Given 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