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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  • But that’s not the point. These programs are based on abstinence because that’s what works and the whole intention from Bill W to Jimmy K. How about the MAT people create their own support group to support a separate issue, which is what this is. You wouldn’t ask Harvard Business School to change their model because us Community College folks can’t handle it would you?

    • Hello Michelle, have you read the original work by M.J Kreek, Vincent Dole et-al ?

    • Hi Michelle, Tradition Three. “The only requirement for membership is a desire to stop using.
      Being a member means being included, there are no tiers of membership in fellowships.

    • Hey Michelle,

      It’s true that abstinence is what worked for Bill W and Jimmy K and that’s why they see it as what “works.” Im saying this as one who has spent much time in 12-step programs and have respect for them but abstinence is not the only thing that works. I can’t even say that it’s the most successful option.

      If pot only helps, then stay with it. If methadone or suboxone helps, keep with it. But if those methods still lead back to a life of using and/or drinking, they are not for you. If 12-step programs yield no results, leave that behind too. keep searching for the tools that work the best.

      My background is in clinical psychology and because I am a recovering opiate addict, I keep myself well informed in current research. Truth is that many roads lead to Rome. Just as in most things in life, there is not one way that is for everyone. Whatever the method is, anyone seeking to stay off drugs must be will to try anything evidence-based and have the discipline to leave behind methods that do not work for them.

      In my path to recovery as an example, 12-step programs are not for me as a tool for my recovery. I attend meetings so I have a social circle not interested in using and have found that many members truly care about the welfare of those who come to meetings. Try finding compassion in the general public for opiate addiction. It’s rough out there. I would never steer anyone away from the meeting but I also would support them if, after careful consideration and reflection, they wanted to try something else cause the program is not yielding benefits.

      I do agree that if someone on methadone or suboxone goes to meetings, understand that the program might not recognize their clean time like others. Members may judge and get jealous. I would say that is ok. If you are staying away from your DOC cause of meetings, keep going. Even if you never get sober time chips or take birthdays, keep going. The group’s opinion of your life does not dictate reality. Let it just be that — an opinion.

    • Sorry, one last point. I think comparing changes thought to benefit NA or AA to wanting to change Harvard business school because it caters to a population seen as “smarter.” A person who just doesn’t have a grasp on business at the level Harvard students do or is unwilling to work as hard as necessary to reach the level of their peers is much different from someone who a 12-step program just won’t benefit. When I read your comment, I took it as only those with a certain type of intelligence will get the program. That may not have been your intention and if it’s not, I understand; however, there is no barrier for entry to see success applying for the program. Yes, there is a large amount of work needed but that work can be completed regardless of intellectual ability. If I was not secure in my intellectual abilities, or lack thereof, I could see that statement stopping some from attending because they have been told on other occasions that they are just not smart enough to get it. Even someone illiterate can find success. That is not true in attending Harvard. Reading and writing are crucial. There is not an IQ spectrum we can expect to see among those with clean time but we can in those attending and graduating Harvard. Now, I’m not here to debate the merits of what we value as intelligence and how tests are swayed to promote that type of intelligence. I’m very familiar with the tests and that paradigm and see all the holes in it. And sure, with enough time and effort, I do think the vast majority of humans could meet Harvard standards — no doubt. I think I was affected by that statement because I hear it so often about those suffering from a mental illness. If they just were smart enough, or had the character, or put in the work, they could get over it. The fact is that some mental illnesses are severe enough that someone who is diagnosed will need close, daily supervision, regardless of what I listed above. Many don’t seek help because they are told they are suffering from their own fault. They deserve their symptoms because they are too lazy to work past them. It breaks my heart when those messages affect someone I know. I can see the defeat, the loss of humanity. And as one who has lost everything to drugs, It’s heartbreaking to think similar ideas are being said about those seeking help for their drug problem.

  • Grateful recovering addict with 4+ years of active , sponsored, service based step working membership in Narcotics Anonymous. Because I participate in MAT, and two of my home areas recently reached consensus, people like me can no longer chair, participate in H&&I, PI-PL, serve at the GSA or even SHARE at our home group meeting. Thankfully I have enough clean time and have done enough recovery work that I WILL survive being squeezed out of my first (and only) program of recovery . I am but one small speck of the recovery community being marginalized by preconceptions, misconceptions and the plain ignorance of other fellow addicts. Addicts who deign to choose who and under what circumstances they will actually PRACTICE what we preach about keeping the focus on our similarities rather than our differences. How is it that MAT (prejoratively DRT) a disqualifier for the majority of participation in the Fellowship? Is that so different from those of us who replace drugs with food, shopping, stealing, religion, sex, gambling and yes, even NA itself? Maybe because it is easily qualiafiable. It’s simple to ask a service candidate if he is ‘on DRT’ ; not so easy to exclude by questioning the member we all know predates his sex addiction on newcomers ..
    I remain no less grateful for the gift of recovery I received in NA. I won’t change your mind, home group assholes. By discarding the bullshit, taking what I need, THEN sharing it with ANY AND EVERY addict who has the desire to stop using, I know I can stay honest, stay real, AND stay clean.

  • Step aside?? How about you leave 12-Step alone if you don’t agree with abstinence and start a MARA group? Some of us like abstinence and wholeheartedly believe in it and WE don’t want NA or AA to change that. MARA is the way for people on DRT a separate fellowship for like people to get the support they need and stop ridiculing 12-Step that has worked for millions and still does. It’s not for everyone but it’s for those that want it we are allowed to have our own fellowship. It’s not our fault Drug Court and MAT programs try to leverage what they know works for us and then tell us to change it! Nope!! http://www.vamarp.org/@/RecoverySupport/_files/1/file.pdf Start a Medically Assisted Recovery Group! Please!!

    • She is not ridiculing 12 steps. She is merely sharing not only HER experiences, but many people’s(on psychiatric meds and/or MAT) experiences when honestly sharing in most organized 12 step meetings. And furthermore, she is only suggesting that they not be hypocritical and that they honor the principles. You know that principle that says “all that’s required is a desire to stay clean”. Or page 98 of the NA book, where it says “There are times, however, such as in cases of health problems involving surgery and/ or physical injury, when medication may be valid.” Or page 99 where it says” serious illness or surgery can present particular problems for us. Physicians should have specific knowledge of our addiction.” or page 97, “If, while practicing these principles, we allow ourselves to feel superior or inferior, we isolate ourselves. We are headed for trouble if we feel apart from other addicts. Separation from the atmosphere of Recovery and from the spirit of service to others slows our spiritual growth.”
      I find it disappointing that you feel the need to judge another addict, just because they have found a different path to Recovery. We get enough of that from society, don’t we?!?!
      People are dying from their addiction. If not for medication assisted treatment, many would die before every finding Recovery.
      I really wish people would stay true to the principles of their program and follow their own literature. Its your right to have your own opinion, undoubtedly. However, it really just seems wrong for one addict to judge another, what?, just because one addict needs a medication from their doctor?!?! If an addict takes their MEDICATION, AS PRESCRIBED, are they really abusing it?!?! Or are they just taking their medication?!? And who are you to make that distinction?!?!
      Please, honestly think about the points I have made. And put yourself in someone else’s shoes, treat them the way you would want to be treated. And dammit! Get off your high-friggin’horse while you’re at it, your royal highness.

    • Thank you Shereen. 100% agree. It’s amazing that such a beautiful spiritual program gets a bad rap because someone would not take responsibility for their actions. AA and NA is what it is. Abstinence and a reliance on a higher power will get your a lot further than MAT. I would also like to pose the question what happens after MAT? And don’t you think all that so called research could be funded and motivated by big pharma? This is a spiritual problem not a medical issue. The brain rejuvenates itself after some time some people are willing to ride that out and have faith. I’m so grateful I got clean when I did and didn’t have these meds shoved in my face. It’s such a disservice. People don’t understand what happens when they want to get off MAT. It’s extremely difficult and when the whole recovery is based on a med and the med is removed then what? I hope people take a look at this before they find themselves backed in a corner.

    • I have to agree with Palakea. 27 years clean without MAT, I’ve seen my home group change character from more liberal, even new-age, types to real book-thumpers who to me are closer to white knuckling it. I liked the group previously but all are sober and honestly pursuing life that is happy joyous and free. My opinion is no more than my opinion, while honest experience strength and hope are are what we provide and receive through meetings. I grew very comfortable and at home in my group, but it is not my club. It’s a place to pursue sobriety and help others.

  • I entered aa 1978 i helped write the first na book was a circut speaker. I had a few months shy of 18 years off heroin. Until prescribed opiates set off a mental breakdown as i found out there is nothing spiritual about a sobriety date or people with one judging those who need prescription for ailments. Your judgements are ignorant and the stigma you so love to perpetuate is killing people and your arrogance is very unbecoming and certainly not higher minded or god like . I gave years of my life to develop the na program when we were not welcome in aa. That it has become so hatefilled and stuck in ignorance is gut wrenching to me. When i would try to get help from people in meetings as a homeless woman no one would talk to me except men offering me money for a blowjob. When i use to showup in my red hot classic car wearing a suit from nordstrom i received much attention. I blame the intervention of the criminal (in)justice system hijacking OUR tradition of “OUR primary purpose is to stay sober and help others into recovery, never letting money property or prestige get in the way of OUR primary purpose.” Due to everything being turned over to the courts or profit making services WE lost the once heartfelt unity to help those in dire straits. WE would not have the homeless problem today or the huge epidemic had our primary purpose not been hijacked by negative control and greed. You who are perpetuating the stigma of medication assisted recovery are guilty of not extending an open hand and heart to those of UShurting your arrogance is killing people and on judgement day i would not want that on my conscience.

  • The 12 Steps came about when a group of long-time, hard core drunks, who had struggled for years to quit (and stay quit) drinking wrote down the process they went thru to finally achieve long-term sobriety. PERIOD. The Big Book states that this is a ‘suggested program of recovery’ – and does not claim to be the only means. My experience over the past 25 years tells me that people who come into AA and claim it doesn’t work have not really ‘given themselves to the program’ – to be blunt, they have not (for whatever reason) ‘been honest with themselves’. I know hundreds of men and women who have recovered thru AA. If you have not found success with the 12 Steps, please seek help elsewhere – and God bless and congratulations if you are successful.
    Peace

  • 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😊

    • Yes!!! Thank God for people like you who get it! I need and deserve NA to maintain complete abstinence for me to stay clean. If it’s ok for some to take certain drugs why can’t I? Nope! Not clean but welcome if they want to eventually achieve abstinence absolutely and I do try to be loving and explain our philosophy but it’s so hard when idiots like this article tell them we are judging them or they are “stigmatized” because we don’t agree with the doctor who is making a fortune off of their continued addiction to medications!! 💙🔷

  • 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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