How to Treat Tramadol Addiction
IN THIS ARTICLE: You can find treatment for a tramadol problem in outpatient, inpatient, or residential settings. Two main therapies are effective during treatment: medication and psychotherapy. Read on to evaluate your potential for addiction. Then, learn how to get help.
TABLE OF CONTENTS
- How Do People Get Addicted?
- Brain Changes
- Signs of a Problem
- Am I Addicted?
- Treatment with Medications
- Treatment with Psychotherapy
- Stages of Treatment
- Who to Ask for Help
How Do People Get Addicted?
Addiction happens because drugs like tramadol affect multiple areas of the brain. Tramadol is has both opioid and non-opioid properties, but has only recently become a Schedule IV drug, as per the Controlled Substances Act. In fact, physicians have long thought of tramadol as having low potential for abuse and dependence. However, now there are more instances and evidence of people becoming physically and psychologically dependent on tramadol.
Addiction occurs because the brain seeks to repeat behaviors that bring us pleasure. Prescription opioids like tramadol are similar to heroin and act on the same brain systems as this strong opiate drug. So, when you take tramadol you can feel high. Because the way the brain is wired, we repeat actions that bring us pleasure.
So, who’s most at risk of developing addiction?
It’s hard to say. Sometimes, people prescribed tramadol for chronic pain can take it and not become addicted. Other times, a small number of people to become addicted even when they take tramadol as prescribed. Addiction occurs most often when people take tramadol to get high. According to the 2017 President’s Commission on Battling Opioid Addiction, people with “prior use of addictive substances are at considerably higher risk for prescription opioid misuse, with addiction to one substance alone uncommon.”
Over time, tramadol triggers changes in the brain that make it difficult to stop.
- Physically dependent on tramadol, which provokes withdrawal symptoms when we lower doses or quit completely.
- Physically tolerant to the effects of tramadol, which means we need higher/more frequent doses to achieve initial effect.
An extra word here on tolerance here (because it can lead to addiction). No one tries a drug with the intent of developing dependence. However, regular use of addictive substances can lead to both dependence and tolerance, or the need to take more and more in order to experience the original effects. When you combine the two, you can suddenly find yourself living with an addiction.
A: While the phenomena of tolerance and drug dependence are highly individual, it can take only a few weeks to develop tolerance to tramadol.
Plus, Tramadol may both change the way the brain connects one region with another, creating disturbances in message transmission. It may also reduce gray matter in the brain’s amygdala, which drives reward-related learning processes. Researchers from Standford University looking into the effects of opioids on the brain published a study in 2012 in the medical journal, Pain titled “Prescription opioid analgesics rapidly change the human brain.” They think that it becomes difficult (if not impossible) to override long-term behavior patterns that encourage drug seeking, even when a drug’s pleasurable effects subside.
In effect, tramadol might actually hijack the brain.
Signs of a Problem
Tramadol is most dangerous and addictive when taken via methods that increase euphoric effects (the “high”), such as crushing pills and then snorting or injecting the powder, or combining the pills with alcohol or other drugs. Also, you risk addiction when you are not taking tramadol exactly as prescribed, like:
- Taking more pills at once.
- Taking tramadol more frequently than prescribed.
- Taking tramadol to get high, or feel ease of anxiety, depression, or emotional pain.
- Combining it with substances like benzodiazepines, alcohol, or other opioids.
However, there are four hallmark signs of any addiction. We call them the 4 C’s.
- Losing CONTROL of drug use.
- CONTINUED use of a drug, despite negative consequences to health, home, or work life.
- CRAVING a drug.
- COMPULSION to use.
Again, experts diagnose addiction whensomeone experiences clinically significant impairment caused by the recurrent use of a pain reliever like tramadol, including health problems, physical withdrawal, persistent or increasing use, and failure to meet major responsibilities at work, school, or home.
Am I addicted to tramadol?
There are several factors that cause addiction. This is because addiction is both a physical and a psychological condition. But what distinguishes tramadol addiction from dependency is an emotional need to use tramadol to help cope with life.
Sometimes, because tramadol is so frequently prescribed, addiction is difficult to diagnose. Here are a few signs to look out for if you think you or someone you know is addicted to tramadol:
- Exceeding your tramadol dose, frequency, or limits beyond prescribed parameters.
- Feeling like your body needs tramadol to function normally.
- Continued use of tramadol regardless of how it affects you negatively.
- Doctor shopping to maintain a constant supply of tramadol.
- Obssessive thinking about or craving tramadol.
- The presence of withdrawal symptoms when you stop taking tramadol
Keep in mind that usually people are not addicted to tramadol in a vacuum. Many times, people have to deal with more than one addiction. Other substances such as alcohol, illicit drugs, and other prescriptions drugs may be involved. You may be combating addiction in general and the importance of staying away from all substances is key.
Treating tramadol addiction may require a stay in rehab. But how do you know if you need an inpatient or outpatient rehab? You’ll need a brief assessment from a medical professional first. You can find NIDA’s quick addiction assessment tools online, but it’s always best to see a medical professional in person.
Inpatient rehab is typically recommended in cases when:
- Drug use is present with anxiety, depression, or mental illness.
- Drug use is chronic, long-lasting, and high dose.
- A person would benefit from 24-7 supervision.
- A person would benefit from a calm, supportive environment.
Outpatient rehab is typically recommended in cases when:
- Drug use is less severe.
- A person has a supportive home environment.
- A person needs to continue with work or school responsibilities.
The time required for treatment averages between 28 days and 6 months, depends on a how long a person has used tramadol and just how addicted they are. After months or years of using, you’ll need to develop coping skills and new behaviors. Recovery takes time. You need to balance out physical chemistry…and start to uncover and address the reasons WHY you’re using tramadol.
Medical practice has shown that the longer a person stays in treatment, the higher the chances of recovery. Of course, the treatment length is not the only determinant of a successful treatment, but it is a huge contributing factor. In fact, according to the National Institute on Drug Abuse (NIDA) a rehab stay less than 90 days is of limited effectiveness. The more time you spend in a drug free environment and the more effort you put in treatment each day, the higher your chances are to maintain your sobriety after discharge.
Treatment with Medications
Effective treatment involves withdrawal treatment along with long term recovery maintenance. The idea is that medications can relieve BOTH withdrawal symptoms and psychological cravings that cause chemical imbalances in the body.
First, medicines treat withdrawal symptoms.
Primarily, medications for tramadol addiction target the chemistry of the nervous system. Medicines such as clonidine or benzodiazepines might be used during acute withdrawal from tramadol. Over-the-counter medications such as NSAIDs can help with acute withdrawal symptoms. You may also need the temporary prescription of anti-depressants called SSRI’s (selective serotonin reuptake inhibitors) because serotonin syndrome that can occur during recovery and withdrawal from tramadol. Altered mood states are one of the biggest things to be careful of in recovery. Other medicines that can help during tramadol withdrawal include:
- Buprenorphine delays tramadol withdrawal and reduces cravings for tramadol. It can come in a pill form or sublingual tablet that is placed under the tongue.
- Methadone can delay withdrawal, even in women who are pregnant or breastfeeding.
Then, treat physical cravings.
Studies show that people diagnosed with opioid addiction who detox from tramadol tend to relapse back to drug use. So, an important way to support recovery is to help reduce the negative effects craving without producing the euphoria that the original drug of abuse caused.
- Buprenorphine is a partial opioid agonist, meaning that it binds to opioid receptors but activates them less strongly than full agonists do…and can reduce cravings.
- Methadone is a synthetic opioid agonist that relieves drug cravings by acting on opioid receptors in the brain.
- Naltrexone blocks the euphoric and sedative effects of tramadol to prevent feelings of euphoria.
It is always important to be careful with the medications you take for tramadol addiction treatment. If you have a high potential for addiction, it is possible that you substitute one drug for another.
Treatment with Psychotherapy
Integrating behavioral and pharmacological therapies is the most effective way to help treat addiction. In a 2014 testimony to Congress, National Institute of Drug Abuse Director, Dr. Nora Volkov stated this: research over the last two decades has provided us with evidence that opioid addiction must include behavioral interventions to support treatment participation and progress. Behavioral therapies treat the emotional and psychological underpinnings of addiction.
The main principle behind psychological treatment is to help people understand, monitor, and control their compulsion to use tramadol. Behavioral treatments for addiction also help you understand and identify triggers which compel tramadol use.
Psychotherapy commonly includes:
- Family therapy
- Group therapy
- Individual counseling
- Relapse prevention
…or other psychosocial treatments. Quite literally, there are hundreds of therapy modalities possible for treating the behavioral elements of drug addiction. These services are best delivered in different types of treatment settings, ranging from inpatient, outpatient, intensive outpatient, residential, or partial hospitalization care, depending on what is most appropriate for you. To find what works best for you may be overwhelming, but once you find where you belong, you will feel hopeful to maintain your recovery.
Stages of Treatment
What happens in rehab? Treatment is a very individual experience. If you select a reputable rehab, they’ll customize the treatment plan to your needs. If they offer you a one-size-fits-all approach…run for the hills! Still, the steps you take as you progress through treatment generally remain the same.
STAGE 1: Thorough Assessment
All reputable rehabs documents a thorough baseline evaluation of any new patient using evidence-based addiction screening tools. This usually includes a drug screening (urine-based drug test) as well as a physical and mental assessment. The initial assessment is used to determine the severity of a drug problem … and then the best course of treatment. You can expect the following assessments to take about 1-3 hours when you’re first enrolling into a treatment program:
- A physical exam
- A medical history
- A family history
- Drug testing
- Interview questions
STAGE 2: Detox
Withdrawal from tramadol is atypical. It can mainfest symptoms such as seizure that require medical intervention. To help ensure a safe and more comfortable withdrawal, treating tramadol withdrawal in a medical detox is usually recommended. Detox can take from 3-7 days, or a little longer. However, most acute detoxification episodes resolve within a week of enrollment.
NOTE HERE: Inpatient rehabs often have medical detox clinics on site. Outpatient rehabs do not have detox clinics on site. If you need to go through tramadol withdrawal, the safest way to do so is under medical supervision.
STAGE 3: Medications
Treatment with medications usually starts in detox and then continues through rehab. As mentioned earlier, medicines help address withdrawal and cravings. Some people may not need medicines for tramadol addiction. In other cases, medication(s) may be prescribed for 6 months, or longer. Each case is different.
STAGE 4: Psycholotherapy
Individual behavioral therapy, group therapy, and family counseling are the most common types of treatments used in both inpatient and outpatient rehabs. These psychological treatments help people learn techniques to resist using tramadol and cope with stress without having to turn to the drug. Counseling usually lasts for at least a year during and after rehab. Some people stay in counseling for two years, or return to counseling when needed.
STAGE 5: Aftercare
Addiction aftercare involves ongoing counseling sessions, which can last several months or years. Aftercare may also include recommendations for sober housing and support group attendance.
More than 14,500 specialized rehab facilities provide detox, counseling, medication, and services to people diagnosed with substance use disorders. As a general rule, inpatient treatment is more expensive than outpatient. This is due to daily intensive counseling and therapy sessions, as well as 24-7 care. Outpatient treatment may require several hours per day of clinical treatment, but does not require additional staffing or overhead costs. Here’s a breakdown of the most common services related to tramadol treatment.
Detox: The average cost of detox reported in the medical journal, Health Services Research varied greatly from $6-12K; final cost depends on your length of stay in a detox center, the use of prescription medication(s), as well as the number of doctor consultations, testing, and procedures.
Psychotherapy: Counseling ranges from almost free to $150 or more per hour.
Outpatient treatment: Residential rehab costs from $50-$135 per day for outpatient treatment.
Inpatient treatment: On average, treatment costs from $235-700 per day for inpatient treatment.
Medications: The average cost for 1 full year of methadone maintenance treatment is approximately $6,550, or $545 per month. Retail cost of buprenorphine varies by formula and ranges from $3,100-$6,700 annually, or $260-560 per month. Naltrexone is the most expensive of the medications, at $14,100 per year, or $1175 monthly.
Who to Ask for Help
Are you ready to treat a tramadol problem? Sometimes it’s hard to know when you’re ready. Sometimes, it comes down to being tired of how tramadol is affecting your life. Or maybe other people are telling you that you need to seek help.
Whatever the the reason, if you are ready to face a possible tramadol addiction, you don’t have to do it alone. Addiction responds to medical treatment and there are many places to ask for help. While there aren’t as many tramadol-specific addiction resources out there as exist for other drugs of use…most opioid addictions present themselves in a similar same way and are treated similarly.
You can find help to treat addiction in medical settings, as well as through informal discussion. The first thing you need to do is to admit that you have a problem. After that, treatment is relatively direct. While the process is never “easy,” your initial honesty and commitment to change can take you a long way. So, if you want to live drug-free…seek help from any of the following:
1. A treatment center
Addiction treatment centers are also commonly known as rehab facilities. They run inpatient treatment programs that are designed to last for a couple of weeks up to several months. A treatment center takes you out of your known environment and gives you a safe place to explore the root of an addiction. It’s also a place to recover and to learn tools necessary to maintain abstinence from tramadol and any other substance you may be addicted to.
2. A detox clinic
If you are wanting to quit tramadol safely, look for an opiate specific detox clinic. Detoxing from tramadol can be painful, and sometimes dangerous, as it has been known to provoke atypical symptoms such as seizures. Detox clinics offer a safe environment with medical supervision to help you in the first 24-72 hours of your withdrawal process. Under supervision, you can also be given medications that help not only withdrawal symptoms but help the overall recovery of addiction. Detox addresses the physical aspects of tramadol dependency. After going through a medical detox from tramadol, you will need to seek out other psychological methods of help.
3. Clinical psychologists and psychiatrists
There are hundreds of psychologists and psychiatrists that specialize in treating addiction in general. They have an intimate understanding of addiction and how it affects not only the body, but also your psyche and interpersonal relationships. Clinical psychologists can also help you explore the roots of addictive behavior, and help you to help yourself. To get started, check out the American Psychological Association’s tips for finding a good therapist.
Clinical psychiatrists are also doctors that can help you figure out if you need any medications during tramadol recovery. Psychiatrists can also diagnose any underling mental conditions that exacerbate tramadol addiction. For example, because tramadol use changes your brain chemistry over time, you may need the support of anti-depressants. A psychiatrist can prescribe these.
4. Tramadol addiction support groups
There are several types of support groups you can seek out. The most commonly known are the 12 step groups such as Narcotics Anonymous (NA) or Alcoholics Anonymous (AA). There are also self-help groups like SMART Recovery or Rational Recovery, as well as local outpatient support groups for drug addiction at a local hospital or mental health center. Finding a support of people with experience in prescription drug abuse specifically may work best for you.
5. Licensed clinical social workers
Social workers are trained counselor who work with people diagnosed with mental health issues and substance abuse. They can reach out into the community and help get you back on your feet. Social workers can also help be a guide in your addiction recovery and help you to navigate treatments and the options that are available to you.
6. Your physician
Since it was your doctor who probably first prescribed your tramadol, go talk to them. Your family doctor or general practitioner can help you seek help for tramadol addiction. Also, they can help you taper your tramadol dosage so that you can minimze the severity and intesity of tramadol withdrawal symptoms. Medical doctors can also help you with referrals to therapists and support groups that can help aid in your recovery and end your dependence on tramadol.
7. A trusted religious or spiritual leader
Spiritual communities help people maintain recovery. If you have detoxed and recovered from tramadol use, a religious leader can be there for you during the moments you feel like you want to use again; they are there to help you maintain your recovery. If you trust someone that you can talk to or a community where you fit in, seek them out.
If you think you’ve got a problem with tramadol…you are not alone.
In the UNODC World Drug Report of 2012, it was estimated that between 26-36 million people have problems with painkillers worldwide. In the U.S., the 2016 National Survey on Drug Use and Health reported an estimated 1.8 million people experience addiction related to pain relievers, with an estimated 1.5 million people misusing tramadol products (see Table A.12B in the NSDUH for specifics).
Why talk about statistics?
We cover the numbers because we want you to know that you are not alone. Plus, addiction is no longer stigmatized. Addiction is a medical condition, not a moral failing. It can be treated medically (and effectively) using a combination of medications and behavioral therapies.
So, if you’re facing tramadol addiction, know this: you are not a bad person. Addiction is a chronic brain disease. Decades of research and experience has told us that you can and will get better!
Now, your questions
Do you still have questions about treating tramadol addiction? We know that the process can be a little intimidating. Please share your questions and experiences with treating tramadol addiction below. We’ll try to respond to your questions personally and promptly. We love to hear from our readers! So, please let us know how we can help.
References Sources: SAMHSA: Medications used in MAT
NIDA: Is drug addiction treatment worth its cost?
NIDA: Principles of Drug Addiction Treatment
The Indian Journal of Psychological Medicine: Evidence based Psychosocial Interventions in Substance Use
Pub Med Health: tramadol
SAMHSA: Significant Growth in Opiate addiction treatment
SAMHSA: Insurance and Payments for MAT
HHS: Opioid Addiction Treatment
Photo credit: Alfonsina Blyde >>