The Difference Between 12-Step and Medically Assisted Treatment

These days there are a variety of treatment options available to those struggling with addiction. Traditional 12-step programs have been embracing a new model of treatment which has been shown to be effective in helping patients recover from addiction. In previous years, such programs had almost exclusively implemented an abstinence-only model of addiction recovery. In fact, although medically assisted treatment was approved by the FDA sometime in the year 2000, many abstinence-only programs have been slow to actually adopt it as a means of treatment.

A Better Answer for Long Term Sobriety

Buprenorphine is frequently used in medication-assisted treatment (MAT) to combat addiction, particularly to opiates. Buprenorphine differs from the more commonly known methadone, which can only be administered in a highly structured clinic, according to the Substance Abuse and Mental Health Administration. Conversely, Buprenorphine is more accessible because it is allowed to be prescribed or dispensed through physicians’ offices.

Although Buprenorphine is not the only drug to be used in MAT, it is among one of the most successful. Yahoo News reports that one of the most influential factors in this increasing popularity of this new method of treatment is due to the fact that “the growing number of opioid-related deaths — particularly among addicts who relapsed shortly after completing or dropping out of rehab — has made the drug’s success increasingly impossible to ignore.”

That being said, the signature 12-step addiction recovery method continues to be the standard worldwide. This approach to treatment began with Alcoholics Anonymous and was created in the 1930s after the 1939 publication “Alcoholics Anonymous: The Story of How More than One Hundred Men Have Recovered from Alcoholism.”

Just 14 years after the first AA meeting was held in Akron, Ohio by Bill Wilson and Bob Smith, The Minnesota-based Hazelden Foundation (now known as Hazelden Betty Ford) was formed. Following its establishment in 1949, the Foundation quickly became one of the nation’s leading providers of both residential and outpatient addiction treatment. Even the Hazelden Foundation, which has historically adhered to the abstinence-only method of treating addiction, has embraced the use of medically-assisted treatment.

Is Abstinence-Only Rehab Truly Effective?

In an interview with Yahoo News, medical chief officer Dr. Marvin Seppala, mentioned fearing a backlash when he initially proposed introducing medicine-based treatments into the formerly abstinence-based 12-step program. Perhaps not surprisingly, the decision did provoke some backlash from the addiction community but, according to Dr. Seppala, the reaction has been pleasantly surprising.

Dr. Seppala revealed that around 100 counsellors were asked to raise their hands if they’ve ever had an opioid-addicted patient that has died from overdose following treatment. Shockingly, according to Dr. Seppala: “Almost all the hands in the room went up.”

With medically-assisted treatment, more lives will be saved.

Relapse and Overdose after 12-Step Based Treatment

This response reflects an alarming statistic regarding the frequency of relapse and overdose after traditional rehab. Dr. Omar Manejwala is a board-certified psychiatrist who specializes in addiction medicine. Dr. Manejwala is one of the country’s leading experts on addictions, cravings, and addiction-related behavior. Following the death of actor and celebrity Philip Seymour Hoffman caused by drug overdose, Dr. Manejwala sought to examine the frequency of relapse for many patients who attempt traditional rehab. In doing so, he presents the findings of an 8-year study which surveyed around 1200 addicts.

According to Dr. Manejwala’s research, the statistics are as follows:

  • “ Only about a third of people who are abstinent less than a year will remain abstinent.”
  • “For those who achieve a year of sobriety, less than half will relapse.”
  • “If you can make it to 5 years of sobriety, your chance of relapse is less than 15 percent.”

These statistics prove that getting sober is difficult, but staying sober is the real issue that needs to be addressed in treatment. The longer a person stays off of opioid drugs, the better the chance they have in living a life without drugs. The challenge of staying sober in the early months following treatment is very real. Many individuals lose the ongoing battle with pain pills and heroin without medical assistance.

A Shift to Medically-Assisted Treatment

There are more and more leading edge treatment centers beginning to acknowledge the advantages of incorporating MAT to addiction recovery programs. Dr. Seppala spoke about his findings and the potential of implementing medical assistance to addiction recovery at the 2013 National Association of Addiction Treatment Providers conference. At first, he said, there was a lot of “resistance to what we were doing. A lot of people thought we were going down the wrong path.” However, it didn’t take too long for perspectives to change. He addressed the conference again in the spring of this past year, where he notes that “the bulk of people were really supportive of what we’re doing. There’s been a shift.”

The change of heart at this conference may reflect a nationwide change in perspective regarding the use of medicine to aid in addiction recovery. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), there are MAT certified physicians throughout the 50 states, though the exact number varies depending on the state in question.

In February of 2016, Obama proposed to include funding (around $1.1 billion) to pay for drug treatments for heroin and opioid abuse for the fiscal year of 2017. This is a major step for addiction treatment as this funding could potentially increase access to medically-assisted programs to patients in need as well as fortify them.

A Difficult Transition – Fighting Misconceptions

Although some treatment centers have been evolving and expanding over the years, there are still some treatment programs who are holding out on incorporating MAT into their structure. Because many recovering addicts do, in fact, choose to abstain from using medication in their recovery. Some facilities have started the transition to medically assisted treatment by separating patients who do and do not elect to use Buprenorphine into different counseling groups.

Separation is sometimes necessary. This is partly because recovering addicts from abstinence-only treatment programs tend to have a “very negative view” of medically assisted treatment. According to specialists, there is a logic behind this mentality. After all, some critics believe that “giving someone a drug like buprenorphine, which is a partial opioid, could prevent someone from real recovery.” But these arguments, he explains, are more philosophical than scientifically-based. The science supports better outcomes of using these medications, which means saving more lives.

This is why when it comes to addiction recovery, medically assisted treatment seems to be the logical long-term answer. Doctors who treat addiction voice support by agreeing that “If you can help more people, it makes sense to go down such a path, even if your peers disagree with you.”

 

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