Best Practices for Success in Opioid Use Disorder Recovery

When it comes to opioid addiction, we talk a lot about “recovery,” but what does “recovery” actually mean? In the world of clinical psychology and psychiatry, we think of addiction (and trauma) as being related to loss of control and powerlessness. So in both senses, recovery is seen as a reclamation of one’s power, one’s autonomy. Regardless, recovery is a process—it’s dynamic, complex, and non-linear. And it’s not a destination or an outcome nor is it solely about abstinence or sobriety; rather, it’s a journey a person takes in pursuit of a better life. And everyone’s journey is bound to look different.

Defining Recovery from OUD

Recovery is defined as the complex, dynamic process by which a person seeks a better life. So recovery from opioid addiction can look different for each person.

For some people, that’s complete abstinence from all substances. For others, that’s complete abstinence from the drug they misused. And for some, that’s using substances in a controlled manner with moderation. What matters is that they are no longer engaging in compulsive and uncontrollable opioid use and have established a recovery plan that works for them.

How to Recover from Opioid Use Disorder

Figuring out the best way to engage in recovery can be confusing and difficult to navigate. There are so many different treatment methods and options, including:

• Medication for Addiction Treatment (MAT), formerly referred to as Medication Assisted Treatment
• Psychotherapy
• Cognitive behavioral therapy (CBT)
• Dialectical behavior therapy (DBT)
• Motivational enhancement therapy (MET)
• Acceptance and commitment therapy (ACT)
• Motivational interviewing
• Contingency management
• Self-help programs
• Mutual support groups like 12-step programs and SMART Recovery

How do these various treatment methods help with recovery? What really works? And what isn’t necessary? Here, I’ve compiled a short list of some of the key ingredients identified by professionals like doctors, therapists, and researchers, and also by real people with lived experience, people who use drugs, and people who are in recovery. 

8 OUD Recovery Best Practices

Here are some best practices for engaging in recovery for OUD, based on the research and expert opinions of people with firsthand experience:

1. Safety first

Above all else, you need to be safe and alive. This means avoiding anything life-threatening like an overdose. This also means managing anything that is potentially affecting your ability to survive. If you’re severely depressed and suicidal, that calls for emergency psychiatric care.

If you’re experiencing psychotic symptoms, hearing voices, or seeing things that others cannot, or your perception of reality is distorted, then you need psychiatric care.

If you have a medical condition that isn’t being treated and could get dangerously worse, you need medical care.

If you’re in an abusive or violent environment, don’t have a safe place to sleep at night and store your possessions, or not getting enough food to eat, please seek out help.

If you’re not safe and you’re not in an adequately stable situation, everything I’m about to talk about is irrelevant. If life is too chaotic and dangerous, it will be very difficult to even participate in treatment.

2. Get MAT through a professional

The evidence is clear. Medications for opioid use disorder like buprenorphine or methadone save lives. They decrease the risk of overdose and the risk of death. They help you stop misusing opioids like heroin, fentanyl, and prescription painkillers. Before anything else, MAT is critical to starting recovery. 

Getting MAT, however, isn’t always easy or simple (though it should be). You need to do your part to start and continue your medication by showing up to your appointments, submitting drug screens, and adhering to any other requirements from your MAT provider and the treatment program.

While the evidence for buprenorphine/naloxone (Suboxone) to treat OUD is robust and considered the “gold standard,” the research findings on the benefits of using psychosocial tools in addition to MAT, are mixed, meaning some suggest that they are helpful, and others show that they’re not. Some large reviews concluded that psychosocial interventions in MAT are generally beneficial (Dugosh et al., 2016; Amato et al., 2011), though it’s unclear which ones are most effective.

3. Find or create a supportive environment—and get out of a toxic one

Having a supportive social or family environment (Anderson et al., 2021; Dekkers et al., 2021; Martinelli et al., 2020) or living in a recovery-supportive housing facility (Jason et al., 2021) helps people engage in recovery.

Do you live somewhere or spend a lot of your time in an environment where your recovery is supported? This doesn’t necessarily mean being in a residential rehabilitation program. Rather, are you in an environment where you can engage in recovery in an atmosphere of compassion and acceptance? Some studies show that strong interpersonal relationships can help support and sustain recovery (Stokes et al., 2018), and marital relationships have been found to improve mental health (Simon & Barrett, 2010). 

However, the opposite is also true. Are you in a situation where people around you are actively using substances? Or do you spend a lot of time in a relationship that is toxic, harming your mental health and emotional well-being? If you have a history of trauma, are you constantly being triggered in your environment? Are you constantly being stigmatized for the disease of addiction? It can be difficult if not impossible to focus on recovery in this type of setting.

4. Find belonging and community centered on recovery

Research suggests that people who participate in mutual aid groups long-term are more likely to (Martinelli, et al., 2020; Anderson et al., 2020):

• Have more positive relationships
• Be connected to other social networks
• Have higher levels of “recovery capital” (i.e., internal and external resources to engage in recovery)
• Be committed to their “sobriety” 

They are also less likely to have peers who are actively using drugs or alcohol (Anderson et al., 2020). In Johann Hari’s famous Ted Talk, he states “The opposite of addiction isn’t sobriety–it’s connection.”

5. If you have a diagnosed mental health disorder (or you suspect it), seek treatment for it

Mental health disorders like depression, anxiety, and post-traumatic stress disorder (PTSD), can influence substance use. On the other hand, substance use can also cause psychiatric symptoms. In this way, the presence of both conditions can create a vicious cycle that can be difficult to break without professional care.

You may encounter some people saying you need to manage your addiction first, or you need to manage your mental health first. Ideally, they should be managed at the same time. The idea of integrating treatment is sometimes called “Dual Diagnosis” or managing “Co-occurring Disorders.”

6. Learn more about your childhood and your family of origin, and how this may play a role in your own addiction and mental health

Sometimes, the things we learned from our families or loved ones—how to show love, express emotions, communicate thoughts, or relate to others—are actually unhealthy and maladaptive. These dysfunctional patterns may have played a role in how you cope with stress, how you handle conflict, or how you view yourself.

It can be helpful to better understand your own past traumas, adverse childhood experiences, or negative relationship experiences that may have contributed to your addiction or other mental health disorders.

You can do this by getting professional help, like formal psychotherapy, or through some sort of community-based support group or self-help program.

Regardless of how you do this, having more insight into your past may help you engage in recovery and address underlying issues that get in the way of your emotional and mental health.

7. Learn new skills related to recovery

There are evidence-based therapy techniques like DBT, CBT, MET, and ACT that all focus, in one way or another, on developing certain skills in order to engage in recovery. Here is a list of some of those key skills:   

• Distress Tolerance: Learning new coping skills to manage unwanted emotions
• Mindfulness and Cognitive Defusion: Improving emotional regulation and reactivity, as well as a growing awareness of triggers and cravings
• Acceptance and Willingness: Being honest, accepting reality, adopting an open attitude, and increasing self-compassion
• Interpersonal Effectiveness: Improving assertive communication, learning to build and maintain healthy relationships, and setting boundaries/limits

8. Find your purpose and live out the values that matter to you

Two key components of ACT are identifying your values, i.e., who you truly want to be and what you want to stand for, and taking committed action, i.e., living out those values. 

Research shows that developing ‘the self’ and a ‘post-addiction’ identity may be crucial elements in recovery (Frings et al., 2021; Kougiali et al., 2021; Van Steenberghe et al., 2021).

For some people, this looks like practicing gratitude. For others, it looks like giving back or helping others with addiction.

Having meaning in your life by knowing your values and walking the walk allows you to live out this idea that recovery is more than abstinence or sobriety, in the same way that health is more than just the absence of disease.

Ultimately, recovery is so much more than stopping drugs like opioids—recovery is an ongoing journey toward healing, well-being, connection, and purpose.