Is the AA system of addiction recovery too unscientific to work?

Alcoholics Anonymous and other 12-step programs are based in part on the idea of a "sponsor," a person who provides support in times of trouble or temptation. But the problem is that the sponsor system doesn't fit with current scientific understandings of how addiction recovery works.

Of course it helps to have a sober buddy to help you through tough times. But as Maia Szalavitz writes over at Time, this model runs into problems when these non-expert sponsors start dispensing medical advice. This is especially a problem in Narcotics Anonymous, where that advice often takes the form of a rule against maintenance systems of recovery, where the addict takes medication to ease their dependence on the harmful drug. The classic example of maintenance recovery is when heroin addicts take methadone, which allows people to wean themselves of the urge to get high without also going through painful withdrawal at the same time.


Though the medical literature suggests that the most effective way for an addict to recover is through maintenance, most NA groups frown on taking meds and forbid sponsors from doing it or advocating for it. In this way, the sponsorship model in NA is actually undermining what medical professionals currently recommend.

Writes Szalavitz:

While recent years have brought greater acceptance of medication use, the issue of clashing advice from sponsors and professionals remains.

This issue is most acute when it comes to the long-term use of medications like methadone or Suboxone to treat heroin and other opioid addictions, NA sponsors have traditionally viewed this practice as "not recovery" and as violating the program's basis in complete abstinence because these medications are themselves opioids. But research shows that these medications can cut death risk for people with heroin addiction by around 70% [PDF]—and some have argued that the stigma against maintenance is part of what killed [actor Philip Seymour] Hoffman.

NA has struggled for years to address the controversy, traditionally not permitting those still on medication to share in meetings, be sponsors, or hold leadership positions. In many NA groups, such people are seen as having no days in recovery until they stop maintenance. As of 2007, however, the organization has taken the position [PDF] that it is up to individual groups to determine whether people on maintenance have equal status.


When addicts aren't given access to accurate medical information, unfortunately, deaths can and do result. Maybe it's time for NA to rethink its sponsor system, Szalavitz suggests.

Read more: Philip Seymour Hoffman: Twelve Step Programs and the Role of a Sponsor |

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