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?
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.
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.
Good for you!!!
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
A very simple way to look at this is if I don’t like what you do I don’t have to do it , that goes two ways.
NA supports those who quality for membership “the desire to stop using”. This is one of our non-negotiable traditions. We do welcome back people who relapse and people who are not clean. We do also protect our message and our society with clean time requirements.
There are other groups with other views and as “we are not affiliated with any outside organization” we (as an organization) have no opinion on how they do there recovery so there are many other options out there for people to try if they do not meet our requirement or want to try something else.
Since we also Adapted the Twelve traditions in 1953 our fellowship has grown and many addicts have “found freedom from active addiction and a new way of life” and I am glad there are no plans to change the program I have come to love.
JFT, I am grateful for NA as it has changed my life in ways I will never be able to fully repay.
These are my options. If you are looking for NAps opinion as an organization the closest thing would be http://m.na.org/?ID=bulletins-bull29
Elizabeth, I admire your courage at presenting your negative experience with 12 step program. I find it refreshing to hear another point of view, another pathway to recovery you have made work. As others have commented, there can be many paths to recovery. I am happy for anyone who is in a good place, able to live their life and pursue their dreams, who has broken the pattern of self-destructive behavior of addiction. More power to everyone.
This is an irresponsible bitter statement that just shows a true lack of understanding not to mention] the ability to have an open mind to all forms of treatment! Sad!
“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.”
A great deal of back and forth is present in these comments, with some rigidly held critical views of MAT on the one hand and of 12-step programs on the other; and with a significant number encouraging more tolerance in NA & AA for those on MAT. Even Ms Brico’s comments waver somewhat and she acknowledges “There are other reasons that I would not use the 12-steps personally” and “…we all need community and peer support, even if we don’t agree with the doctrine of the 12-steps”. She is very clearly knowledgeable about the science behind MAT, though I’m unaware of such support for the need for community and peer support. One thing apparent in the rejection of 12-step programs by those criticized or silenced for being on MAT is the emotional vulnerability of the newly clean. I was, but very fortunately found a sponsor and grandsponsor who stood behind me through every doubt, tirade, craving etc.
There have always been people who tried 12-step programs, couldn’t stay clean and sober and went on to die. We in AA and NA are well aware of those who do not come back and of estimates of our low success rate (however one defines that). The huge number of deaths in the current opioid crisis brings the low success rate to the forefront. Most of us who have found sobriety in AA or NA want other addicts to find what we’ve found. But they cannot if they’re dead.
There have been critics of AA since before I got clean in 1990 and alternatives like Rational Recovery that arise from time to time. I get annoyed, but the truth is if they prevent relapses and save lives, then more power to them. I say the same for MAT.
And there have always been AA members who seem to think the way they got sober is the ‘right’ way and are free with that opinion.
On the one hand it’s not reasonable for Ms Brico to expect every 12-step member to hold identical opinions on every issue around sobriety; any more than she would expect every political party member or member of a religion to hold identical opinions on every matter. In AA meetings we are free to speak up so each of us routinely hears things we don’t agree with.
On the other hand, we in the 12-step community need to remember that we help each other by sharing our experience, strength and hope; not our opinions and beliefs. Every member invariably expresses those opinions but our own sobriety is best served when we acknowledge those opinions are our own and not required for sobriety. And that we are a program of attraction not promotion.
I’m afraid this will ever happen so it pointless to harp about it. They’ve been doing the way they’ve been doing it for decades and it works for most at least the serious folks that want it it.
I’m of the opinion that if you want to stay sober or stay on a path to sobriety then you just might have to go out of your way to find support groups that are welcoming and avoid this that are not. Many have stated here they have never experienced the rejection this author discusses in this article and I would have to agree with them. I’ve never in 30 years seen anyone rejected from either program who had an honest desire to get sober, with or without medical intervention.
Elizabeth Brico says, and I totally agree:
“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.”
I totally agree. NA and AA have a valuable and important place in recovery
but they are not the only way. They should not rule but they should remain as an important program. NA and AA are good for those who succeeded in NA and AA but the rest of the people need to find their recovery what ever way works for them. If they can recover in a medically assisted program that’s what they should do
We also need to have programs and safe guards for the people that are continuing to use like needle exchange and Narcon and Supervised Injection sites
It’s not one way or the highway
I totally agree with the author of this article. After 35 years of research on drug use and drug problems, it is clear to me that abstinence-based approaches are ineffective and counterproductive. Community-based treatment based on long-term maintenance on methadone, heroin and other drugs is the only effective approach for reducing crime and health problems
Clearly this person does not know what they are talking about. Total rubbish. Please state your facts and figures!
If they’re ineffective and counter-productive, then my 20 years in recovery must have been a dream. Better than the 20 years that went before, that I can promise you.
John – more like a nightmare than a dream. The 12-step approach is unevidenced, as anyone who takes the time to check the research would know. Go to the Cochrane Reviews website, search ’12-step’, ‘recovery’ and such like, and see for yourself. You will see that there is no evidence that abstinence-based approaches work – harm reduction approaches show far more success in achieving their goals.
Who says something like this? “abstinence-based approaches are ineffective and counterproductive.”
I’ll tell you…someone who has no experience in 12 step recovery other than reading research studies that have been notoriously lacking in their overall effectiveness. How can you actually do a research study on an anynonomous worldwide group of individuals? You can’t, It’s never effectivly been done and therefore statements like this are just idiotic and ignorant. Anyone who would make geneneralized statement like that clearly has a closed mind and has 0 interest in the ability of seeing that there are many ways to treat addiction not just one. I never would have fared well had I gone the MAT route. I’d never been able to get sober and would have probably relapsed over and over.
Addiction is psycho social and spiritual disease. There are 3 areas that need to be addressed in recovery. The physical, the social and the spiritual. The 12 steps are NOT just faith based. They are a prescription for a continuing life that address’s the social and spiritual aspects of those suffering with additction probably never had and experienced. Perhaps Mr. Newcombe doesn’t factor these components into his data when assessing the recovery rates of addicts and what their actual behavioural needs are for long term recovery.
Before you condemn the sanity of the 12 steps perhaps more should try and inderstand them and what their purpose is in a recovering persons life. Those that poo poo these solid directions for becoming a better overall person living in society probably have never taken the time to actually understand and incorporate these marvelous tools. Try it sometime you might actually see that your condemnation of them is akin to being a closed minded fool.