Methadone and 12-step

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This blog is a re-run but I’ve published it again because of recent comments it has attracted (at end of blog)

Methadone and 12-step

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 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.

NA & AA ‘helpful’

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.

Philosophical clash?

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.

[A version  of this blog was published in April with more recent comments which I’ve copied below]

From Kev Neary on Nov 1st 2014

“I totally identify with people on ORT – they have to be acknowledged for their achievement in staying on ORT and not using illicit drugs. This is a massive stepping stone to being abstinent,  N/A & C/A all followed the 12 step program by AA so why can’t METHADONE ANONYMOUS do the same? GOOD LUCK & wish you all well in RECOVERY”

From William Purcell on Nov 2nd 2014

“I have been a member of Narcotics Anonymous for 19 years and have known people to have gradually come off amounts of methadone in the rooms, ranging from 20 mls to 100mls. I believe there has to be a distinction between ORT and abstinence hence the guideline for who can chair the meeting and who can sponsor.

If a Methadone Anonymous started in Scotland I have no doubt that due to the altruistic nature of people on a Twelve Step program the ones who have successfully come off methadone in N.A. would be more than happy to help and support this new fellowship to get established the same way in which Alcoholics Anonymous helped N.A. Yee haa..”

    3 Responses to "Methadone and 12-step"
    1. Kuladharini says:

      A Scotland wide working group of recovery activists met last week and is developing an ORT specific mutual aid format and groups for Scotland, that we hope will sit inside local recovery communities and along side treatment.

    2. john c says:

      I’ve a lot of experience with everything you’re talking about above. I was on methadone for far too many years – and loads of other medications that I manipulated out of caring doctors and health workers. I’m now a member of NA and have been for a number of years. And the truth is my favourite dealer was my doctor; I only started to get well once they finally kicked me off everything and I suffered and started looking for real help.

      Drugs play their part but at the end of the day prescribing a drug addict more drugs to get off drugs is nuts. I had 20 years of it and I nearly died so many times it’s a miracle I’m here. My old script would have killed my whole street.

      As for NA, we believe you can only really start to heal and work through your past if you’re drug-free. NA works very well it won’t change and as far as everyone I no is concerned it doesn’t need to IT WORKS IF YOU WORK IT!

    3. Tom says:

      “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.”

      In my experience addicts on buprenorphine or methadone are welcomed at 12 step meetings. I have seen many people engage with the fellowship to help with the detox process. They have a desire to stop using the prescribed opiates, that is why they come to a 12 step abstinence programme.

      I would be concerned if an abstinence based 12 step fellowship bent to outside pressure to accept abstinence and methadone assisted recovery on an equal footing. We follow certain directions to recover from addiction in our fellowships. If we start changing the core components of the programme – self will, even good intentioned self will may lead to problems.

      However an ORT specific mutual aid programme would seem to be a good idea. Those that wish to remain on methadone/ bup would be comfortable in this setting.

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