Twelve Step Recovery and Medication Assisted Therapies

by Louis E. Baxter, Sr., MD, FASAM | June 12, 2014

"You're not clean and sober if you keep taking that medication from your doctor!"

"You're just substituting one drug for another."

"You are depressed because you are not grateful enough."

These and other statements are often made to 12-step members who are legitimately prescribed and taking FDA approved medications to treat their addictions and other co-occurring illnesses. Unfortunately, this so- called “advice” from well-intended but misinformed members is not founded in scientific or 12-step philosophy and violates a long held 12- step policy of " AA members should not give medical advice to each other." (Read The AA Member - Medications & Other Drugs).

It is well known that AA supports and encourages its members to "follow doctor's orders." In an article published in AA News in 1999, author Dr. Jacqueline Chang wrote that research regarding short-term abstinence showed "other things besides and in conjunction with AA are helpful. These include therapy, counseling, and others like Valium, Antabuse, Naltrexone, and Acamprosate."

Dr. Ruth Fox, the Founder of ASAM, supported MAT. It is well known and documented that she regularly prescribed Antabuse to her family, friends, patients and colleagues to assist them in their recovery from alcoholism.

Further, Alcoholics Anonymous and Psychiatric Medication (September 7, 2010) says that "it became clear just as it is wrong to enable or support any alcoholic to become re-addicted to any drug, it equally wrong to deprive any alcoholic of medication which can alleviate or control other disabling physical and or emotional problems."

Although there is no dispute that abstinence from alcohol and other drugs with potential for addiction is the foundation for sustaining recovery in most instances, there are other cases where MAT, especially for persons with co-occurring illnesses, is essential to obtain and sustain term recovery. 

In the late 1980's it was discovered by NIH that addiction was a brain disease. Since that time, medications with FDA approval have been developed to target those areas of the brain. These medications have shown great efficacy in assisting patients into and sustaining recovery. Every other chronic medical disease employs and encourages the use of medications in concert with life-style changes. Addiction medicine should examine the benefit of following suit.

MAT in addiction treatment is not required for everyone, but used in conjunction with 12- step programs and other biopsychosocial interventions, for those that need it, has shown to be invaluable in appropriate cases.

Louis E. Baxter, Sr., MD, FASAM

Dr. Baxter is the Immediate Past President of ASAM and Executive Medical Director of the Professional Assistance Program of New Jersey, Inc, located in Princeton, New Jersey and Medical Director, of the Division of Addiction Services for the New Jersey Department of Health and Senior Services. He is also an Instructor in Medicine at the Thomas Jefferson School of Medicine in Philadelphia, Pennsylvania.


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  1. Sonny Apr 10, 2017 - 04:32 PM
    @Jack Wagoner, thanks for sharing your comments, I can entirely relate to your story. I'm 32 and have been in and out of rehabs and the rooms for 10 years. I'm not knocking 12-step fellowships, they do work, but I see them more as a single tool to be used in conjunction with many other tools to live a balanced and healthy life. I'm struggling now with the "guilty feelings" of wanting to seek out medical assistance for my addiction issues. I've finally had enough of feeling "nothingness" and I have an appointment with the doc in 1 week. I will continue my NA / AA meeting attendance but I'm really hoping that there is indeed an underlying medical issue that can be resolved with meds and help me to enjoy life again. 
  2. BoB Feb 14, 2017 - 11:00 PM
    AA is for alcohol abuse. When one is not drinking, he is considered sober. NA is for drug abuse. When one is not abusing drugs, he is clean. Gamblers Anonymous, Sex Addicts, Overeaters...Going to one does not make me need another.  So just because I am in an AA meeting doesn't mean that I have any other issues.  I decide what my issues are, I decide what I'm powerless over.  I don't understand how I went to one program and someone else decided what else was wrong with me and how I need to live.
  3. Chelle Jan 06, 2017 - 11:23 AM
    Heidi C, no-one in or out of AA has a right to tell you you are not sober if you take necessary medicine as prescribed.  If you need relief from the very real physical pain you've described, you do what is best for yourself.  If you have the inkling, desire, compulsion to overdose yourself, perhaps there is another medication that can be prescribed that is less of a problem.  Ultimately, we have to be honest with ourselves (and your higher power) about our motivation for taking any medication. This is how I look at it.  If I had a bad contusion on my body and I was able to treat it naturally by keeping it clean and applying essential oils and praying, I would.  If it wasn't responding to those measures, however, I would put some antibiotic ointment on it.  If it became worse, I would get an antibiotic before it got bad enough to go septic and infect my whole body.  No-one in AA would advise me not to take an antibiotic, would they? Ironically, Bill W himself was part of a trial using LSD in the hopes that it might help him with the debilitating depression he still suffered and hoping it might be another tool to help other alcoholics.  I love AA and the 12 steps have really helped me get sober and be honest with myself and face life rather than numbing out with alcohol.  Thankfully I've never done any other drug to have to shake.  I take any advice or opinions given by other alcoholics with a grain of salt because, as we know, we don't know everything.  I hope you are not still suffering.  Happy new year!
  4. Heidi C. Dec 14, 2016 - 06:50 AM
     I was in a terrible car accident and broke my right ankle, my left arm, C4 fracture and a C7 burst fracture....... I deal with chronic pain...... I am taking pain medication for the chronic pain...... Without it.... The pain is so bad in my neck.... I feel like my head is going to explode...... I was in the program before the car accident.... I have titanium in my neck and in the winter time.  I am in so much pain... Life just doesn't seem liveable..... To put it bluntly..... I just want to blow my head off because the pain is so intense and lasts for days to the point that I vommit...... I like the program... The way the steps work.... But I  am told.... You are not sober..... You dont even need to start your step work because.... You are not sober..... Without this pain medication..... Im in so much pain..... I can't even think straight..... I think it is unfair for people who have no idea what chronic pain feels like to belittle me..... It's coming to the point were I am about to just walk out and never come back to the rooms of NA I love so much.....anyone have any advice for me? I am nit abusing my meds and think this is wrong to do to a person....
  5. Jack Wagoner Oct 26, 2016 - 08:30 PM

    I am a 55 year old lawyer with his own law firm where three other younger lawyers and three staff members. My peer review rating is the highest in the state in my area of practice. I also have twin 14 year old daughters and a wife of 15 years. My daughters are both on the honor roll and have had no discipline problems. And I am a severe alcoholic and opiate addict. For 30 years I have played the "fundamentalistic" version of the AA program. I have been completely abstinent for 5 years on two occasions and for 1-3 years on many occasions. I've been completely abstinent for probably 27 of the last 30 years. When I was 24 they sent me to my first treatment center. Just as with the next 8-10 treatment centers a "one size fits all" AA approach was used. Hard line stuff.

    So, over 30 years I've probably spent $200,000 on straight line, nothing but AA treatment centers. The individual counseling even the top ones like Hazeldon advertise does not exist. From all the scientific studies I've read that have been done over the last 20 years the AA success rate is pegged at about 10%. The percentage of people that stop using addictively on their own is higher. So the routine is that they put you through a one size fits all treatment with a 10% success rate. Then when you fail it's because you didn't "work your program hard enough" or some other reason is offered. But it is always blamed on the patient and not the treatment. Something badly needs fixing here. Each relapse threatened my career and my family and could have destroyed my life.  To quote from AA, insanity is doing the same thing expecting different results. So I figure I won't be writing any more $30,000 checks to treatment centers.

    i am on buprenorohine for my opiate addiction. I was abused as a child and have been diagnosed with anxiety disorder, depression, ADHD,  and a few others. I have a buprenorphine doc whose specialty is addiction. He's also my medical doc. I have a psychiatrist that prescribes me an anti-depressant and xanax, which I take as directed.  And I smoke weed at times because I've found it relaxing since I was a kid. If it was legal in my state I'd have a prescription for this. Marijuana never led to one bit of trouble for me. I see my regular therapist (sober 30 years) and another therapist for child abuse and trauma issues. So I'm closely monitored.  And I function great. My therapist told me that in the 15 years she's watched me, I am in the most stable sustainable state she has seen me in before. And that's because I ceased becoming an AA fundamentalist. I only use one pharmacy and all my docs and therapists have consents and can confer about my case. And they're all trained in addiction. I've been stabilized in this manner for nearly a year now. I routinely go to AA meetings and just keep my medical issues and choice to use marijuana to myself. AA is no longer the end all and be all for me. There's AA, my job, my meds, my family, I work out on weights 3 times a week, meditation and mindfulness exercises, and I have a full functional routine.  The combination of all these various things have led to a happier state--a state that I could see as something permanent rather than always wondering when the next shoe will drop  AA is a religion and the vast majority of courts have defined it as such.  I get support from my friends there and I enjoy it to some degree.  But as scientific knowledge grows, AA will fade out in the way of the Oxford Group because it is primarily religious in nature and a lot of AA doctrine written in 1935 is coming into conflict with medical science.  Ultimately AA will have to update from its fundamentalist views and doctrines to the extent necessary to remain relevant.  As it is, the one size fits all approach is dangerous and killing people  told to get off their meds or they're not REALLY sober and then the person commits suicide.  This kind of thing has happened too much because of the strict dogma of AA and 1939 beliefs prevailing over 2016 medical knowledge.  From now on, AA is one element of my program, but it will never be THE program for me again without all the additional support system I have in place, including the meds my doc gives me.  If you're in AA and are not already too brainwashed to consider anything that might be considered AA heresy, then get to googling and do some research here like I did.  You'll find that this view--with less focus on forcing religion down the throats of an increasingly secular society, working to make AA compatible with modern science, and remembering the "do no harm" oath doctors are sworn to follow, we are at an intersection here. I do hope that AA does have the balls to update their "holy bible" -- the "big  book" -- to render it compatible with current science and knowledge.  But I doubt that happens as the big  book is some kind of sacred thing with people in AA and they'll never change it. As the book the whole program is based on becomes more and more archaic and unyielding. AA will go the way of the Oxford Group.


  6. Jayjay Jul 29, 2016 - 03:14 AM
    Don't know what the comment above mentioning people in AA telling others to not take medication. It's simply not true (or at least from my experience). AA has no opinion on outside issues, which includes people's medical decisions. AA is not a doctors haven, it's a fellowship for support. My sponsor told me, if I was in severe pain and a doctor told me they should put me on morphine, then I can do it. It's a different story when you abuse medicines in order to achieve a high as a way to escape. But when we are told by medical professionals that it's for our own well being then we can follow through 
  7. Loriann Witte Apr 23, 2016 - 01:17 AM

    Dual Diagnosis medication and 12 step program advice, California Wits Inn Recovery

    Dual Diagnosis Rehab Placements Can you be clean while continuing with your psych meds ?
    The answer is yes. Often addiction is an attempt to self medicate serious brain chemistry issues, and diagnosis like bipolar, borderline, obsessive compulsive disorder, major depression, ADD, ADHD, psycho effective, social anxiety, and schizophrenia.                So many of these life hampering problems can be controlled with psychotherapeutic medications. Non-Compliance to the medication regime is a regularly presenting problem.  We are hesitant to expose our medically stabilized loved ones to........     a 12-step program group that might give advice about total drug abstinence, and confuse the dual diagnosis person.  Compliance with Psych Medication is Working a Program of Recovery All levels of schooling and maturity are represented in the people who make up the 12 step programs.  The written literature is a more organized and researched source of facts du jar'.  "Working a program" means walking a line of self examination while comparing our findings with the words of the recovering community, and cross referencing with the approved 12-step literature.If you think this high level of structured thinking is too much for a dual diagnosis addict, who can appear low functioning while under the influence, you may well be pleasantly surprised by the amazing transformation the 12-step experience can bring to America's least wanted. The people of addiction and dual diagnosis.The word Miracle is used on a regular basis among people in recovery.    Psych meds, are medications and not to be confused with drugs of abuse.AA, NA, and the other 12-step members are not to give medical advice.Each individual must become the CEO of their own life.  Addicts possess a lot of knowledge about drugs.Denial and manipulation of the truth goes on in the mind and comes out in the behaviors of the addictive personality type person. Benzodiazepines like Xanax, Klonopin, and other anxiety pills are addictive and mind altering. This principle stands true with all narcotic pain medications. Clean addicts would only take benzos or opiates in an emergency medical situations like surgery and only for a few days. Not regularly, not PRN, not daily and not for emotional issues. Adderall is also very questionable? Once an addict takes these medicines and becomes mind altered, then we are not their strong, educated selves and it is even harder to work your program and stay clean and in emotional recovery. No sleeping pills either. I love my natural sleep that has become my greatest gift of the recovery. It took about 6 or 9 months after stopping heroin and cocaine for me to get good sleep. But I eventually got it, and I hold it up as a great value. I use my love of natural sleep as a tool to stay clean and honest.Psych medication Compliance is an important part of working a program.Learning about acceptance is a primary lesson clearly expressed in the reading that begin many 12-step meetings.Acquiescence with a prescribed schedule of antidepressants or psychotropic medication is an intricate part of living a manageable life in recovery.Taking psych meds at the same time everyday keeps a person healthy.Like we say, "Go to meetings for as long as you want to stay sober"Take your meds for as long as you want to stay sane.This is what the NA Basic text (approved 12 step literature) says about using medication as a clean addict in the program. Suggestions to Follow When Faced with Illness   Some of our members have found the following list of suggestions helpful in dealing with the impact of illness on their recovery.Go to as many NA meetings as possible.Work closely with your sponsorRead NA literatureReach out to other NA members.  Ask for support.Write about your feelings.Practice the Twelve Steps and Twelve Traditions.Pray and meditate.Share your thoughts and feelings honestly and openly.Identify yourself as a recovering addict to health care professionals.Talk to your doctor or pharmacist before taking over-the-counter drugs.Arrange for an NA member to be with you during surgery or other medical treatment involving drugs.Honestly evaluate your condition and explore alternatives to medication.Continue on your path of recovery in Narcotics Anonymous.Dual Diagnosis Treatment Placements Wits Inn places people who need drug and alcohol treatment into rehab that.... address mental health needs & is licensed to treat dual diagnosis clients.Understands the correlation between addiction and medication compliance Rehabs also licensed to treat chemical dependency  Treatment paid by Insurance PPO HMO or with in your cash price rangeGoogle my name to see more about me and my workLoriann Witte 877-724-7472 or text my cell 949-413-4109 Loriann@wirecovery.comIntervention Video Cities Addiction Referrals ReferralsInterventionProcess AddictionsMedicine Assisted Detox ReferralsHMO or PPO Insurance for Rehab paymentAssess what you need, want,In your price rangePet Friendly Beach ProgramsChemical Dependency Rehabs Weight Loss, Fitness, Anti-aging949-292-2000Wits Inn RecoveryAlternative Sentencing ProgramsDrug TestingAssessment and ReferralTreatment PlanningLike us on 


  8. Trait Sep 21, 2015 - 05:52 PM

    I am not a medical professional of any stature. I am a real deal junkie & to me alcohol is no different than heroin, crack or Xanax. Now I have been clean for 100 days & I am being treated for post traumatic stress disorder & bi-polar disorder. The medication I take for these very serious disorders is Lithium. Lithium is a chemical element & the pharmaceutical form I take is lithium carbonate, which is a salt ion form. All this medication does is helps me not go into a manic episode, because I have tried to kill myself several times in my life due to a manic episode. A few of the times I tried to kill myself was way before I ever picked up a drink or drug, meaning I was a young child when I first tried to kill myself. Now I would love to hear some jackass who thinks he has the fucking jurisdiction of a certified medical professional, tell me that taking lithium means Im not sober. I can't stand people who have no idea what they are saying try to dish out some poorly thought advice. I have tried to STAY sober in the past while not taking any medication for my bi-polar or PTSD... & I will tell you now that EVERYTIME I ended up back shooting up heroin & crack & eating 10-15 Xanax bars at a sitting. I have read the big book of Alcoholics Anonymous & I have worked steps while completely abstinent from all pills except for occasional Tylenol for headaches. In that time period I fully forced myself to work steps with my sponsor, call my sponsor daily, do service work, pray & meditate everyday, ask for help from fellow recovered addicts & alcoholics & I frequently read AA approved literature & I shared in meetings & was as honest with myself & with my sponsor & AA support as humanly possible, to the point I would call my sponsor literally 10-15 times daily to tell him of a thought I had inside my head that I feared would manifest itself into a behavior favorable of a relapse. My sponsor eventually told me " you don't have to call me Everytime to tell me these things, just pray or go to a meeting" & I would go to a meeting or talk to a friend in recovery. I would pray & ask God to help me to develop a positive perspective on life & to help me not be a complete psycho. Well nowadays I am taking my lithium & sometimes I don't want to even take it but I know that if I don't take it I will end up relapsed or dead. I go to meetings bc it is my SPIRITUAL medicine ok... On the flip side I take my lithium bc it is my MENTAL medicine, & if I do both of those things & just take other AA members amateur medical advice with a fucking grain of salt, & continue to trust in my HP, then I will be ok bc I have tried to use the 12 steps to cure my bi-polar disorder & THAT DOESNT FUCKING WORK & you can just stfu if you disagree bc I work my program for me not to inventory other people. Complete peace of mind is my ultimate goal in recovery, not to appease some jerk off crack pot AA tyrant. GOD BLESS ! 

  9. Lk Apr 20, 2015 - 10:47 AM

    6 weeks of aa and I haven't had a drink. I stopped taking Valium as my sponsor said that none of my sobriety counted if I took it. Had seizures for the last 3 days on my own. I used to date someone who refused to take medicine for psychosis because he took pride in being totally clean meanwhile I was running for my life from him and his murderous threats. Aa is fine though with smokers..hmmm

  10. Dave J Dec 04, 2014 - 06:36 PM
    I just want to be sure someone takes issue with citing a 1999 study and lumping some pretty useful drugs like naltrexone and acamprosate in the same box as valium. You'd be hard-pressed to find a knowledgeable addiction specialist today who views valium as an important component of treatment past the first week. I'm assuming that these days, most professionals know the high abuse potential for valium, a drug which uses the same reward system as alcohol. Benzodiazepines have emerged as one of the most abused drug families for alcoholics, not to mention their capacity for lethal interactions with alcohol.
  11. esdr Dec 02, 2014 - 10:44 PM
    I was sober for 22 now have a few months. Upon my return after being out of AA for 15 years was the shocking reality that possibly 75 % members, including those with 20+ years of sobriety, were on some kind of mind altering medications such as antidepressants, anti anxiety, bipolar this or that, and even medical marijuana, and still consider themselves sober!!.It is very difficult for me to share in an AA meetings about my difficulties and personal struggles when I know everyone is on drugs. How do they know how I feel if they are not willing to face their own difficulties. It is my frank opinion that if you are on meds you are not sober. Period. What you really have is pharmaceutical sobriety. I wish I could find meetings specifically for those completely sober off all drugs.
  12. Yo Sep 16, 2014 - 11:14 AM

    In my not so humble opinion, but I think am pretty accurate. AA and NA unfortunately had been avoiding independent scientific studies. The treatment facilities would state something like "all we need to know about effectiveness (and safety I add) is a God and a Spiritual Program".  Although this may be true (or not) it has never been proven to be true.

     I have sat in too many meeting where I hear claims, (sometimes outlandish and exaggerated one added with quite a bit of embellishment)  for which they have no evidence of its existence nor truth.

     It should be in the best interest of AA/NA to allow independent scientific studies. And stop thinking that our own personal opinions are facts. It is in the best interest of the patient and its members that they should at least be honest with themselves. 

    I suspect that AA/NA might have something to offer, but as long as they continuo with this holy than everyone else attitude, I dare not go or recommended. What is the code of ethics. First do no harm? I can not in good conscience recommend something that operates in the fashion that AA/NA does.


    by the way your statement Dr. Baxter

    "In the late 1980's it was discovered by NIH that addiction was a brain disease."

    I guess that NIH is the NIDA main umbrella, but as far as I have been able to find. it is NIDA who has been making this claim. Although I wouldn't have any difficulty if this statement was true. That way we can deal with conditions more with facts.  It is my sense that this claim has not been proven but only repeated.  There are too many researchers who have been refuting this statement science it was brought up by Dr. Leaher and is being promoted by Nora Volkow <for which I have a lot of respect).

    Nevertheless, I believe given all of the research available the best we can truly and honestly say is that "the professions have yet to reach a consensus on this issue" Scott Lilienfeld PhD and Sally Satel MD the book Brainwash make some very compelling arguments that brings this claim in to question.  I follow Richard Dawkins philosophy that says "no amount of wishful thinking changes the facts." We have too many biases a work here.

    While Galileo Galilee has been reported to have said " Eppur si muove"  (still it moves, And yet it moves or  It does move) after he was sentence by the Roman Inquisition. I continuo to assert "This world still looks flat to me!!!".  



  13. Violetagain Sep 10, 2014 - 07:29 PM

    I appreciated this article.  And I also appreciated all of the comments.  I think it is interesting that one person admits to telling her clients not to discuss MAT in AA/NA without gaining trust from the group first.  Obviously, this is a smart suggestion.  But what does this say about the social and political climate in the rooms of AA/NA?  I have been around AA for twenty years and I have seen very, very little evolution in the way people regard medication.  It is overly simple and obvious to point out the program (which is indeed faith based; please spare me the argument about it being "spiritual") is based on archaic doctrine.  The fellowship can be a wonderful thing; however, it can also be something that works against someone, too.  Esp. someone who is being judged by ignorami for using medication. I am not sure what the solution is here.  But I think articles like this one speak to an iota of evolution.  I just wish I had higher hopes for more of this kind of thing.  I think, without much despair, that AA/NA will mostly dissolve before it evolves. 

  14. Michael Weiner, Ph.D., CAP Jul 30, 2014 - 01:46 PM
    Perhaps the only surprising thing about Dr. Baxter's excellent article regarding the effectiveness of Medication Assisted Therapies (MAT) is that it's still being debated.
    MAT works when it is individualized, accompanied by counseling, support, and is monitored by a physician certified by the American Board of Addiction Medicine (ABAM).
    It occurs to me that deeply rooted resistance toward the use of medication in any stage of recovery has prevented an open discussion. The result may have been that many people could have had a better chance of achieving long term recovery.
    Medications need to openly discussed.  All medications prescribed for a person recovering from an addictive disease should be monitored.
    As recovery progresses people get older. The likelihood that a person with an addictive disease will experience surgeries, pain, stress, panic, anxiety, depression, hypertension, sleep disorder, etc. increases.
    I would like to suggest Medication Monitored Recovery. The best situation would be that every person in recovery has a Primary Care Physician who is ABAM certified.
    At a minimum, an ABAM certified physician needs to be on the recovering person's medical team.
    There are physician groups that have shared medical records. If my ABAM certified physician is part of that group, he/she can review every medication prescribed.
    I would find that physician group very attractive.
    Perhaps we can move toward every physician group seeking a member who is certified by ABAM and toward Medication Monitored Recovery.
  15. Mike D Jul 02, 2014 - 12:42 PM

    Interesting that the only MAT highlighted as prescribed to " she regularly prescribed Antabuse to her family, friends, patients and colleagues to assist them in their recovery from alcoholism." I, for one would like to see how many would prescribe methadone and or suboxone to this same cohort. Frankly, I have been asking this very questions to friends and professional colleagues in the field informally for the past 2 years. From what I can observe, first hand, the answer is pretty much "none."  So it is apparently OK for "us guys" to prescribe these powerful medications to "those guys" but when it comes to someone close to me they are "off the list." What does that imply about these beliefs, prescription meds, and the principles we allege to be promoting????

  16. massive Jul 01, 2014 - 03:01 PM

    This is not true. AA members all over the country do tell their members that  to take medication or not take is not being " sober" . They are filled with "Playing Dr" all the time. Even the AA approved pamphlet you mention here is hogwash. How dare AA , a religious peer support group from the 1930's that is never been updated, tell anyone how to talk to their DR. How arrogant AA is and why are they so arrogant. AA members have no business taking about anything like this. They should say...I have no opinion! I have no knowledge! I am not a Dr  .... I am not a therapist. The day is coming soon when these sponsors will be sued, for all the suicides that have occurred in AA and NA rooms and culture because of this nonsense. 


  17. Counselorchick Jul 01, 2014 - 02:33 PM

    Addiction is NOT a disease. 12 step programs are dangerous to acquiring a healthy mind. The only reason why AA wrote and released their pamphlet supposedly advising members to refrain from telling other members that their meds make them 'not sober' is 1) the practice is so widespread and 2 ) they are covering their ass. 

     The Church of BILLshit. Our mission - To Disempower you when you are at your most vulnerable and then to skull-fuck you till the day you die. Our door is always open. Leave your brain at the door and come right in. You cannot trust your own thinking but you can leave the thinking to us. We have no trained facilitators and we spout thought-stopping dogma to keep you coming back. We will, we will Rock You.

  18. Rasha Kowalewski, BS, LADC Jul 01, 2014 - 08:14 AM

    Thank you, Dr. Baxter!  As a licensed alcohol and drug counselor working at an opioid treatment program, I encourage my clients to attend 12-step meetings.  I also encourage them to keep their status as a medication-assisted treatment particpant to themselves--until they establish themselves in the program and cultivate a feeling of trust with their fellows.

     Just as no one can label someone as an alcoholic or addict (only the sufferer can lable themselves), the same is true of sobriety.  I can call someone sober or "in recovery" all day long; if they don't believe it, what does it matter? 

  19. Carlos Jun 24, 2014 - 04:56 PM

    I have been running from 12 Step programs since I hear them "share" at a  treatment facility. "Only 2 or 4 of you (of 100 or so present) will be clean and sober, one year after completion of treatment. I guess they were trying to impressed something on us. I was disappointed not inspired.

    I know a thing or two about statistics, and I told myself "Are you kidding me!!! and you want me to be listening to what you have to say?" Jesus Christ, maybe if I do not pay attention to you I might become at least a coincident, at best a placebo effect if I get clean on my own. From what I understood (am not sure how honest this numbers are either) I heard that 20% of patients who stop using substances do it without treatment. If this is true, and I do understand there are other variables. This may mean, that the 12 Step approach maybe doing worst than placebo. Or even some of the things they believe in or tell people actually may cause relapse rather than recovery  ( I sure like to see a number of studies that would try to answer those questions).

    This wouldn't be the first time that the field of mental health haven't done more harm than good. Back in the early 70s I believe it was the National Institute of Mental Health did a study and found that patients in waiting list were getting better than those who were getting "treatment". That was bound to raise my eye brows

    First I was not sure where they got this statistic from. I suspect that this number maybe a misinterpretation of the Triennial Report done by a non alcoholic Physician which is a member of the board of Alcoholics Anonymous.  Among other things the Triennial Report states that.  Only 4 or 5 persons who attend AA for the first time continue in the program a year later. They are not sure why? but one of my guesses is that they find the program unattractive like I have.  But of course in the mystic mentality of AA/NA member since they believe that unless you are going to meetings, have a sponsor and are not doing the steps you are bound to relapse. Of course they had never done a study, but they claim to be able to make conclusions from the mere observation of their group experience "We have learn from group experience that those who come to meeting regularly stay clean" Of course there seem to be some studies that indicate that it does have some ground in reality, but the numbers are not really that great either. It is not 100% as the statement seem to have implied to me. People who go to meetings regularly, have sponsor and do THE STEPS also seems to relapse regularly.

     As I recall, historically AA sponsors have been known to tell sponsees that they needed to get off their anti psychotic and anti depression medication, if they were expected to recover. If I recall correctly that also cause some problems and it may have been part of the reason why some doctors in recovery started to look at ASAM. Bringing a little sanity on this issues of medications. Keeping sponsors from trying to play doctor (or God).

    I think we need to rethink and redefine what is it meant by RECOVERY. Abstinent is surely not THE only definition. I always thought he had more to do with improving you social and perhaps even economic conditions of the patient. I have wonder if there is such thing as an Ego Syntonic opiate dependent person. I have read both in "Licit and Illicit Drugs" by Consumer Union Report and "Brainstorming" Dr. Solomon H. Snyder (the main researcher who discover the Opiate Receptors in the brain) both states that historically prior to the War on Drugs and the laws (like the Harrison Act) Opiate Dependence was not much of an economic or social.  problem. It is obvious to me that the whole history of Opiate Dependence (nor 12Step history) is not clear and up on the table.

    Researcher have had a problem studding The 12Step Program.  Many of the subjects and facilities avoided the studies on its effectiveness. They claimed that the only thing they need to know about the effectiveness of the program was a God and spiritual program. Recent studies have shown not so great statistics either. Some proponents attempted to "confirm the effectiveness" of the 12 Steps doing poor designs studies and extrapolating where there was no data. And like any other scientific research in any other field studies research is done to confirming and refuting their most beloved theories.

    To be honest, of course, the 12Steps never claimed to be a science (only a society or a fellowship). But its professional proponents did crossed the line into science when they tried to adapted it into a treatment protocol. They never checked to see whether the protocol was safe and effective. And given that 20% of addicts or users seem to quite doing substances on their own without treatment. I have to wonder whether the protocols was outdated before it was even implemented. Why Bogus Therapies Seem to Work

    Am sorry, but I need to question why it seem to be that there is a lot more recovery on patients who are treated with Methadone and Suboxone, than in the dominant protocol of the 12Steps. I do not have the data, nor studies to back it up. But if I am to assume (correctly) that not one treatment works for every patients. I surely need to question why is it not use as a option in all facilities to all patients both residential and out patients. Seems like we need to learn more about which treatment works best for which patient. But seem to be clear to me that we should be given patient and honest description of each of the programs and have the patient chose which one they think will work best for him. What a noble idea!!! Why don't we ask the patient what they want? Hester and Miller 2003 "Manual of Alcoholism" stated the data suggest that patient DO have an idea of what may work for them. After all Whose Treatment is it Anyway?

  20. Joseph DeSanto Jun 18, 2014 - 05:35 PM
    This is a concept and decision that needs to be addressed on a patient to patient basis. Most patients I feel will benefit from complete (no addictive prescription medication AT ALL) abstinence and total physical sobriety. But based on personal experience, I have found that it's spiritual sobriety that actually keeps you from the next  (first) drink or drug. I have many patients with chronic pain issues and patients that are in high-risk fields (bartenders, nurses, pharmacists, doctors) that I maintain on  that are transparent with their use with me and their sponsors and partners, and attend 12-step meetings regularly and consider themselves sober. They possess a desire to stop drinking or using, maintain conscious contact with a power greater than themselves,  practice principles aligned with selflessness and good,  and they are helping those who still suffer. To me...THAT is true sobriety.
  21. j. Becker Jun 16, 2014 - 06:48 PM

    How well a medication does work depends, partly, on the acceptance of its use by all those around the patient. Years ago I used Antabuse for the first few weeks of sobriety and compared it to punishing a puppy as soon as he made a mess as opposed to the next mornings hangover. The folks in my group "got it;"no problem. I was also taking antidepressants-a different story. It was obvious that a few members-influential members-didn't "believe in" those, like an article of religion.

  22. Tony Riccobono, MS, LCADC Jun 16, 2014 - 06:12 PM
    I believe we are doing a disservice to our clients when we deny them the benefits of medication assisted therapy as long as it is coupled with some form of counseling or psycho-social support group. It is egocentric and close-minded to think we can treat the problem single-handed.
  23. Peter L. Myers, Ph.D. Jun 14, 2014 - 06:15 PM
    The counseling field is quite dogmatic and resistant to innovation. The subfield of addictions is even more so. Nevertheless, I have noticed amongst my students that there is less resistance to MAT.
  24. Edward Reading, PhD, LCADC Jun 14, 2014 - 11:38 AM

    We need more information like this spread out to addiction professionals...and those in training...

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