Do AA & NA fit with methadone maintenance?

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ResearchBlogging.orgGiven the dearth of research on NA populations this study from Bill White and colleagues is welcome. Knowing what we do already from the research on mutual aid groups, the researchers made the reasonable assumption that clients on ORT (opiate replacement therapy) attending 12-step mutual aid were likely to achieve to higher levels of abstinence (no illicit drugs or alcohol) than those who didn’t attend. Furthermore they theorised that if people got more involved in 12-step groups (joining a home group, getting a sponsor etc.) then this would be associated more strongly with abstinence.

Confusingly, neither of these things could be evidenced. The only thing that they could correlate with higher levels of abstinence was being on ORT for longer. The authors set down so many caveats, cautions and concerns about the findings that I ended up a little muddled about how useful the research was.

A few things did stand out for me though.

  • The first was that patients in this treatment service were routinely encouraged to attend NA.
  • Further, about three quarters of the people on ORT attending NA or AA found it helpful.
  • Another point was that 63% of the 322 patients in the study admitted to using illicit drugs or drinking in the previous year.
  • About a quarter of participants reported a negative experience in AA or NA. Some of these negative experiences will have been around not being allowed to chair or sponsor others due to being on methadone.

There are already concerns that methadone maintenance (or the way that we deliver it) is not the best route to abstinent recovery. Mike Ashton recently asked the question: Is methadone “too sticky” for recovery? Perhaps buprenorphine maintained clients would have a different experience. Perhaps it’s not to do with the drug but what goes alongside the drug.

I wonder if the cultural and philosophical clash between maintenance and abstinence and the focus of NA on all mind altering substances means that trying to integrate patients who want to stay on ORT in the medium to long term will lead to tensions and differences which are difficult to resolve. Specific groups like Methadone Anonymous might help to ameliorate negative experiences in the short term, but I don’t think MA has groups in the UK yet.

In the longer term there would need to be a significant cultural shift in 12-step groups to a place where abstinence from all medication, including prescribed, was on an equal footing with abstinence from illicit drugs and alcohol only. That’s not an easy ask.

White, W., Campbell, M., Spencer, R., Hoffman, H., Crissman, B., & DuPont, R. (2014). Participation in Narcotics Anonymous and Alcoholics Anonymous and Abstinence Outcomes of 322 Methadone Maintenance Patients Journal of Groups in Addiction & Recovery, 9 (1), 14-30 DOI: 10.1080/1556035X.2014.888883

    3 Responses to "Do AA & NA fit with methadone maintenance?"
    1. Brian says:

      Hi I have been on methadone for most of my adult life and alongside CBT type treatments including user based self help groups Which I have found some helpful others not so. I have been on many different size doses from 400ml a day down to 30ml daily the problems I have found in the past in the UK is that unless you commit a minor crime or get referred by a third party those wanting to access immediate help for drink/drug problem find it reasonably difficult to get on a program yet if the powers that be recognise this affliction as medical fact you would be able to go an see your doctor and get immediate help,but although they say it is a medical condition it is not treated serious enough. Now I would like to point out that if a person had cancer they would be treated with respect and given typically the best care possible and look at the funding for that compared to addiction treatment, yet somebody living with addiction is shunned and ignored by the medical profession and society alike but I see that addiction is also a cancer in society and it affects not just the patient but also their friends, family and wider society. I although still on a low dose of methadone am aiming to be opioid dependent free, I have been FREE from illicit poly drug use for two years now and I’m looking for what treatment may suit my final push. As I have said I have tried many of the old school therapies but I would be extremely interested if you have any information on any new treatments for the end of the physical side of this terrible affliction and if I can help you in your cause in anyway please feel free to contact me, I look forward to hearing from you kind blessings Brian UK

      • djmac says:

        Thanks for commenting Brian. Well done on your recovery so far and your points about how different conditions are treated are well made. I’ll drop you an email.

    2. Daria says:


      I was wondering if you could speak more to the differences and similarites of 12 step meetings in relation to MMT. In what ways might it be complimentary?

      Looking forward to hearing from you!

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