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hree 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.

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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.

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  • Compelling story. As a person in recovery for 25 years, I value your journey, and as a healthcare professional, I certainly embrace MAT as critical to combatting substance use disorders. Would be interested to discuss ways to collaborate on educating communities on what works, together.

  • This article takes a useful step towards helping to end opioid epidemic. It is a tragedy that the main program for Drug Courts is 12 Step and yet 12 Step discourages the use of medication. Medication is the most helpful solution to opioid addiction and 12Step is the least effective. The success rate for alcohol with a 12-Step program is about 5-10% and for opioids 12 Step is much lower. In fact, someone is more likely to OD just after leaving a 12-Step based rehab than if they continued to use on their own.

    It is a useful effort to say that NA and AA and other 12 Step need to stop discouraging the use of medication, even if NA and AA are unlikely to do this because the reaction of 12 Step shows how harmful 12 Step programs happen to be. But more useful still would be for Drug Courts and the general public to stop relying on 12 Step. I’ve glanced at a few other comments here and it is typical of NA and AA culture, the kind of culture that the article correctly critiques, there is an insistence that the only way to be sober is through the 12 Steps and total abstinence. The reason that NA and AA are unlikely to change this view is that 12 Step is more religious cult than it is useful self-help program for addiction. Its entirely ideology hinges on personal powerlessness and turning one’s will and one’s life over to the care of the Higher Power of AA, as manifested through Sponsors and Old Timers in AA.

    Thus, if the courts are going to mandate a free self-help group have it be HAMS, SMART, Women for Sobriety, or LIfeRing or even an openly religious group affiliated with a church, provided it isn’t 12 Step and isn’t a religious cult like 12 Step.

  • This article was written by a person who knows absolutely nothing about Recovering from drug addiction/alcoholism and living sober. I’m curious what is the motive behind this article and bashing 12 Step Recovery? To justify you substituting one drug for another drug and calling yourself sober? No one gets sober going to meetings. Meetings are where struggling Alcoholics/addicts meet Recovered and sober Alcoholics/addicts, ask them to be a sponsor, go through the 12 steps, get and stay sober, start sponsoring and helping Alcoholics/addicts get sober as a sponsor. For 82 yrs 12 Step Recovery has been recovering lost lives through sponsorship. There is one person that can heal an alcoholic/addict and that is another sober alcoholic/addict going through the 12 steps. Sober meaning abstinent off of all mind altering drugs. You are killing people with this message of curing one drug problem with another drug. 12 Step Recovery will always be around bc it’s fellowship members are all sober and live bc they beat drug addiction. Your drug solution of using drugs to fix a drug problem will get all of your patients eventually killed by drug use. Drug addiction is a symptom of the deeper underlying problem of fear and delusion. 12 Step Recovery is free, there is no charge for money, we give it away freely once we get sober. The medical field bash 12 Step Recovery bc they will be without a career field and a job once 12 Step Recovery steps outside of anonymity which is happening at a rapid rate today with the opioid epidemic. No alcoholic or addict gets sober under a medical professional or therapist bc the medical person does not know the experience of being an alcoholic/addict. Someone who has lived the hell of alcoholism/addiction does not trust and take the advice of a person who has studied and read about the hell of alcoholism and addiction. You promoting a drug use solution to drug addicts is a bandaid on a gunshot wound and keeps drug addicts from experiencing real sobriety and the freedom of drug addiction. If you are writing your articles and your blogs to inspire people and help people then write from a place of love of people, care, companion, and at a bare minimum know what you are talking about. Addiction is a death sentence and 12 Step Recovery has been saving lost lives for 82 yrs. It is awesome that you are writing about being a Mother and PTSD. Keep writing!
    Here is a writing tip: Bashing and tearing down others does not inspire or heal people. If you have to tell everyone your the queen…your not the queen…your the jester 👸 Hugs to you😊

  • SMART recovery is just one more avenue in the options for folks to get to recovery and hopefully sobriety. While SMART recovery is extremely limited in size, scope and accessibility compared to other 12 step programs it does serve a purpose for some. When I looked into it a few years back I was glad to see there were options for those who were unable to become members of the other programs. While I would never pretend to label one better than the other, I welcome any program geared to people who have a desire to stop using. One has to be open minded and utilize all the tools out there and besides it’s so much better than going around trashing other programs like this author does.

  • I am a facilitator for SMART recovery and totally agree with the article’s conclusions. SMART offers a self help program with weekly and on-line meeting that focuses on the power of choice. It is recognized as an alternative to AA by courts nationwide. I don’t speak for SMART officially but their approach is generally that the use of medication is a decision made between medical professionals and their patients. Each individual is different and there is no one path to recovery. All are welcome at SMART meetings, and issues surrounding medication are only discussed in the context of changing addictive behaviors

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