The dentist gives the patient a prescription after extracting his problem tooth, and the orthopedist gives him some for his torn rotator cuff. A migraine headache gets him another prescription, and when he really develops a serious backache he gets bumped in strength. Pretty soon our unsuspecting patient has enough bottles of Vicodin and prescriptions to support an addict for months. After months of taking this potent opiate, his brain chemistry has actually changed until he believes that his very survival depends on taking the drug. And this is supposed to be a controlled substance?

Vicodin is a narcotic analgesic that's recommended for everything from moderate to severe pain, so it's prescribed to millions of patients every year. It's a mixture of the opiate hydrocodone and the painkiller acetaminophen, which enhances the effect of the opiate. Lortab, Lorcet, Zydone, and Dolacet are other brand names with similar ingredients, but they all spell the same thing: trouble. Taking more than the prescribed amount beyond the suggested time period creates a serious risk of dependency, because hydrocodone is so good at triggering the pleasure and reward centers of the brain. It interacts strongly with alcohol, antihistamines, antidepressants, and dozens of other prescription drugs, making the user drowsy and more euphoric.

Unfortunately, harried doctors have hundreds of patients and often don't follow up to make sure their charges are taking their medicine exactly as prescribed. If the patient doesn't call to complain, all is assumed to be fine until his next visit. Taking the drugs just a little longer than he's supposed to, the client eases unsuspectingly into addiction. Complicating this is the fact that Vicodin has become a popular recreational drug sold on the black market and the internet. It's much easier to smuggle across the border from Mexico than marijuana and cocaine, because it's harder to detect. Over 55% of Vicodin addicts are women, breaking with the usual pattern of drug abuse, and all ages and social strata succumb to this disease. According to the 2003 National Survey on Drug Use and Health, 4.7 million people ages twelve and older misused pain relievers in 2003.

Despite the casual way most Vicodin abusers fall into dependency, they feel a great stigma and often resist getting help. They're not the kind of people who would ever have a drug problem. It's easy to rationalize keeping the secret, because hydrocodone is not an illegal drug – the doctor prescribed it. Surviving pain, real or imaginary, becomes an obsession. When the problem is impossible to ignore, the addict might try to quit on her own. She quickly confronts the fact that she's both psychologically and physically addicted, and withdrawal effects are a fierce reality. Getting in was a do-it-yourself project but getting out is not. Until recently, the opiate abuser's only hope lay in an intensive hospital stay followed by months of therapy and withdrawal from the world.

Now there's new hope for those addicted to Vicodin, Percocet, OxyContin, Demerol, and other prescription opiates – an outpatient treatment which includes the drug buprenorphine hydrochloride. Sold in the US as Suboxone, it's a partial opioid agonist, which means that it can both activate and block the opioid receptors. This allows a trained doctor to decrease the withdrawal effects and fool the receptors in the brain into thinking all is normal while the patient is weaned off opiates.

Until recently, such treatments were only available at a hospital or clinic, with a lengthy stay involved, but now a doctor can administer Suboxone in his office on an outpatient basis. That doesn't mean this therapy has gotten easy for anyone to do – it shouldn't become the same kind of prescribe-and-forget policy that went badly in the first place. Drug rehab has to be done under a doctor's watchful care, so the patient should make sure to find an office with the proper experience and credentials.

Treatment for the physical symptoms of addiction is not enough – a good program should include behavioral modification and individual counseling to aid the client in all aspects of recovery. The patient is never regarded as just a list of symptoms and ailments, but a complete person who must be treated as a whole. Of course any residual pain should be addressed in a way that doesn't depend upon opiates, and this might involve working with a fitness trainer, nutritionist, hypnotherapist, acupuncturist, and other professionals. Holistic therapies and lifestyle changes give the best result for long-term success in conquering both pain and addiction.

The best patient is motivated to become free of drugs while keeping his life and career intact, and this fits nicely with improved outpatient programs for Vicodin rehab. The best facility is one that has extensive experience with heroin and opiate addiction, not some fly-by-night taking advantage of the new laws to go into the drug detox business.