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.
Excellent! Being a Big Book Thumper for many years in “abstinence” helps me today only because after spending years in my active opiate addiction and continuing to attend the meetings long after abstinence was gone, I was fortunate enough to be a veteran and fell up into their medical program over 13 years ago. I started OTP on methadone, and after my dose was titrated enough I began to feel “normal” again – not AA normal, but people normal! I began college at 53 after being unemployable and also an ex-prisoner for the past 12 years after AA, and at 63 I received my MS in Addictions Counseling. I am 13 years, 1month, and 16 days into my recovery from all unauthorized substances including opiates and in my 3rd full year of counseling others just like me in a local OTP clinic. I had wanted to become a counselor for years while “sober” in AA, but could never wrap my mind around, OR my heart around it…Today, I do use the 12 steps with many of my patients as an approach to learning to live life in recovery; stressing that the only requirement is to not abuse your medication, become completely honest with yourself (and at least one other person), and learn to do the “Next Right Thing.” I became a member of NAMA-R my 2nd year in recovery and college; immediately I attended (w/NAMA-R’s assistance), the training on becoming what was then titled the “Certified Methadone Advocate” program and am still a practicing member today. It is important that we continue to fight the stigmatism that our fellows endure by helping them to realize that their own self-learned education on what OTP, and more importantly methadone or buprenorphine are and why they are primarily effective when one practices a therapeutic program of their own choice in order to keep this disease of addiction in remission – medicine alone will not cut it. There are many of use who carry this torch, but we need more…
I have been a heroin addict for 35+ years. Other than two years of sobriety at age 18, I have not been able to maintain sobriety without methadone or Suboxone. I’m 58 yrs old. I’m on methadone AND I’m clean. I don’t know what the official
12 step stance is re: MAT. I’ve had both reactions from folks.
I think that somewhere in the Big Book it says – (I’m paraphrasing) – we only know a little, more will be revealed and that addicts should follow their Drs. advice.
I refuse to allow others opinions on MAT to get in the way. I’m sober and I have shared that my recovery includes medication. If someone takes issue with that – then I consider that their problem. It’s a life or death situation and I will use any tool available.
Excellent insight…it is life or death! …”I refuse to allow others opinions on MAT to get in the way; if someone takes issue that is truly their own problem.” When a person reaches this level in their recovery then personal liberation is at hand. Good Stuff Kaylene..!
12step does not shun MAT. There might be some boneheaded old timers who do, but read the literature. There are times when medical intervention is required, and we are not doctors. MAT works. Sobriety is at times reliant on managing your health with medication. 17 years in 12 step meetings and never saw a recovering addict turned away.
Really? I just told my my NA sponsor I was down to 40 mg of methadone down from 100 and he told me you know you cant start counting clean time.
Agree with MAT … grandson on medication … does not do heroin anymore, but uses xanax. It is so frustrating. He does attend meetings.
Check out SMART Recovery
MAT members are welcomed No stigma
SMART is an alternative for those who the AA/NA have not accepted
AA, NA, CA…these are programs of total abstinence. If your recovery program includes Methadone, Suboxone, etc, then maybe a 12 step total abstinence program isn’t for you! If you want relief, take Suboxone. If you want freedom, get off everything. If you want 12 steps plus Suboxone, then start your own fellowship. Call it “AA On The Rocks”
I wish everyone another sober day, no matter how you get there…☮️
12/29/03 After 30+ years slamming speedballs & whatever else was handy (anything – alcohol, meth, benzos, crack, etc) And years in and out of treatment kicking many times cold & taking methadone maintenance at the VA, multiple MAT attempts on Bupes etc, I was, with a Superior Court Commitment and a Felony Conviction for Possession with Intent, finally, finally done. Kicking both Methadone & Heroin was an “endless” physical & mental torture exercise. But we did it. A tough VA program – RTC built originally to deal with Nam vets coming home hooked, the program was tough as boot camp. I have extensive, long term experience with MAT and believe short term (a couple 2-3 weeks with rapid titration down and off can be most effective in managing the kick. Yes, forever I have neurological damage brought to full light as I 3 years later battled Stage IV Lung cancer. Pain management required a specialist to manage the huge pain spikes following multiple tumor removal surgeries. I work with some of the finest 12 step focussed long term recovery institutions and see often the effects of long term MAT on guys trying to get clean – a total cluster_uck! You guys will learn as long term (truthful) tracking & followup data is amassed. So this “new” approach is actually 10-15 years old as we speak but many Johny come lately clinicians/practitioners are not well informed at all but blither endlessly about how behind the times 12 step programs are. Well, that’s why we say, “Keep coming back”. We’ll keep the lights on and and the doors are always open to anyone still suffering (drinking, using or not)
I am a recovering heroin addict that is on suboxone for mat. I was on methadone for eighteen months prior and mat programs have single handedly saved my life. I enjoy working steps and regularly attend NA meetings but just learned that what I take that’s prescribed to me by doctors is my business I used heroin for bnb over a decade and have finally found freedom from that and no 12 step nazi will take that from me. Loved your article btw. Need more like this one
While I think you bring up an important issue, it’s unfair & inaccurate to present as if all AA & NA groups react to medication-assisted treatment (MAT) as incompatible w/ 12 step recovery. There are many individuals on MAT who DO attend 12 step meetings & work a program of recovery available through AA & NA. Yes, there are those attending meetings who are against MAT, but there is nothing in the literature that says a person on MAT isn’t welcome in either fellowship. I’ve been clean for 13 years from opiates & know many in my meetings on MAT who have been welcomed & embraced. There are not 2 different ways to recover; MAT or the 12 steps. They compliment one another in many cases since addiction is a physical, mental, & spiritual disease. Just like there are many members taking psychiatric meds for depression, anxiety, bipolar, etc, there are members on MAT. Every study out there will tell you that MAT w/ no counseling component does not have the rates of success as those with some kind of component addressing the mental & spiritual aspects of this disease. A person w/ clinical depression who attends AA or NA but doesn’t receive medications that may be needed, have a lower rate of success. There is a parallel w/ MAT here as well. It’s not necessary to broadcast in AA/NA what meds anyone may be on, because it’s not everyone’s business. When I was first treated for my opiate addiction, it was found that I had ADHD. I was given medications (stimulants) that changed my life & made recovery much more likely for me since the main thing I liked about opiates, quieting my head, was actually an ADHD symptom. I never abused anything in my life other than opiates. There were a few people who preached to me that by taking Adderall, I was using. This was bs, but it really upset me in the early days of my recovery. Thankfully I had a sponsor & others who told me differently & treated me no different than anyone else in the rooms. My doctor knew I was an addict when she prescribed the Adderall, & I’ve never abused it.
Privacy of one’s medical info isn’t the same as keeping secrets & lying.
I just don’t like how this article makes it seem as if all AA/NA groups shun MAT & won’t let those on it be a part of the fellowship. It’s simply not reality & this article is misleading which could keep those on MAT from coming into the rooms of AA/NA.
In a loving and caring way…
Narcotics Anonymous is a program of “Complete and total abstinence…”
It’s sole purpose is intended for abstinence allowing all members with the “desire” to stop using.
There is no need for a fellowship that holds so closely to abstinence and the freedom from same to change their principles or values because a treatment of addiction is now prevalent. When drug users were “not welcomed” in AA, or perceived to be, they started a program that was all inclusive to suit their need.
There are 12 Step models that focus on many different things; Cocaine Anonymous, Heroin Anonymous, Overeaters Anonymous
OH and Methadone Anonymous and MARA which are specifically created for individuals to feel comfortable in THEIR CHOSEN recovery plan!
We’re now judging abstinence-ers, who are judging MAR- ers, who are being judged by abstinence-ers, who are ALL being judges by the elite “normies”.
What would be wonderful is if that we can all come to some acceptance that there are MANY pathways to recovery and that they ALL can work. Instead of kicking backs in, if there is a pathway that has a different belief than you- START A NEW MEETING! There are models available for everything and they can be duplicated. There is no need to force any type of fellowship to bend to the beliefs of others, there is absolutely no need. If anyone reading this needs any information on ANY meeting format just find it on Google. Let’s help unite the recovery community instead of “creating” silos. <3
Its the same rehash of the same argument NA gives about MAT over and over Tara, and frankly its a weak argument. Should NA members decline medication during surgery? Just open me up doc, no need for meds, im abstinent. Of course that is ludicrious, taking meds during or after surgery would not comprimise ones clean time, which in the same way, nor does taking MAT meds, as prescribed.
It is eaually ludicrious to discriminate against those on MAT while serving coffee and taking smoke breaks. Caffine and nicotine are both addictive substances, yet they are never mentioned, because they dont make life ‘unmanageable’, yet MAT does?
Any way you look at it Tara, its a weak argument that doesnt hold water. And ‘make your own meeting then’ is a cop out from being unable to recoginze that your truth doesnt match reality.