In the world of recovery from Substance Use Disorder the terms abstinence and sobriety are often used interchangeably. They are meant to discern if someone is not using substances that are mind altering. Traditionally recovery programs consider someone as “not in recovery” and “not sober” if they continue to use such substances. These programs promote total abstinence as the only way out of addiction.
In recent years that belief has been challenged and has become a focus of controversy within the Recovery world. This is due to the increased frequency of the use of medications to treat substance addictions, referred to as Medication Assisted Treatment. (M.A.T.) Methadone, buprenorphine, Vivitrol, naltrexone, disulfiram and acamprosate have all been used to treat opiate and alcohol use disorders. Some of these have the potential to be misused and can cause dependency issues themselves. They all, however, have demonstrated effectiveness in treating substance use disorders in many people. At the same time, many individuals with substance use problems have an underlying mental illness such as anxiety, depression, bipolar disorder, PTSD, and psychotic disorders. They often require medication to help control their symptoms to allow for optimal functioning. These problems often coexist with Substance Use Disorder.
More and more individuals are benefiting from medications that aid in the psychological stability and recovery from addiction but it is not unusual for many in traditional 12 step programs such as Narcotics Anonymous and Alcoholics Anonymous to consider those taking medications to be not “in Recovery.” They purport that true sobriety requires that one be free from any substance that may be mind altering. Those with this belief, at times, harshly judge and diminish the efforts of the taking these mediations and this has led to a rift in the Recovery Community. Many individuals taking these medication feel unsupported in certain 12 step meetings. Recently there has been growth of self help recovery groups that openly support those on M.A.T., but the argument about the use of these medications in Recovery persists.
Traditional 12 step program philosophy does not include the growing scientific evidence that addiction is a brain disease and that there are physiological bio-chemical changes in the brain that occur in substance use disorder. These changes have been demonstrated with brain PET scans. In addition, Substance Use Disorder has been likened to Obsessive Compulsive Disorder long recognized by psychiatric professionals. Those addicted to substances live with near constant obsessions about their need to obtain and planning for acquiring their next “dose.” They use the substance in a compulsive manner. Compulsions are “all consuming,” excessive thoughts, urges, and behaviors that persist despite negative effects on health, relationships, and work. In addition to behavior therapies, psychotherapies, stress management, and mindfulness approaches to OCD, many individuals find benefit in the use of medications such as anti-depressants and anxiolytics. (mild tranquilizers)
Another argument against certain pharmacological treatments for Substance Use Disorder concerns the use of buprenorphine and Methadone for Opiate Use Disorder. The medications are opiates themselves and carry the risk of dependence and possible misuse. Those against the use of these medications for addiction consider this form of treatment as “ just replacing one addiction with another.” They seem to disregard that many on buprenorphine or Methadone are able to function in a healthy manner; hold down jobs, have health relationships and contribute to society in a positive manner. The scientific evidence shows that those in recovery from Opiate addiction have a significantly improved chance of sustained recovery, when used a part of a comprehensive bio-psycho-social treatment approach, compared to those that do not use these medications.
Certainly the best approach to treating Substance Use Disorder is the one that works best for each individual. It is advantageous to have many avenues to successful treatment, as there are also many different paths to developing addiction. We need to stop judging someone for using a different approach to Recovery. We would do better to support anything that helps an individual with Substance Use Disorder sustain a healthy, productive, and content life and discourage others that denigrate those who find serenity on a different path.