Why Residential Rehab Matters in Heroin Addiction

A recent study shows why rehab may be an addict's best bet.

Posted Feb 11, 2015

Why Residential Rehab Matters in Heroin Addiction
Photo purchased from iStock, used with permission

Rehab has traditionally been dismissed as relatively pointless for those dependent on heroin, but an epic study shows it may be the addict’s best bet.

A sweeping 11-year study out of Australia adds fresh understanding to our knowledge of heroin dependence and, in the process, challenges a widely held misconception—that residential rehab doesn’t really do much to help the heroin addict. Instead, the research shows residential rehabilitation may well set the best course to long-term improvement.

The research team, representing Australia’s National Drug and Alcohol Research Centre, followed 615 heroin users, checking in with them at 3, 12, 24 and 36 months and, finally, at 11 years. The goal was to determine just how they would fare over time in terms of drug use patterns, mortality, remission, overdose rates, suicide attempts, criminality, and mental and physical health. By the final year, 10 percent had died, almost half were still in some form of treatment, and those still using heroin fell to a quarter. With the drop in use came less crime, less risk-taking and better overall health. In the final analysis, residential rehab treatment was associated with positive outcomes across the board and was the only factor significantly associated with better physical health.

In the first year of the long-term study, residential rehab appeared to be about as effective as other forms of help, such as methadone maintenance. Ultimately, however, it was those who spent time in residential rehabilitation who recorded the best outcomes, especially if that rehab stay came early in the course of treatment.

Misunderstandings About Residential Rehab

Why was there such pessimism in the first place about the ability of residential rehabilitation to help the heroin addict, especially when rehab is generally embraced as a treatment for other forms of substance use? Part of the reason was a simple lack of data. Until the Australian team launched its epic study, much of what treatment providers knew about heroin dependence was based on limited research from the 1960s and ’70s.

In addition, some gave up on the notion of “rehabilitation” for heroin addicts when attempts to add therapy to other forms of heroin treatment proved less than impressive—although that likely had more to do with a lack of long-term commitment and trained staff to run the sessions. The thinking was, therapy is a key part of residential rehab, so why would therapy be a solution in that setting if it didn’t really work in others? What wasn’t always recognized is that residential rehab intervention is more complex, more intense, and more multidimensional than, say, a weekly psychotherapy gathering tacked on to a methadone maintenance program.

For those struggling with heroin dependence and who may have been discouraged from even attempting residential rehabilitation, the new study, released in January, is a heartening signal that the healing potential of rehab doesn’t just extend to those with other kinds of addictions.

The Negative Power of Depression

While residential rehab helped predict positive outcomes in the study, major depression was the single biggest predictor of negative outcomes, with the potential to erase any hard-earned gains. Those who were depressed were more likely to use heroin and other drugs, to relapse, to be ill, and to be active criminally. It’s a graphic reminder that depression is an all-too-common accompaniment to all types of substance use—and one that remains under-recognized and under-treated in heroin addiction.

The researchers also found:

  • Detoxification works best as a gateway to treatment. By itself, it does little to curb use.
  • Study participants tended to move in and out of treatment, but having fewer treatment episodes was associated with more positive outcomes. 
  • Even when heroin was no longer used, other drug use remained high. 
  • Major depression is the main predictor of a poor outcome, but screening positive for borderline personality disorder was not far behind.

Insights for Effectively Treating Heroin Addiction

So what are we to do with the wealth of information the study provides? The researchers recommend more targeted interventions to help those with issues such as depression and borderline personality disorder, as well as a commitment to more sustained and stable treatment that follows the person long-term.

My hope is our treatment providers, our community leaders, and our government health care officials will join together to do this and more. For example, we should move beyond the generic types of treatment so commonly offered and tailor our therapy to the individual, helping them to create an environment in which they can succeed. We also need better training of all those who come into contact with heroin users so they can better spot and treat co-occurring mental health issues such as depression; as it stands, we not only have a skills deficit but a clinical service care delivery deficit. It’s also time to get out the word that residential rehab is not only a valid option for the heroin addict but one that may well be a crucial first step.

David Sack, M.D., is a triple board-certified psychiatrist and addiction specialist who serves as CEO of Elements Behavioral Health, a network of addiction treatment centers that includes The Recovery Place in Florida and Brightwater Landing drug rehabilitation center in Pennsylvania.