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

Illustration for article titled 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.

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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 | TIME.com

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DISCUSSION

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straightup

I'm so sick of reading all these articles and comments by people who speak about AA/NA and addiction with gross inaccuracy . As a recovering addict, with years of first hand experience in both programs, and who has first hand experience with methadone and Suboxone, I feel qualified to speak, and would like to set the record straight on a few facts.

First off, anyone who cites a "study on AA" (or NA, I'm using the two interchangeable from here on) or spouts off statistics about the program, is full of shit. AA, by its very nature, cannot be tracked. Its insistence on anonymity for its individual members, as well as at the "level of press, radio, and film" (quote from AA 12 Traditions), prevents any accurate studies from being done. It is too hard to track members, since many come and go, there are no records, and there is no way to verify honesty. Furthermore, in order to see if AA is truly working for an individual, it must be determined whether they are truly and accurately "working a program of recovery" which means, in simple terms, practicing the principles of AA in their daily life- which is virtually immeasurable. Simply attending AA meetings is NOT the same as working the program of AA.

A sponsor is not there to give medical advice, nor should they. It is up to the addict to seek and follow the advice of a medical professional. It is stated in program literature that a sponsor is 'just another recovering addict of alcoholic' who is there to share their "experience, strength, and hope". It is generally accepted that, whether or not to use certain medications, is up to the individual and their sponsor. If they have differing views than their sponsor on the matter, then they are free to find a different one. The same goes for how to count one's clean time when on these maintenance medications. NO NA group "frowns on taking meds and forbids sponsors from doing it or advocating for it"! Individual members may feel that way, but that just speaks to the nature of the program which is that people are free to form their own opinions on such matters. I wonder where the author got her (mis)information from. She goes on to contradict herself, debunking her own article "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."

There is also an important difference between Methadone and Suboxone that puts them into two completely different categories. Methadone is an opiate from which one can get high. Suboxone is half agonist, half antagonist, with a built in ceiling affect. Not only can an opiate addict not get high from it, it also, to a point, blocks the effect of any opiate taken while on the medication.

There are so many other things I'd like to address, but, in the interest of time, I'll end with the misconception that AA is in ANY way a religious group, or requires its members to believe in God. There are plenty of successful atheists and agnostics in the program. Yes, much of the original literature contains the word "God", but in practice this has been substituted with a "Higher Power", which really means ANYthing/ force greater than oneself. For some it is the group of AA, a group of recovered addicts, one's own higher consciousness, or inner strength, nature, the list goes on… The idea behind it is that we are not the be-all and end-all, that there is something that knows better than us, that there is room for us to change and grow...

I hope this has been informative, and perhaps cleared up a few misconceptions. I only ask that one does their research, before presenting their words as fact, and does so from more than one source. Stay open minded. Recovery is possible, and there is hope.