Recovering from opioid addiction goes far beyond just overcoming physical dependence. Often a person has to sift through the drugs' wreckage to rebuild a life. That's why experts are trying to emphasize recovery is biological, psychological and environmental.
To begin, there is no permanent "cure."
Biologically, our brain's chemistry means the desire to use is not easily extinguished. Here's why: When addicted to a drug, there's the physical rush. But also, parts of the brain create associations between the good feeling and the environment where it's experienced. These "conditioned associations" lead to cravings when a drug user re-encounters the same people, places, highs and lows.
Those associations get especially complicated for people with opioid addiction in the criminal justice system. According to a 2018 study published in the journal JAMA Network Open and analyzed by NPR, just 3 percent of the U.S. population had been recently arrested or were on parole or probation. Compare that with 20 percent of those addicted to opioids and 40 percent of heroin users.
The study also found being locked up carries its own risks. Most jails and prisons don't offer medicine-assisted addiction treatment. Experts say without this, people with addiction are vulnerable to relapsing and at risk of an overdose.
Obstacles for long-term sobriety mount from there, when someone has poor social support, medical problems and lack of money to support life after jail and addiction.
Of course, a criminal record also makes finding a job hard. A few options exist. First, cooperative or therapeutic workplaces. They offer employment in exchange for sobriety.
Then, federal employment assistance like the Access to Recovery program. It gives former addicts vouchers for work-related needs and pays them to attend career training classes. In Massachusetts, people who found a job using ATR were 40 percent more likely to stay sober, find housing and avoid jail.
Then there are the intangibles. Human connection can help break the cycle of isolation and desperation. A study of former inmates found family and spirituality are two key factors preventing relapse. And people in opioid addiction recovery with a recovery coach relapse less often.
Housing is also crucial. Right now, "recovery houses" are the norm. But they often require people to quit cold turkey without medication. That can backfire.
Some are now pointing to a "housing first" approach. In other words, a place to live without a "sober" requirement can actually stave off addiction in the long run. The opioid bill signed by President Trump in 2018 also includes a pilot housing program.
