First of all, plan to fail.

I don’t want to sound pessimistic, but over 2.5 million Americans suffer from opioid use disorder, which contributed to over 70,000 overdose deaths in 2017.

Once the brain gets basically highjacked by opioids and is being held hostage or damaged, don’t expect much in the way of good, near-term decision-making. The opioids take on the quality of air: the brain perceives them as necessary for survival.

That’s why it’s a good idea when a person has finally made the decision to stop using opioids once and for all, to plan to fail.

Let me explain.

A person can quit opioids, go to therapy, change their friends, change their lifestyle, and change their environment as much as possible, but inevitably something will happen that will put them in the direct path of opioids again.

You just can’t control every environment. Too often, a person in early recovery will find himself in a situation that catches him off guard and triggers him beyond anything he’s prepared for.

This where Implementation Intentions come in. A well-researched idea in motivation psychology, Ben Hardy, author of Willpower Doesn’t Work (2018), describes it this way:

“Implementation intentions come down to knowing ahead of time exactly what you’ll do if you veer off course, as well as defining precisely what veering off course means for you. It’s planning to fail so you can proactively respond.” (page 111)

This is exactly why the Coleman Institute for Addiction Medicine has been a pioneer in the using of long-acting formulations of naltrexone for people who have firmly committed to stop using oxycodone, hydrocodone, heroin, Vicoprofen®, or any number of other opioids. Once a patient has completed our rapid, or accelerated, outpatient opioid detox, the naltrexone becomes the built-in implementation intention.

It’s not that we don’t have confidence in our patient’s intentions or motivations, but we know how difficult it is for the damaged brain to give up the idea of ever using opioids again.

Early recovery is an extremely vulnerable time.


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Because the opioid receptors are occupied when using a long-acting formulation of naltrexone, our patients feel no physical cravings for opioids. This is one of the single best strategies for beginning the next phase of recovery-- building the groundwork for a lifetime free from craving and using drugs, and living life according to what our patient truly values-his health, his family, his friends, his profession, etc.

It goes without saying that combining naltrexone (or any evidence-based, Medication Assisted Treatment --MAT) with counseling is beyond important. Although we have patients who stay on naltrexone for many years (it’s a very safe medication), at some point, most people want to stop. Working with trained therapists who can guide patients to create strategies for the inevitable roadblocks when they are no longer under the safety net of naltrexone, is another form of using Implementation Intentions.

The bad news is the statistic I referenced earlier: opioid use disorder contributed to over 70,000 overdose deaths in 2017. The good news is, this has caused an explosion of research into treating the condition of Substance Use Disorder.

The Coleman Institute for Addiction Medicine has locations around the country specializing in safely, comfortably and affordably getting people off opioids and onto long-acting naltrexone therapy. Please call us if you have any questions going forward about how this works and if it’s the right therapy for you or your loved one.

Joan R. Shepherd, FNP

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