What You Must Know
The Purpose of Buprenorphine:
To suppress the debilitating symptoms of cravings and withdrawal, enabling the patient to engage in therapy, counseling and support, so they can implement positive long-term changes in their lives which develops into the new healthy patterns of behavior necessary to achieve sustained addiction remission.
Buprenorphine is only a small part of the treatment and by itself would only serve to temporarily suppress symptoms of addiction which would likely reemerge upon cessation of the medication. Recovery is the process of reversing and/or coping with the abnormal brain adaptations responsible for the disruptive addictive behaviors. Medication merely helps facilitate this effort by suppressing symptoms of addiction.
Addiction: a chronic disease
Addiction is classified as a disease because it negatively alters the biology of the brain from an otherwise healthy state. It’s considered a chronic disease because the changes are long-lasting.
The Essence of Addiction
The uncontrollable compulsive behaviors of addiction are the product of changes to the brain caused by chronic use and misuse of opioids. Just as it took time for these changes to develop it takes time to reverse – to the extent they can be reversed. Some changes may be irreversible and for those changes, coping strategies need to be learned in order to deal with them successfully.
In broad terms, addiction is the manifestation of abnormal brain adaptations. These biological changes to the brain have an influence on behavior in unhealthy ways. The changes are responsible for the cravings associated with addiction. Humans, and animals, are innately programmed to crave and repeat activities determined to be necessary for survival and propagation of the species. Some natural examples are sex, food, exercise, and accomplishment. But the repeated artificial stimulation of the brain’s reward system with opioids creates a memory and association which prompts repetition of destructive behavior via cravings. In other words the part of the brain responsible for survival is in effect hijacked and tricked into believing opioids are necessary for survival. And just as hunger and thirst prompt eating and drinking, the strong cravings for opioids prompt the person to repeat the behavior, in this case opioid misuse. It’s the strong cravings that are responsible for the uncontrollable compulsive behavior common to all addictions. It’s important to understand that the psychological experience of cravings is rooted in abnormally altered brain biology.
“…the psychological experience of cravings is rooted in altered brain biology…”
Successful addiction treatment consists of reversing, to the extent possible, the destructive brain adaptations. This is accomplished with a deliberate reconditioning effort by making significant positive changes in behavior and reflex reactions to stress and other things that prompted past drug use, not by simply taking medication. Gaining experience with these new behavioral patterns slowly creates new brain pathways while allowing the old destructive ones to fade. Counseling, therapy and support, all help to guide the patients to make the behavioral changes. The medication suppresses symptoms of cravings and withdrawal that might otherwise interfere with this effort, but it’s the deliberate self-reconditioning process which is the actual recovery. Once significant experience is gained with the new patterns of behavior, the patient may be ready to transition to the medication-free phase of treatment, in which case a slow taper is initiated to resolve the physical dependence to opioids that has been maintained, by the medication, throughout the treatment.