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12-step programs not the only way to beat the opioid crisis

A prescription for Suboxone, a maintenance treatment for

A prescription for Suboxone, a maintenance treatment for opioid dependence. Credit: Getty Images / Spencer Platt

Jeffrey Reynolds, a 20-year veteran of the battle against addiction on Long Island, wants hospitals to give drugs to opioid overdose victims treated with the antidote naloxone, which both revives opioid users and sends them into pangs of withdrawal.

Reynolds, an expert in addiction and treatment, says that an immediate dose or two of Suboxone, a synthetic opiate, can help users of heroin and prescription pain pills fight cravings, because it can help them stay sober and get a chance at recovery.

As it stands, addicts revived with naloxone often end up using opioids again hours later — and overdosing again.

Reynolds has statistics and the views of most public health officials on his side, because studies show opioid addicts who are treated with only behavioral therapy are twice as likely to relapse and twice as likely to die of an overdose than those being treated with Suboxone or methadone.

But working against the practice of using Suboxone or methadone to help opiate addicts, a protocol called “medication-assisted treatment,” are the weight and history of addiction therapy in the United States. Many leaders in the fields of medicine and law enforcement fear and preach that using one drug to stay sober is no better than being addicted to another.

The consensus among medical and treatment professionals is that opioid addiction is a disease. Diseases are treated with medicines and scientifically tested methods, which is now possible and effective with opioid addiction. So if opioid addiction is a disease, why is society so often adamant that it must be overcome with only prayer, support groups and behavioral therapy?

Mostly, it’s because of the model of Alcoholics Anonymous.

Since AA’s founding in 1935, its recovery method has become the dominant model of addiction treatment, and not just for the alcoholism. The recovery manual known as the Big Book of AA, the model of total abstinence from addictions and the organization’s 12 steps and 12 traditions have been adapted to help people overcome everything from smoking to anger.

The AA model involves accepting powerlessness over alcohol and inviting God into one’s life, admitting to and making amends for bad behavior and helping others to recover from alcoholism. Also crucial are the fellowship and support that come from regular meetings with other alcoholics.

AA does not operate or endorse rehabilitation facilities, does not advertise for or seek members, does not ask judges or families or employers to send prospects to its meetings, and does not claim that the 12 steps can help end addictions to anything other than alcohol. And AA embraces the idea that doctors may well prescribe drugs for members or addicts to deal with physical, emotional and mental problems other than addiction to alcohol.

The biggest offshoot of AA is Narcotics Anonymous, which has helped millions of people, but too often stands in opposition to medication-assisted treatment. This animus against using medication to help people recover from heroin and prescription pain addictions is widespread, and can be deadly. Too often, judges who sentence addicts caught up in the criminal justice system, clergy counseling them and families with addiction histories believe only in the total abstinence path of 12-step programs. They dismiss methadone and Suboxone treatments as “replacing one addiction with another.” But recovering opioid addicts who use replacement substances correctly often manage to defeat their craving without getting high. They can hold down jobs, stay out of trouble and care for their families. Often, they can, over time, stop using their replacement substance. But even those who never do generally fare better than active addicts.

Methadone and Suboxone are also inexpensive ways to treat addiction, because they can be used effectively in outpatient programs and combined with free 12-step meetings, rather than costly inpatient rehabs. But in Suffolk County, there is a waiting list of about two months for methadone treatment. And even in Nassau County, where there is no waiting list, experts say a lot more addicts need medication-assisted treatment than seek it because of their own bias against using one drug to get off another. Opioid overdose deaths in both counties have skyrocketed, with 442 in 2015. Using substitute drugs to break the addictions is a crucial and underutilized part of getting a grip on the epidemic.

Addictions are often both a disease and a behavior, and they require both medical help and behavior modification therapy and support. It’s madness for 12-step devotees to oppose medication-assisted treatment for addicts who want it. But it’s just as destructive to deny or debunk the good 12-step programs can and have done. Either path can help the addicts. And many addicts will need the help found on both paths to achieve their best possible lives.

NA and AA are widespread, free, socially accepted and available for anyone who needs them. That’s not yet true of drug therapies to treat opioid addiction. And that’s a gap addicts are falling through, often to their deaths.