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.


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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  • 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

  • John Newcombe, Elizabeth Brico and those that point out the lack of published evidence for effectiveness of 12-step programs.
    Mr Newcombe suggests we search Cochrane Reviews, which I had previously done regarding MAT. Here is what I found- http://www.cochrane.org/CD005032/ADDICTN_alcoholics-anonymous-aa-is-self-help-group-organised-through-an-international-organization-of-recovering-alcoholics-that-offers-emotional-support-and-a-model-of-abstinence-for-people-recovering-from-alcohol-dependence-using-a-12-step-appr
    Please remember that absence of evidence does not equate with evidence of absence.

  • I can’t drink in safety and AA helped me stop drinking I’m many yrs sober now. I used to also smoke a lot of weed and would say I was addicted. I can now control weed smoking and have done so for a few yrs.

    I’m very fit and healthy and still attend AA meetings but dare not tell anyone that I like to sneak off and smoke weed every now and then, listening to live jazz music.

    I understand drug , set and setting now and it has been one of the most valuable lessons ever. Norman Zinberg’s work on this has been invaluable to me.

    I won’t drink alcohol because I’m just not prepared to take the risk of another binge. Be true to thine own self !

    Good luck everyone and do what works for you.

  • If 12-step works for someone, then that’s great, and I hope they get what they were looking for. But the evidence suggests that it does not work for most drug users, partly because drug habits are chronically relapsing conditions, or just because they like taking drugs. For these people, a long term prescription of methadone, diamorphine or other opioids is often best for reducing the harmful effects of their drug use while they continue to use (notably crime and disease). In my research, most drug users matured out of their drug habits as they got older, without any need for interventions other than substitute prescribing, and getting bored with drugs. We either decide to have an evidence-based approach to drug treatment, or we can do things on faith. Do whatever floats your boat, but I prefer evidence-based approaches, as do many others. And the Cochrane reviews show that there is no evidence that abstinence-based approaches to drug treatment are any more effective than no treatment at all (though there are always individual exceptions, this is the general picture). If you want your views on drug treatment to be influenced by scientific evidence and not just faith, why not check out the Cochrane Reviews website, and see for yourself? Good luck

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