Posts Tagged ‘12-step recovery and MAT’

Tiny Candle of Hope

 

 

Every Friday at 6 pm at the Crossfire Biker’s church in North Wilkesboro, NC, people gather to attend a tiny meeting of Narcotics Anonymous, called the Brushy Mountain Group.

It’s not a large meeting; only six to eight people are there on any given Friday. It’s not an old and established meeting; it only started three months ago. But this meeting’s impact could be massive because it has the potential to change the lives of the participants.

This meeting was started with the intention of giving all people seeking recovery a place to get well. Applying the spiritual principles of acceptance and unconditional love, this NA meeting welcomes every person who wishes to recover from the disease of addiction.

This meeting makes no distinction between members who are prescribed methadone, buprenorphine, anti-depressants, stimulants, or other medications. Everyone is welcome to attend and everyone is welcome to share their experience, strength and hope. The recovering people who happen to be prescribed methadone and buprenorphine are treated as full members.

For critics who say Narcotics Anonymous is meant to be a program of complete abstinence from all drugs, people at this meeting have no issue with this statement. They know there is a difference between using drugs and taking medication. Surely the founders of NA never meant for members to be completely abstinent from all medications!

These members know the Third Tradition of Narcotics Anonymous says, “The only requirement for membership is the desire to stop using.” The assumption is that this means using drugs, not medications. At this meeting, members make their own decisions about their “clean date.” For most, the clean date is the day after their last illicit drug use.

At this meeting, the Fifth Tradition of Narcotics Anonymous is felt to be of the upmost importance, and should be a main guiding principle of every meeting: “Each group has but one primary purpose: to carry the message to the addict who still suffers.” No clean time distinctions are made. This still-suffering addict may be a newcomer, or it may be a member with twenty years of recovery. Suffering is suffering, and the group is there to support suffering members.

If a participant shares about taking medication, no one clutches at their pearls and gasps. No one  tut-tuts and asks them to shut up and talk to someone after the meeting. These people are given the same esteem as all other members. The others listen in respectful silence, and sharing continues after that person is finished.

Participants don’t often share about medication, except in passing. Most share about how they are feeling and how their emotions affect their recovery. They talk about situations that could cause a relapse, and they share gratitude for achievements big and small. They talk about how to handle the guilt from their actions in active addiction, or about how they want to do a better job raising the children.

In other words, an observer couldn’t tell this meeting was any different from any other NA meeting where recovery is underway.

This meeting is a tiny candle, spreading just a flicker of light into a small corner of one community darkened by the opioid use disorder epidemic.

But what if this light spread…what if more 12-step meetings welcomed people on methadone or buprenorphine with open arms, with hugs and unconditional love instead of judgment and put-downs?

Then 12-step recovery could be ablaze with the light of changing lives.

That’s my prayer.

 

Peaceful Coexistence

aaaagetting along

For years, I’ve asserted that patients on medication-assisted treatment for opioid addiction can find benefits in twelve step recovery meetings. Many of my readers have disagreed with me, vehemently at times. I was surprised and pleased when one of them forwarded me a reference to an article in the Journal of Substance Abuse Treatment that showed participation in 12-step recovery increased retention in buprenorphine treatment. (Thank you Zac). Of note, coercing patients to attend 12-step meetings was not found to be helpful. [1]

I know 12-step meetings work for my buprenorphine patients because I’ve seen it. However, I do think I have unusual patient population in my office-based buprenorphine practice.

I inherited many of my patients from a doctor for whom I worked for several years, until he retired in 2010. He was well-known and well-respected in the recovery community of the city where we worked.

Some people, already in recovery from alcohol addiction, were members of Alcoholic Anonymous when they sought treatment for chronic or acute pain conditions. These patients were prescribed opioids for pain by doctors who underestimated the risk of developing opioid addiction, in these patients with a personal history of addiction to another substance. Some of these patients were dismayed to discover they developed addiction to opioid pain pills, meaning they were misusing them by taking too many and running out early, or having obsessions and compulsions to take ever more pills.

Baffled and angry, those patient sought care from my doctor friend. He started buprenorphine and got them off the pain pills, and directed them back into 12-step recovery.

When he retired, I was fortunate that many of them followed me to my new practice.

Around twenty-five percent of my office-based buprenorphine patients are in this category. Most still go to 12-step meetings, though the frequency of meeting attendance varies widely. Some patients go a few times a month, and some a few times per week. I have one patient who goes two times per day. My patients have varying levels of attachment to the 12-step meetings and their participation at the meetings. All of them say they learn and are reminded of important tools of recovery. They say applying concepts like acceptance, tolerance, and kindness enhances the quality of their lives.

These patients, with very few exceptions, are doing very well in their recovery. They are also delightful people.

For these patients, being on medication like buprenorphine has stopped being as issue. Most of them say they know their recovery is better since starting buprenorphine. They don’t tell people they’re on medication, but neither do they hide it. They don’t really care what other members of 12-step meetings think about their medication; it works for them and improves the quality of their lives, while not causing euphoria or the compulsion to take more and more of their medication.

Let’s present 12-step programs as options for our medication-assisted treatment patients on methadone or buprenorphine. As this study shows, and as I see in my own practice, these two options can benefit our patients. Also, as I tell my patients, you can’t beat the price of 12-step meetings, since they are free.

I know 12-step fellowships aren’t for everyone. Though 12-step fellowships don’t endorse one religion over another, these fellowships are intensely spiritual. Not all people are comfortable with such things, or are uninterested in the spiritual side of life. But for those who don’t object to spirituality, or even enjoy or embrace it, 12-step meetings can be a haven of recovery.

1. Monico et al, “Buprenorphine Treatment and 12-step Meeting Attendance: Conflicts, Compatibilities, and Patient Outcomes,” Journal of Substance Abuse Treatment, May, 2015.