withdrawal symptoms like chills, runny nose, agitation, yawning, anxiety and sweating. Serious symptoms include vomiting, diarrhoea, cramps, nausea and muscle/bone pain.

Withdrawal symptoms differ from individual to individual. Medical research has indicated that both long-term and short-term use of Vicodin may cause the symptoms. For instance, an individual given Vicodin in the hospital following surgery may experience short-term effects similar to the flu.

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Vicodin detox process

Most clients are advised to undergo medical detoxification in addiction treatment centres to overcome the effects of withdrawal symptoms. The Vicodin detox process may be done in four categories:

  • Medically Assisted Detox: Clients are recommended to undertake this detox process because it is the most supportive. The client receives individual counselling, 24-hour medical care and nutritional support among many other supportive services.
  • Outpatient Detox: This mode of detox involves offering treatment to clients during office working hours. It is not recommended for clients with severe Vicodin addiction.
  • Holistic Detox: This involves alternative therapies and herbal medicines to detoxify the body, like spiritual counselling and yoga.
  • Home Detox: This one may be preferable because of its flexibility. However, it has the worst results because detoxification is difficult for a person to manage on their own. .

Overcoming Vicodin Addiction

Overcoming Vicodin addiction starts with rehabilitation in a medically supervised environment that allows a person to overcome the unpleasant symptoms. For the majority of clients, the average withdrawal period is less than 10 days.

Individuals tend to avoid Vicodin treatment because they fear the unpleasantness of withdrawal symptoms. That’s why medical supervision is required to increase the effectiveness of the detox process and enable the clients to undergo the uncomfortable withdrawal symptoms, manage pain and constantly monitor the symptoms before they worsen.

Full recovery from Vicodin addiction involves teaching the client the importance of maintaining a sober lifestyle in the future. For a person to fully overcome addiction, they need to take the initiative to begin the detox process. This involves increased care, followed by relapse prevention and finally pain management programs.

Over 50% of clients who receive addiction treatment relapse to Vicodin abuse. Most addiction centres focus on relapse prevention for all clients. The clients are equipped with coping mechanisms and support programs that enable them to overcome the addiction.

To help clients completely overcome Vicodin addiction, hospitals and drug rehabilitation centres offer treatments such as holistic therapies, dual-diagnosis treatment, 24/7 medical care, group counselling and psychotherapy.

Inpatient and outpatient treatment

Inpatient treatment is the most rigorous type of Vicodin treatment after detoxification. Clients may receive 24-hour medical support that will aid in their swift recovery from the addiction. Inpatient care programs are preferable because they help clients balance both physical healing and mental health.

Clients suffering from co-occurring disorders like depression should consider the inpatient program to receive comprehensive health care.

Outpatient Vicodin treatment may be an option for clients who don’t need intensive care because they are physically and mentally stable. Outpatient clients have access to counselling and weekly medical support and may require a greater level of responsibility.

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Vicodin Addiction Medications

Vicodin alters the way a person’s body responds and causes the user to experience extreme withdrawals. However, there are many medications approved that help to lessen the side effects associated with Vicodin addiction.

Methadone: Methadone is a long-acting opioid that has been used for many years in the treatment of Vicodin addiction. However, methadone is an opioid just like Vicodin and is highly addictive; hence, clients may end up abusing it. (3)

Suboxone: Suboxone is currently used in the place of methadone to treat Vicodin addiction because it doesn’t have addictive properties. It contains two different drugs; buprenorphine (a partial opioid agonist) and naloxone (a pure opioid antagonist). (3)

Naloxone: Naloxone is an emergency drug administered by ER doctors to individuals who are experiencing an opioid overdose. The medication functions by swiftly changing sedation and respiratory depression caused by opioid intoxication. (3)

Buprenorphine

Buprenorphine is an artificial opioid obtained from thebaine, which is a natural alkaloid found in the Iranian poppy. It is a partial mu receptor agonist that was initially developed as an analgesic. (10)

Buprenorphine provides unique pharmacologic advantages in treating Vicodin addiction compared to methadone because of its partial agonist properties. A person using buprenorphine will experience a lower risk of toxicity, decreased respiratory depression, few withdrawal symptoms, less sedation and decreased risk of diversion. (10)

Buprenorphine is the first medicine to be used for opioid dependence treatment. It produces opioid effects also, making it prone to misuse. Naloxone is added to it to reduce the chances of misuse, especially by people who do not have an opioid dependency.

Naltrexone

Naltrexone is a drug that inhibits the effects of narcotics or opiates. Initially, it was specifically used to treat clients who were dependent on opioids. Currently, it has been approved for users dependent on alcohol. Individuals who are dependent on opiates like Vicodin or heroin have to stop using the drugs a week before they start using naltrexone.

The drug functions by hindering the effects of opioid drugs. Naltrexone prevents relapse by opioid addicts by lowering the cravings for opioids. An opioid user can only receive naltrexone after going through the detoxification process, and the drug is only administered via the mouth or by injection.

Vicodin Therapy Options

Therapy treatment focuses on healing the mental aspects of clients. Despite having undergone the detoxification process, which helps clients overcome the urge and withdrawal symptoms in less than a month, most clients require months and some even years of continuous counselling to recover from the mental side effects and prevent relapse.

Therapies have been productive in the treatment of substance abuse and co-occurring disorders that arise due to Vicodin addiction, such as anxiety, depression and obsessive-compulsive disorder. The purpose of the therapy is to equip clients with skills for complete recovery after detoxification.

Therapy for Vicodin addiction is available in several settings, such as private practices, sober living communities, inpatient residential rehab programmes, sober living communities and outpatient rehab programmes, and in various support groups.

Cognitive behavioural therapy

Cognitive behavioural therapy (CBT) is the most extensively used results-oriented treatment in the discipline of addiction treatment. CBT works by focusing on the clients’ thought patterns. The role of the therapist is to help individuals alter their negative actions by recognizing and overcoming pessimistic thoughts.

The therapy was initially applied in the treatment of patients suffering from severe depression. Rigorous medical research has enhanced this technique and it is now widely used in the treatment of eating disorders, drug addiction, alcoholism and other numerous conditions.

CBT has been productive in helping individuals recuperate from their addictions by equipping them with contemporary survival skills that minimize their likelihood of relapse. It may be used as a single therapy or in conjunction with other therapies.

Behavioural therapies

A national survey of substance abuse conducted in the UK in 2012 found that behavioural therapies are widely used in the addiction treatment centres compared to other therapeutic approaches.

Behavioural therapies assist the clients in figuring out the origin of their vulnerability and equip them with the requisite skills to thrive in stressful situations, as well as surroundings that have the potential to activate their urge for drugs and may result in relapse.

Behavioural approaches are effective because they engage and empower a person with skills that enable them to abstain and change their actions and attitudes. Some of the behavioural therapies used in addressing substance dependence include dialectical behaviour therapy, cognitive behavioural therapy and the matrix model.

Therapy for Vicodin addiction

Several therapeutic interventions are incorporated to treat a client suffering from Vicodin addiction. Below are some of the common therapy options available to the client:

Dialectical Behaviour Therapy: Dialectical behaviour therapy (DBT) was initially used to assist critical suicidal clients to find their purpose and meaning in life. Currently, DBT therapeutic techniques are also applied to treat clients with eating disorders and substance dependence disorders like Vicodin.

Motivational Interviewing: In motivational interviewing, the therapist collaborates with the client to uplift and motivate them. This therapeutic approach takes an optimistic and non-prejudicial stance on Vicodin addiction treatment. Instead of considering addiction a morality failing, this technique addresses addiction as a disease that can be treated.

Relapse Prevention Training: The top priority of a rehabilitation centre is to minimize the likelihood of a client relapsing. The relapse training approach is intended to impart clients with practical coping skills to handle daily life triggers.

Individual therapy

Individual therapy is essential in the Vicodin treatment program because it enables an individual to work through addiction both mentally and physically.

This therapy involves clients working together with a therapist in private sessions to find out how their addictions originated. This helps discern what activates their urges for the addiction to help them build positive survival mechanisms after their treatment.

In most cases, the sessions are conducted on a personalized basis in the therapist’s office. At times, the sessions may happen in an outdoor environment, classroom or meeting room depending on the client’s needs. A single session may take an hour or less and is usually a collaborative process.

Family counselling

Effective counselling and therapy for substance addiction in most cases includes counselling for the client’s family members. Family counselling educates families on the root causes of the addiction, how to minimize the likelihood for relapse and how to correctly assist the client in recovering from substance abuse and drug withdrawal.

Family counselling is good for family members who have been adversely affected because of the client’s addiction. The counselling session involves family members like children, spouses or parents. Therapists focus on educating them with knowledge and skills that enable them to improve their relationship through communication.

Group therapy

The road to addiction is difficult, especially when a person undertakes it alone. That’s why group recovery is encouraged, because people struggling with addiction can learn new survival techniques and gain confidence and strength from their fellow clients. In group therapy, clients encounter men and women like themselves facing similar struggles with substance abuse. Additionally, people may even end up forming sincere friendships with fellow group members.

Group therapy sessions are led by a qualified mental health professional for about an hour during which clients are allowed to talk and express themselves. Sessions are usually held three or more days per week when held in residential settings.

Topics vary depending on the agenda of the meeting. Common subjects include handling relapses, education on addiction, managing medications, living with grief and emotional trauma, among many others.

Post-Rehabilitation Support for Vicodin Addiction

Addiction treatment is a lifelong journey that does not end even after an individual leaves the rehabilitation centre. Post-rehabilitation support for Vicodin addiction includes involvement in halfway houses, sober living, relapse prevention and therapeutic communities. (12)

Clients may access some aftercare options in these centres like:

  • Support programs: Involves family therapy, group therapy sessions, support groups and so on.
  • Weekly check-ins: Mostly conducted via phone to monitor clients’ progress and assist them through any challenges.
  • Drop-in Sessions: This is where an individual can drop in without booking an appointment in the centre for a meeting if they need any extra support.

Additionally, clients are encouraged to build a new social life by engaging in activities that are drug- and alcohol-free like volunteering, going to movies and taking extracurricular classes. Such activities provide an individual with a mental and social outlet. (12)

Ongoing Vicodin Treatment and Relapse Prevention Strategies

According to the National Institute on Drug Abuse (NIDA), relapse is often part of the disease because substance addiction is chronic. NIDA compares the relapse rate for addiction to those of chronic diseases like asthma and hypertension.

To avoid relapse, it is recommended to have a consistent ongoing treatment for the entire rehabilitation period. This makes it possible for the client to adopt new strategies and coping mechanisms in their system before returning to their daily life. Medical evidence shows that spending more time in treatment improves abstinence and recovery. (11)

Strategies for preventing relapse include getting enough sleep, exercising regularly, avoiding caffeine, eating a balanced diet low in refined sugar and high in protein, attending all counselling sessions and joining a support group. (11)

References

(1) https://www.rxlist.com

(2) https://reference.medscape.com

(3) https://www.ncbi.nlm.nih.gov

(4) https://www.medicinenet.com

(5)https://www.gov.uk/government/publications/controlled-drugs-list–2/list-of-most-commonly-encountered-drugs-currently-controlled-under-the-misuse-of-drugs-legislation

(6) https://www.drugs.com

(7) www.deadiversion.usdoj.gov

(8) https://www.webmd.com

(9) https://www.drugabuse.gov/publications/finder/t/128/heroin

(10) https://www.samhsa.gov/

(11) https://blogs.psychcentral.com

(12) recoveryresourcehub.org

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