Motivational interviewing


Motivational interviewing is a form of counselling that helps you motivate yourself to improve your life by making goals, plans and changes to your behaviour. Since 2005, a programme, KISS (“Self-determined reduction of substance use” – [Kompetenz im Selbstbestimmten Substanzkonsum]), has been using these techniques in Germany, Austria and Switzerland. In KISS, trained addiction professionals aim to empower drug users struggling to abstain completely to reduce their legal or illegal drug use. During 12 weekly individual or group sessions, items like keeping a consumption diary, weekly goal setting and identifying and coping with high risk situations are covered. KISS has been shown to help drug-dependent people successfully cut down their drug use and make improvements to their lives. Similar programmes may exist in your area. If you are interested in this type of support, you should discuss it with your doctor.

Cognitive-behavioural therapy


Cognitive-behavioural therapy (CBT) focuses on identifying your drug-using triggers and helping you to learn how to avoid them. It also teaches you coping and problem-solving skills to help you stop using drugs. CBT has been shown to help people control their drug use or even become abstinent. If you are interested in participating in CBT, you should discuss it with your doctor.

Detoxification

Couple interested in heroin detox

Many people attempt going ‘cold turkey’ but find it too difficult and relapse. An alternative approach is detoxification.

What
Managed withdrawal, making the move from your regular drug use to no drug use, with the assistance of various medications. Detox can take place over a short period of time in an inpatient facility or over a longer period of time in the community. Hard work, but worth it.

Who
People looking for a break from drugs.

Like
Stopping using drugs.

Dislike
Discomfort and an increased overdose risk if you relapse and return to drug use.

Agonist-assisted detox uses a gradually decreasing dose of an opioid in order to minimise withdrawal and cravings as much as possible.

Symptomatic medications can help alleviate some of the withdrawal symptoms if you wish to avoid taking opioids. Although you are likely to still feel cravings, some people find they are easier to deal with when the physical symptoms of withdrawal aren’t so “in your face”.

Along with either treatment, psychosocial support greatly increases your chances of completing the treatment. Research also shows that detox patients who receive psychosocial support are more likely to follow their treatment correctly and less likely to use again.

Access
Detoxification can be accessed through your community drugs service, who will help you decide which approach will suit you best. In some areas you may also be able to access detox through your GP or a local mental health service.

If you can afford it, you can fund detox yourself but beware of unscrupulous private providers who may charge excessively high fees for inappropriate treatment.

Detox won’t kill you
Although it can be extremely unpleasant, detox is not life-threatening. Medications are available to ease some symptoms, which include dehydration, vomiting, diarrhoea, sleeplessness, aches and pains, appetite loss, cravings, depression, panic attacks, sweats, tears, agitation and distress. Symptoms usually peak shortly after the start and for many people resolve after a week or so but some people may experience a longer withdrawal. Your treatment service will be able to help you with this.

What’s next?
All kinds of things can trigger cravings even years after your last use of heroin/opioids. If you feel you need medication to stay abstinent, you can consider using naltrexone, a medication that blocks opioid effects to prevent relapse, or maintenance therapy to eliminate cravings and give you the time to make changes you feel you need in your life before trying to be completely drug free.

Tips for success
Seeing your old drug-using friends, passing through places where you used drugs or even finding an old piece of drug-using equipment can all create the desire to use again.

Try writing a list of the people, places and things that were associated with your drug use in the past, then think of ways to avoid them. Consider deleting the numbers of your old dealers or drug-using friends from your mobile phone, or even changing your phone number to avoid contact from them. Any of these steps are a good start.

People who have support in place for when they complete detox have a much better chance of staying drug free. Talk to your counsellor or community drug team about aftercare, mutual aid or rehab to help you adjust to life after detox. Rehab doesn’t have to mean going away! You can get help with rehab in the community. For some people going to a residential rehabilitation centre can be really helpful.