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By Oct. 4, 2017
Three years ago, I checked myself out of a Colorado detox center against medical advice. I had nowhere to go but the broken-down van in which I’d been sleeping with my husband, but I was in the worst part of heroin withdrawal and all I could think about was ending the pain.
On my way out, the resident peer support specialist made one last attempt to stop me.
“The only way you can get sober is by working the steps,” he said, referring to the 12 steps of Narcotics Anonymous.
I told him I was going to try medication-assisted treatment instead. In response, he predicted that I was destined to be a “lifer” — someone who bounces between street drugs, prescribed medications, and brief periods of sobriety, but who never truly turns her life around.
He was right about one thing: I relapsed within hours of leaving the center. But the following month I enrolled in a buprenorphine program. It has worked for me. Today, I live drug-free in stable housing with my husband and our two daughters — and I’m still taking buprenorphine combined with naloxone, prescribed by my doctor.
Buprenorphine latches onto natural receptors in the brain, the same ones that heroin, oxycodone, and other opioids bind to. These receptors are involved in many of the body’s basic functions, like eating, breathing, sleeping, pleasure, and the perception of pain. Buprenorphine partially binds to these receptors, which is why it’s called a partial opioid agonist. It is prescribed as an alternative to methadone, which is a full agonist. Naloxone blocks the effects of opioids, and is added to prevent the abuse of buprenorphine.
Both medications stave off withdrawal symptoms and decrease physical cravings for drugs. They also deter people from abusing other opioids by preventing them from feeling their effects. Buprenorphine and methadone are recognized by World Health Organization as the most effective methods for lowering health problems, overdoses, and deaths related to opioid abuse.
Sadly, there’s a lot of misinformation out there about medication-assisted therapy for drug addiction. Take, for example, a comment made about medication assisted treatment by Tom Price, who recently resigned as secretary of Health and Human Services. “If we’re just substituting one drug with another,” he infamously said, “we’re not moving the dial much,” indicating his clear preference for faith-based and non-psychoactive interventions.
The most recognized providers of those kinds of interventions are the 12-step fellowships, which include Alcoholics Anonymous and Narcotics Anonymous. If that’s what the secretary of health said works best, we should count ourselves lucky that thousands of free 12-step meetings occur every day across the country. Right?
Wrong. These programs are making the opioid crisis worse by making recovery from opioid addiction harder than it already is. By turning their backs on people like me on medication-assisted therapy to kick opioid addictions, these programs are prolonging addiction and contributing to overdose deaths.
Here’s what a regional chairperson for Narcotics Anonymous told me. “People on methadone and buprenorphine are getting high every day, they’re just not buying it on the streets. It’s like you’re replacing one addiction with another.” (As part of their creed, service members of 12-step fellowships are required to maintain anonymity when speaking in the media. This individual agreed to be quoted anonymously.)
But that thinking about total abstinence is outdated. Dr. Mary Jeanne Kreek, who helped develop methadone as a treatment for addiction and who now heads Rockefeller University’s addictive diseases laboratory, believes it is necessary for habitual opioid users to take replacement therapy medications to correct endorphin deficiencies that developed during their use of opioids.
“You’re not going to treat genetics and brain changes with counseling and psychological support,” she told me by phone.
Writing in STAT, two Seattle-area addiction experts said that medication-assisted therapy helps stabilize brain receptors thrown out of whack by an opioid addiction, allowing the body and brain to establish a “new normal.”
Narcotics Anonymous and other 12-step programs describe themselves as wholly abstinence based, but claim to welcome anyone interested in pursuing addiction recovery. The reality, however, is that if someone in medication-assisted therapy seeks the support of a 12-step fellowship, he or she will most likely be met with a lecture or worse — denied the ability to speak during meetings.
I met with a Narcotics Anonymous secretary, who asked me to share his story under a pseudonym (I call him Jay) in keeping with the organization’s media guidelines and to protect his privacy.
Jay, who is in recovery from a 30-year opioid addiction, regularly attends 12-step meetings in Seattle — both AA and NA — and also takes buprenorphine. He recounted that when he first began attending meetings and mentioned his prescription, one member spent 15 minutes ranting that buprenorphine was “just a maintenance drug,” that Jay needed to “get off that crap,” and that he was “still a drug addict” as long as he continued to follow his doctor’s instructions.
“It really affected me,” Jay told me over coffee. “I was reaching out for help. It was really disheartening.” He admitted to relapsing shortly after leaving that meeting. “I thought: There’s no hope for me. I’m a drug addict.” Now sober from heroin for almost a year, he is very selective about where he shares information about his use of medication-assisted therapy.
Honesty and community support are essential to addiction recovery. Forced secrecy about medication-assisted therapy compromises an addicted person’s recovery by causing him or her to repeat patterns of deception implemented during active addiction. It is antithetical to every modern addiction treatment model. So why are we still relying on programs that vilify people who use evidence-based treatment for their recovery?
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Narcotics Anonymous and Alcoholics Anonymous are not just widely available — they are often mandated by Drug Courts, the system that oversees many nonviolent drug-related offenders. Even costly rehab centers across the country employ 12-step programs and the accompanying abstinence-based approach.
This doesn’t make sense to me, since the science of addiction has evolved in recent years to include medication-assisted therapy as a cornerstone of treatment, while the 12-steps have not been touched by science since the 1940s.
As someone who has struggled with heroin addiction, I know how difficult recovery is. Beyond the physical and psychological discomforts, addicted individuals face being ostracized, sometimes even by our own families. Now, the stigma against using medication-assisted therapy is so rampant it’s even in the White House.
As we approach the second year of the Trump administration, the need for camaraderie between those of us in recovery is greater than ever. Many of us rely upon the 12 steps for our sobriety, but many also rely upon medication-assisted treatment.
The time has come for Narcotics Anonymous, Alcoholics Anonymous, and other 12-step programs to update their approach, or step aside. Abstinence-based models are too dangerous to rule the recovery community any longer.
Elizabeth Brico is a writer based in the Pacific Northwest who blogs at Betty’s Battleground. She is also a contributing writer for the HealthyPlace trauma blog.
Hi, I am a heroin addict with a little over 45 days clean but i have signed up for MAT services and am taking suboxin on a regular basis. I am having a really gnarly internal controversy on weather or not to continue with taking my medication or trying to go completely clean. I love N.A., but im finding that anytime i raise the issue of me taking suboxin i find myself kinda shunned by most at the meetings. I like the idea of being totally free of all mind and mood altering substances but i also like the idea of suboxin helping my brain in the chemical area. I dont know what to do. I thank you for your info I i agree that its time for N.A. to welcome people that are taking suboxin. I mean its not like we’re getting high. I dont think? All I know is MAT is working for me at the moment so I think Im going to continue with his services. Thanks MAT.
My friend, you are preaching to the wrong choir, I have been sober and clean for 30 years with the help of the 12 steps, never took any other drug to keep me clean, it works if you work it, it’s called grace my friend, grace
“Tradition Ten restricts NA, as a fellowship, from stating
opinions on outside issues. However, it places no such
restriction on the individual member.”(It Works, “Tradition
Ten”) Our hope is that those who receive medication
to treat addiction will come to meetings and listen
to people who are recovering. Through listening and
through asking questions before and after meetings,
attendees may gain a better understanding of NA and
what it has to offer. NA offers a community and a lifestyle
that support staying clean, and NA may be compatible
for addicts on medically assisted protocols if they have a
desire to become clean one day.
We understand that addicts whose path is medically
assisted treatment may hear many messages in NA
meetings. Some NA meetings make no distinction as to
whether those receiving medication to treat addiction
may share in a meeting, while other NA meetings limit
the participation of those who are taking this type of
medication. Each group is free to make its own decision
on recovery meeting participation and involvement in
group services for those receiving medication assistance
for drug addiction. To the author of the accompanying article. Please get your facts straight.
She DOES have her facts straight, and your comment confirms it. You stated that NA will encourage people on MAT to listen and ask questions IF THEY WOULD LIKE TO BE CLEAN SOME DAY. Sorry, but I’m on MAT and I AM clean RIGHT NOW. The 12-step model is outdated at best, dangerous at worst.
As a member of a 12-step fellowship with 25 years clean, and an addiction therapist at a VA facility, I see firsthand the effects medication-assisted therapy and Drug replacement therapy on clients that continuously relapse. Although medication-assisted therapy has its merits, and most who are on it maintain abstinence from heroin and other opiates, only complete and total abstinence from all mind-altering chemicals has been working for me. I take clients to 12-step meetings and they are made to feel welcome.
I’ve been in recovery since 1984 and haven’t stuck anything in my arm or up my nose since 1986. I have managed to get clean and stay clean without medically assistant therapy. For years I’ve seen people who choose to go the medically assistant route to recovery have their recovery devalued at tables. Which to me is insane for the simple reason that individuals who go the medically assistant route have a far greater success rate than those who go the way of just talk therapy or self-help groups as the stats show. I believe I can speak with some authority on this subject being that I worked as a therapist and as a clinical supervisor for some thirty plus years before I retired.
If you’re on maintenance prescription heroin taken at a supervised injection facility in Vancouver, should NA consider you in recovery? No? Then why so if you’re on Methadone or Buprenorphine?
Does the absurdity of agonist maintenance have any limits?
I believe there is more than one way to recover. As an addictions counselor and a person in long term recovery i believe the 12 step fellowship is very helpful for any one that wants recovery, i also believe that if someone comes seeking help in a 12 step meeting they should be welcomed with open arms. I believe in AA their literature includes the saying “we are not doctors if you need to seek outside help please do” I am sure i am misquoting this but the simple truth is to thine own self be true and if you feel you are in recovery while on MAT then you are! To many People are dying because of this terrible disease and all should be able to choose the way they recover.
I am a recovering addict and will be celebrating 8 years of total abstinence tomorrow. That being said I am also a counselor that works in a program that prescribes long term Suboxone. My roots were in 12 step recovery and I worked in an abstinence based program for 5 years. In the last 7 months of working with pharmacotherapy I have seen more people be successful and have attended fewer funerals. My hope is that all of my clients will someday be successful at complete abstinence but until they are ready taking MAT would be setting them up for failure. NA’s stance on MAT is that they have no opinion it’s an outside issue. I am grateful that my hometown (which is recognized as the epicenter of the opiate epidemic) has 12 step meetings that have let go of those old ideas and welcomes the newcomer saying “keep coming back.”
Thank you for your story. It’s like thousands of other stories out there. It’s like mine. I really needed to read this.
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