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.

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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?

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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  • Reading this definitely shows that the writer has a limited experience with 12 step recovery and has made an opinion based not in long term experience.

    First would be the AA information. AA is (as they state in thier first step) for Alcoholics and focuses on Alcohol, so going there for drug addiction is like taking a BMW to a Ford dealership. That doesn’t make any sense as they both drive down the road they require different tools and part to make them work.

    The second issue is the “I spoke to a chair person” comment. In any 12 step fellowship that also uses the 12 traditions “our leaders are but trusted servants, they do not govern”. On the matter of drug replacement I have only seen one article from the 12 step program that I have been going to for over 22 years (Narcotics Anonymous). http://m.na.org/?ID=bulletins-bull29
    and I thought it was pretty well written to show our office views as a fellowship.

    I am happy to say that I and many like myself have stayed completely abstinent with great success by following the program of Narcotics Anonymous to the best of our ability. I am even more grateful for the change in my thinking and freedom I continue to gain by practicing the 12 steps in my life.

    I have had the misfortune to sponsor many men who struggled to get off of drug replacement programs but I have also seen some of these people finally drop the replacement drugs and gain back there freedom from active addition and go on to focus on the true nature of their disease and find peace.

    12 step programs may not be the only group working to help the suffering addict but they do have a significant success rate.

    Funny thing about opinions are they come from one’s own perspective. That is why I am glad I am a part of a fellowship of addicts, for addicts, put together by addicts who continue to show a way that has worked for them and countless others.

    God bless,

    Chris W

    • I am a social psychologist who has spent 35 years specialising in drugs research. I am too busy (and currently ill) to do the research for you that you should have done yourself. Go to the Cochrane Reviews website, and you will see that all systematic reviews and meta-analyses on the 12-step approach show that there is no acceptable evidence of the effectiveness of this approach. Like religion, it is based on faith. The success rate of the 12-step approach is no better than spontaneous recovery in the community with no help at all.

    • God bless you too! The problem I’ve found with AA is that they believe a supernatural force will keep you from drinking. Pray it away. Bill Willson, the founder of AA was a severe alcoholic drinking whiskey from morning to night. When he had his white light experience he was coming off of alcohol and the hospital administrated an experimental hallucinogen to him to treat his addiction. Of course he saw a white light and heard God. lol Throughout Bill’s life, it is well documented that he suffered from major depressive episodes. During the 60’s he experimented with LSD to have that white light experience again. Bill was known to also cheat quite a bit on his wife. He eventually died of emphysema related to his smoking addiction. I guess the higher power cured him of alcoholism but didn’t cure him of smoking which eventually killed him. We know more now about mental health. Many people that abuse alcohol or drugs have other things going on that need proper medications to treat ie depression, ocd, bipolar disorder, etc. AA can be used as a good group support system but some might tell you to get on your knees and pray for it. That happened to me. I recommend out or in patient services and use the proper medical approach to treating addiction or other mental illness. Many of the AA people are genuine good people desperate to find answers and to keep their sobriety. I get it. There is nothing wrong with having spirituality or faith in a higher power/god. But that’s not going to treat your addiction or mental health issue. The sponsors are not trained medical professionals.

  • Bravo, so much time wasted, two years and three overdoses my daughter trying to be abstinent the AA way. Thought that was the only way in the beginning, and then I educated myself about the science of addiction, what it does to the brain, and what these medications do. Now she is doing beautifully on MAT, 22 months later, went to school and received her CASAC credential and now fully employed. Recovery in my opinion is defined by more than what is in one’s bloodstream. It is no coincidence that 7 countries that have turned the opioid epidemic around has done so by increasing access to MAT. With the stigma that still exists against MAT in this country, including the recovery community, I don’t see our turning around this epidemic anytime soon. Stigma against MAT kills. Bottom line for me is whatever works and I would never seek to disparage any method that was working for someone.

  • I had an exchange with the author of this article on Twitter and she won’t even admit that buprenorphine is intended for opiate withdrawal at all, just replacement, she says. It’s not true.

    She strikes me as someone whose problem was so hard to break that, when she found an answer that works for her, she was excited, and then probably had someone in AA/NA give a negative opinion on medically assisted treatment, copped a resentment, and now it’s all about defending her uninformed opinion.

    I’ve done the same thing. I feel bad that she’s not getting the whole recovery package, and I think she knows it, so it’s eating at her to work out her internal issues with 12 step fellowships. Like many before her, she wants to decry them instead of founding a new organization or helping support an existing non-abstinence-based recovery model.

    • Please don’t psychoanalyze and misquote me. You don’t know me and that’s not your place. Anyone can go on Twitter and see what you wrote and what I wrote, so lying is ridiculous. I did extensive research for this piece, and for the many other articles on addiction recovery that I’m writing. Anyone who follows my blog knows I’m engaged in psycho-social treatment. I just don’t go the 12-step route because I choose to engage with people who are informed, educated, and accepting of medical science. And the fact is that while some doctors use methadone or buprenorphine as “withdrawal meds,” that’s not their only or primary function, which is what you stated. I didn’t say they are never used that way; I myself was in a buprenorphine detox program once upon a time. I said they are not only used that way, and that at least one of the research doctors most involved with the biology of addiction considers them necessary long-term medications to correct brain changes which research has shown can be permanent.

      If you want to psychoanalyze people, you’d be better served getting a psych degree so you can (hopefully) do a better job of it.

      12-step meetings have accrued a certain status and level of power over the years. How, I’m not totally sure, but they have, and as a result they dominate the recovery community. That means they have a responsibility to grow and adapt alongside our understanding of addiction. They have not. That is my issue with them. You don’t know enough about me to make the statements you have, and if you wish to continue to be foolish, that’s a personal issue. Leave me out of it.

    • I believe the man is simply stating opinions just as you did in your article. You choose to engage with people that are informed, educated, and accepting of medical science? Um, are you aware these so called accepting people are getting paid from your prescriptions and therapy? Are you assuming that all people in 12 step programs aren’t informed, educated, and accepting of medical science? You haven’t done much research if that’s the case. Opinions are opinions so please educate yourself more. I left a comment below on how to do so and I truly hope you do just that Elizabeth

    • Anthony has clearly hit a raw nerve with Ms. Brico. 12 step programs have a responsibility to continue doing what it is they do best, and that is help people suffering from addiction whether it be alcohol or drugs and that have an honest desire to stay clean one day at a time. Your dismissive attitude toward the 12 step philosophy is truly coming from a position of someone who clearly has never practiced these steps in all of your affairs. I will always maintain these steps are basically good sound practical and fundamental ways to cope with absolutely anything that comes up in ones life. I said this before and I will say it again, if more people in the world practices these very sound principles the world would be in a far better place. Imagine! Happy Birthday John Lennon!

  • Different things work for different people.Methadone(short-term) saved my son’s life. Let’s all try to support and encourage each other. God bless.

  • This article is a sad thing to see. You are belittling a program that works so well for many and has for many years and still does. You are basing your research on your own opinions and not facts.
    I remember that I had a very similar way of thinking as you did when my mind was still being controlled by an opioid. So I get it. But in all actuality you are completely wrong about NA/AA.
    NA/AA accept all addicts whether or not you are on drugs, drunk, taking prescription opioids, etc. The only requirement is the desire to stop using. You will always be an addict and someone in the program, working the program fully, genuinely accepts this fact. The difference is, you become a recovering addict. So this Secretary of NA that you speak of may not have fully accepted their disease and acceptance is key in recovery.
    Opinions are opinions.
    Let’s state some facts:
    Fact: buprenorphine is a derivative of thebaine, an extract of opium. The drug is an opioid (synthetic opiate) partial agonist.” This means that buprenorphine is an opioid (with the capacity to produce opiate effects such as euphoria and respiratory depression)
    Fact: This is an opiate replacing an opiate.
    Fact: Your brain is still affected because it is an opiate
    Fact: Buprenorphine may be habit-forming, even at regular doses
    These are just a few facts.

    I did the “maintenance drug” thing for many years. I started off on Methadone, took as prescribed for 2 1/2 years, tapered down and switched to Buprenorphine thinking it would be a “better” solution, as you described, being partial agonist. I was on it for 2 1/2 years and I was told in the beginning from my doctor this should not be something you should be on long term and you should stabilize and start to taper down by 12months. It took forever to get off of because even when you taper down off of it, you still will experience withdrawl as it is still an opioid, especially when it is not on a 30day on and completely off taper.
    The mental part of it was difficult. I started going to NA/AA meetings before I stopped buprenorphine and I, as you are now, justified to myself that it was okay to be on this medication because it was prescribed to me by a doctor and I wasn’t on the street “chasing the high”. No one cared in these NA/AA meetings whether or not I was on buprenorphine. They weren’t a problem. Me being on a controlled prescription opioid was a problem. But I had no clue of this at the time

    From my experience, it was no different (mentally) than being on a street drug or methadone. Getting off of Buprenorphine was by far the worst withdrawl for me physically and mentally. I justified staying on this for years because I have a great job, 4 kids, a husband, and every time I would stop I would withdrawl and I would get right back on because I didn’t want to deal with it because ALL opiate withdrawl takes time.
    I am the real when it comes to addiction. I believe you are too. I live a beautiful full life now more than I ever have because of the NA/AA program. There are many people out there that will say the same. You should try the program and keep an open mind. Do not allow some peoples opinions to affect you coming into the rooms and enjoying the meetings and taking from them what you can. A lot of them are open meetings and not everything that is said you’ll be in agreeance with.
    I encourage you to watch the Netflix documentaries, Prescription Thugs and the two Russell Brand documentaries, one of them is called Addiction to Recovery.
    I wish you the best with recovery and I hope you can give NA/AA a chance and find other meetings that you can relate to

    • Some very good points from whoever wrote this comment. It is very true that both suboxonne and methadone are reported to be a far worse withdrawal than px drugs or heroin. Question? What is an addicts biggest fear? Withdrawal! So are we helping or hurting people by allowing them to have access to these alternative methods of treatment for years. Why are there not defined protocols for eliminating these drugs in an individually defined time frame. It is truly unfortunate that this society allows folks to remain on these drugs for years. It only serves to reinforce in the long run the fear of withdrawal and living a life on life terms without mood altering drugs.

  • I am in recovery, 3 years I follow a faith based, 12 step abstinence, program to keep myself in recovery…that is what works for me, I have allot of friends with multiple years clean from abstinence 12step faith based programs, however there all a bit different there tailored to work for the individual, were all different therefore what works for us is going to be different, I respect there way and they respect mine we may debate or voice concerns if we see someone standing on the track with a relapse train bearing down on them as friends and support we get to voice concerns, and I for one love my friends for caring enough to voice those concerns they may see something from there vantage point that I can’t in the thick of it. I also have friends and family members on Suboxone and Methadone, if you need medication to aid you in recovery if that’s your choice, I have no issue with it, I don’t look down on it, and I can’t answer if that is recovery, for me recovery means you function, your engaged with life, you are active in society working paying bills, raising children, your okay you are relatively for the most part content, stable, emotionally well, you meet life head on your not using drugs to avoid. The writer of this article seems to be in recovery, and if a medication is what he needs to keep that I am all for it, and am proud of him for changing his life the same proud I feel when I look in the mirror. But from first hand knowledge that it is not the norm. I have family members on Methadone who are high everyday the clinc ups the dose when asked, just because the addict says I am getting sick, there are no qualifications that have to be met before there dose is upped. There nodding all day the same as I did with a needle in my neck, they can not function like I couldn’t function on heroin they have to run for it almost daily the same as I did for dope, and it’s been years 5 and better so now they mix other things with it to get that high feeling and when I talk to them there in recovery, no no that is not recovery your using that methadone for a high mixing things for a better high and your life revolves around it, your still in the insanity, that is not recovery we can all agree on that, My family members on Suboxone, again on it for years, drink on top of it, sell them for stronger drugs from time to time, can’t function normally still practicing avoidance through addiction, some picked up other addiction like gambling and they say I am on Suboxone I am in recovery, that’s not recovery your just getting high legally and cheap. First we need to educate as to what recovery is. There needs to be rules and better protocol that govern these medication aided sobriety programs, remember abstinence and sobriety is not recovery, there are people not taking the meds sitting in a NA meeting abstinent but not in recovery. And there needs to be time limits I understand opiate addiction is tough to stop hell I know from experience so if at first you need the support of a medication to keep you from using while you get stronger mentally healthy, so you don’t use in early recovery when the shit hits the fan and struggles come, by all means use the medication I think that is a great aid for an addict newly in recovery first year first two years if your struggling but there has to be an end game, at some point it stops being an aid for the struggling addict in early recovery and becomes a way for people to get high have a drug daily and say look at me I am in recovery…..If you stop that drug tomorrow would you definitely use after multiple years on it in recovery, because you would be in withdraw, or because you never stopped having a chemical in your body that took you out of yourself and you didn’t learn coping skills, didn’t do counseling and 12 steps, did work on chareter defects, if you know without a shadow of a doubt if you didn’t have that drug for even one day you would be finding the dope man you have not recovered your still plagued by the diease. Those drugs need to be coupled with a program of recovery so it is just an aid for the first year maybe 2 while you work the program hard make changes get well get recovery, and get stronger than these docs need to ween the patient off . Most clinic and doctors are not making sure that the patient is getting all the care they need to arrest the disease, they throw the drug at the junkie get there pay and say see you tomorrow or in a month for your next dose if that is the case your getting your fix not getting medication to help arrest the disease… I look down on know one trying, I do not tell people if they are or aren’t in recovery, that is a question only the person involved can answer that question….but I do watch friends family who thought that medication was the answer to this diease, they path they could take to get better and can’t figure out why they still don’t have peace… Today from the 12step faith based program I have peace, and it’s the best feeling I want it for them.

  • Thank you for sharing your perspective with courage. I’m very sorry for the reactions that will want to shut you up or shut you down. Sad, really, that the 12 step groups encourage dependent True Believer thinking. They can do much good for some. NOT FOR ALL, you guys.

  • Medically assisted recovery has such a wealth of evidence behind it to affirm its efficacy, that’s it’s ridiculous in this day and age that the government are advising people to go to 12 step groups and the like that have zero evidence base ore medically assisted recovery which not only has a huge evidence base behind it going back over 5 decades, but who’s patients are routinely drug screened.
    Participants of NA and similar groups are never drug screened, so we only have their word for it that they’re drug free.
    As has been proven, substance use is a chronic,relapsing condition, for which medically assisted recovery is currently the gold standard of treatment and as such more people should be sign posted to it so we can save more lives, especially during this opioid epidemic!

    • Do you have evidence or research to back up you point of view? Just because you say it or feel strongly about it doesn’t mean that it is true.

  • My last comment and only because it’s still on my mind and during Meditation this morning it lingered. So I know this is something I have to let go of.
    I’m taking oxycodone, tramadol, Motrin and other medications right now.
    I am 51 and had a total hip replacement on Monday. 22 year’s of Army didn’t do my body Justice however I’d do it again.
    Long before this surgery I found out what I can expect for and from medications. My Dr knows I’m an alcoholic because I want them to know.
    My sponsor knows what I am taking. And my wife knows what I’m taking. I’m taking medication as prescribed for a real world situation. There is no sobriety relapse because of it.
    Tonight my sponsor is picking me up to go to a group conscience/business meeting prior to the regular meeting. Everyone in this group knows me and my situation. They’ve been praying for me constantly.
    I’ve already been cutting back on the medications and frankly can’t wait to get off of them because they disrupt my conscious contact with God and I don’t like that.
    My stinking thinking the last couple days has gone back to drinking. So I know I will be in the right place tonight when my butt is sitting in a chair with fellow alcoholics, laughing, Loving and sharing.
    Without my two home groups and several other meetings that I pop in on occasion I would be dead. Not maybe or probably but definitely.
    I wonder does the author have a sponsor? A home group? Is she involved with the community and attend functions outside of the meetings? Are you in fellowship with other AA’s or NA’s? Do you stick around after the meeting and help pick up or chat with others? Do you have a list of names and numbers that you can call 24/7? Do you call others in the program?
    The program is real. And 98% of it is worked outside the tables. Meetings just bring us together in one spot. Your lack of experience and opinionated article shine through. Perhaps you have heard an old timer say “take the cotton out of your ears and put it in your mouth”. If you haven’t heard that yet you haven’t been to enough meetings and in your case it would probably be very beneficial.
    Our old timers carry the wisdom of the program and without them I’m afraid we’d have meetings run by people like yourself.
    God bless you and I truly hope you find what you’re looking for. I’m not worried or even concerned about people like you hurting the program.
    I’m worried about people like you pushing newcomers away from what may save their lives. That’s not good

    • That’s the problem. Once NA finds out about our meds out sponsors can turn that vicious and we are not allowed to do readings or service as we are not clean. We deal with such bad attitudes about it that we don’t feel welcome at meetings or like we have the support of the fellowship. Most of us look for other programs and get our 12 steps elsewhere. We know we need the steps too. We just want to be able to work them without sweating and twitching and being in immense pain. I wish that the people of NA were more understanding and that they didn’t call is weak.

  • Respectfully Ms. Elizabeth, I have been a member of 12-step programs for over 10 years. It is abstinence based for alcohol and illegal drugs but you may have also heard members quote our Big Book that “We are not doctor’s” In fact, people with good sobriety will suggest to Sponsee or friends in recovery to seek help from their physician, there are things that we need to take medication for such as diabetes, heart, disease etc. It is the same with other conditions as well, I personally suffer from Bipolar Disorder and anxiety, P.T.S.D. etc. I have to take meds. When people have surgery they need to take meds it is not relapse as long as they are being honest and accountable and not misusing the prescription. It is the same with your prescriptions. They are needed and you are not misusing them. I understand the stigma and honestly a lot of it I was placing on myself. However it’s not secrecy. Anonymity is there to protect you. It is different. You may share whatever you want with whomever you want, whenever you wish. It is suggested that we share some things with a sponsor and not everyone may understand and as you previously mentioned make you feel uncomfortable at a meeting to prevent embarrassment or misunderstanding. We don’t all feel that way. In fact it is also heard in the meetings “Take what works referring to things people say in meetings, (remember they’re a lot of sick people trying to get well) and leave the rest. The mean or closed minded comments etc. 12 Step programs fundamentals to thrive are honesty, open-mindedness and willingness. A.A., N.A., H.A., C.A. and the like are not for profit. The only requirement for membership is the desire to stop drinking or using. Please do not knock a program that has been working for over 75 years. It works. Please read the A.A. Big Book where you will find the stories of real men and women who have recovered from a seemingly hopeless condition. There is also other 12 Step material, pamphlets and literature that describe how these programs work. 12 Step Recovery.org also some pretty useful apps in the app store. Peace and Serenity my fellow traveler. Congratulations on your sobriety.

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