In spite of the founders of Alcoholics Anonymous (AA), and AA’s literature encouraging collaboration with the medical community, there remains attitudinal barriers to the integration of medication into the culture of Twelve-Step-based recovery, particularly in Narcotics Anonymous (NA). Conversely, many in the medical community are hesitant to refer patients to Twelve-Step programs. This is in part explained by differences in philosophy and approach; contemporary medical practice seeks solutions emerging from empirical research, while Twelve-Step programs, which emerged in a time when medical science had yet to develop effective means to support recovery from addiction, are largely based on a spiritual solution. Physicians may, therefore, be hesitant to embrace Twelve-Step’s ‘non-scientific’ approach to recovery, while Twelve-Step practitioners may not be well versed in the potential benefits of pharmacotherapy for addiction, or may be hesitant to engage with the medical community as a result of unproductive previous encounters.
It wasn’t long after I started to work with Kenneth that I became the leader of HAMS for Women, a subgroup of women who are trying to change their drinking. In HAMS for Women, we refer to each other as “ladies,” because women who drink have too often been described by derogatory names — anything but ladies. We carefully moderate the group to make sure that shaming, blaming, and judgmental comments are kept off.
We don’t just talk about alcohol, though. We talk about spouses, children, and we post pictures of our pets! We’ve had extremely sad moments: the day we learned of the death — from cirrhosis — of a woman we had seen through crisis after crisis as her abusive husband kept pushing things just a bit further, all the while keeping her too drunk to work and make a living. We exchange stories we dare not tell in public. In this group we find nothing but love and support.
This study found that taking advantage of both medications and mutual-help during treatment, especially outpatient treatment, is relatively rare. Only 1 in 7 discharges from inpatient/residential OUD treatment and 1 in 10 discharges from outpatient OUD treatment used both medication and mutual-help at the time of discharge. While this study did not examine the reasons behind the low rates of combined use of medication and mutual-help, other studies have noted that individuals on opioid medications, such as buprenorphine and methadone, may encounter negative messaging and attitudes in 12-step mutual-help meetings. In program literature for Narcotics Anonymous (NA), there is explicit acknowledgment that some meetings may restrict attendance of individuals taking agonist medications. As a result, patients may either stop attending meetings or stop using medication. Despite these barriers, prior research has found that mutual-help group attendance is associated with increases in the likelihood of abstinence among people receiving medications for OUD. Individuals in buprenorphine maintenance treatment who attend mutual-help groups are also more likely to be retained in treatment. While using both medication and mutual-help was uncommon, 60% of the sample used either medications or mutual-help at the time of discharge. This is encouraging, as these resources have both been found to be independently associated with abstinence from opioids.