AA and Medication
The Clash Between 12-Step Programs and Prescription Medications
(All names have been changed to protect client confidentiality)
Managing a sober living house, I was responsible for enforcing house rules and guiding clients on their paths to recovery. I tried to set an example by working my own recovery program. I have always been partial to cognitive behavioral therapy(CBT)-based programs, but most of the clients participated in 12-Step based recovery programs. In case any concerns or questions about 12-Step programs were raised, I familiarized myself with the program, attended meetings, got my own sponsor, and worked through the steps. I always encourage others to try every program out there, increasing the odds that something sticks! So, I knew it couldn’t hurt to get my own sponsor and work the steps.
One evening, Client Ivanna B. Sober, came home from a 12-step meeting ecstatic she had found the ‘perfect’ sponsor, named Fay KemDee. I was excited to witness Ivanna’s spark, willingness to recover, ignite into a small flame, an actual plan to work a recovery program.
The next morning, I brewed coffee, turned on my 90’s rock playlist, and made my rounds, waking each girl for morning chores. Shortly thereafter, I opened the medication safe to distribute prescription medications.
Ivanna entered my office and explained she did not want to take any of her medications. She explained Sponsor Fay advised her, as a condition of sponsorship, to stop taking her prescription medications.
On more than one occasion, sponsors like Fay KemDee carelessly told clients to stop taking their prescription medications. Here are some of the justifications they gave:
“Once you let go of your resentments, you won’t need your anxiety meds” or
“You will be able to fall asleep without your medication, once you make amends” or, my personal favorite,
“Instead of taking your depression medication in the morning, make a 100-item gratitude list.”
Trying to Make Sense of Things
I could not make logical sense of the issue. My thoughts swirled:
12-Step programs preach addiction is a disease, but these sponsors don’t believe prescription medications are helpful?
- The program states addiction is a disease, with no cure.
- OK (True according to AA)
- Well, cancer is also a disease with no cure.
- OK (True according to…everyone)
- Doctors prescribe medications to cancer patients to help manage symptoms. (pain, nausea, mood swings)
- OK (Acceptable)
- Psychiatrists and doctors prescribe medications to help recovering substance abusers manage their symptoms. (inability to sleep, inability to regulate mood, restlessness, treatment of underlying psychological disorders)
- NOT OKAY! (Call the Cavalry!)
Would anyone tell a cancer patient to stop taking their prescriptions? Does taking prescriptions to manage symptoms make recovery from cancer more difficult or less likely? Absolutely not!
I could not make logical sense of it this in my mind, so my next step was to investigate. With observation, I discovered three differing views, held by 12-step members, regarding AA and medication.
Tolerance of Prescription Medications Taken in 12-Step Programs
Sponsors have different definitions of what it means to be clean and sober and will only take on sponsees who conform or are willing to conform to these personal definitions.
I identified three definitions of ‘clean and sober,’ categorized by tolerance, or lack thereof, of prescription medications. From strictest to most liberal, they are as follows:
- No exceptions. Even Advil taken for a headache is prohibited.
- Exceptions only for prescription drugs with no mind- or mood-altering effects
- Allowances made for prescriptions like
- antidepressants for mood disorders
- lithium for bipolar disorder
- Prohibited prescription examples:
- Adderall for A.D.D.
- Valium for generalized anxiety disorder
- Allowances made for prescriptions like
- Case by Case Bases
- Sponsors decide whether to take on a potential sponsee on a case by case basis
- Willing to trust medical professionals to prescribe the right medications
- If prescription medication is being abused, issue is addressed
(If you are a 12-step member falling into category three, you should know you are appreciated!)
How could a worldwide recovery program give rise to so many different definitions, die-hard beliefs, of what it means to be clean and sober?
What the Literature Says:
What does the Big Book of Alcoholics Anonymous say about medications?
Page 133 of A.A.’s Big Book, explains:
- A recovering alcoholic may suffer from lingering physical symptoms resulting from alcohol abuse
- “that a spiritual mode of living is a most powerful health restorative”
- God gave us wonderful, talented health professionals
- a member should not hesitate to seek consult from said professionals
- services of these professionals “are often indispensable in treating a newcomer and in following his case afterward.”
Years later, “The A.A. Member – Medications & Other Drugs” literature was published warning against A.A. members giving medical advice to other members. (Read full text here)
Where does Narcotics Anonymous (N.A.) stand on the issue?
NA has published significantly more in-depth literature on the issue. N.A. text, “In Times of Illness,” lays out safeguards to be implemented by a member seeking help from a medical professional. (Read full text here) They are as follows:
- Member should explain to medical professional that he or she is in recovery
- Member should express his or her will to abstain from mind- or mood-altering medications
- Member should “consider and discuss alternative treatments and smaller doses when a prescription for mind-changing or mood-altering medication is offered.”
- Member should take his or her sponsor or a trusted NA friend with him or her when going to the doctor.
Is it possible the Big Book’s text, “a spiritual mode of living is a most powerful health restorative,” has been interpreted to mean turning our will and our lives over to a Higher Power is the only way to achieve freedom from active addiction?
The Big Book was published in 1939! Science has come a long way in the last 80 years and recovery programs need to adapt when new discoveries are made.
12- step members subscribing to a ban on all prescription medications believe drug users will abuse any mind- or mood-altering prescriptions we get our hands on.
Well, from personal experience, I would not recommend prescribing a newly sober heroin addict a monthly allotment of Oxycontin. However, this should be discussed with a doctor. If a user is serious about getting clean, he knows to tell his doctor which substances he struggles with.
Drug users are very knowledgeable on this subject. In fact, most know more than your friendly neighborhood pharmacist when it comes to a specific medication’s effect, potential interactions, and side effects.
Also, many Suboxone and all methadone programs initially require clients to report daily to a clinic for dosing. This is to safeguard against any clients acting on any urge to abuse these drugs. Trusting safeguards like these should provide peace of mind for those worried about abuse.
If a member does con a doctor into prescribing unnecessary medication for the sole purpose of getting high, they were not ready or willing to take their recovery seriously anyway.
The 12-Step Witch Trials
During the Salem witch trials, women suspected of witchcraft were stripped, bound, and tossed into the nearest body of water. It was common belief that witches, thought to have rejected the sacrament of baptism, would float on top of the water while those innocent of practicing witchcraft would be submerged. Unfortunately, many innocent women drowned as a result of this test. Guess they did not think that one out thoroughly! Luckily, in modern times, we see how ridiculous and dangerous this practice is.
Ultimately, the dangerous practice advising members to stop taking prescription medications is rooted in fear of potential abuse of said medication. The belief recovery is ONLY possible through acknowledging and then establishing a relationship with one’s Higher Power leads some 12-steppers to dismiss the validity, sometimes even necessity, of prescription medications in recovery.
These beliefs are archaic, harmful and make as much sense as the swimming test did during the witch trials. Any good recovery program will incorporate new discoveries into their teachings. It seems 12-Step programs have tried to acknowledge the problem with additional publications, but some members have failed to hear the message.
N.A. seems to have handled this issue much better, setting out guidelines for members, but A.A. still struggles to modernize. Leveling with sponsors like Fay KemDee is like arguing to keep evolutionary science in our schools curriculum to a die-hard Creationist. It’s almost comical.
12-Steppers, who define sobriety like Fay KemDee, usually will not examine their beliefs, even after someone points out how dangerous they are when enforced on others. Inevitably, the God- card (or should I say Higher Power-card) is played. You will not change their mind. Instead of getting frustrated, I suggest telling a story like this:
A woman is stranded on a lifeboat, sole survivor of a plane crash in the ocean. A passing cruise ship attempts to pull her in to safety and she refuses. A Coast Guard helicopter is sent out to bring her to shore, but she refuses again. The woman drowns and goes to Heaven. At the gates, she asked God where He was and why He didn’t save her. God responds, “I sent a whole cruise ship and a helicopter! What more do you want from me?
SMART Recovery and Medication
Smart Recovery and other CBT-based recovery programs are science- based. There is no talk of finding a higher power, although participants are not faulted for their beliefs, whatever they may be. Unlike 12-Step programs, spirituality is not the only way to treat substance abuse disorder. Meditation and mindfulness are taught as ways to cope with urges, but that is as spiritual as it gets.
These programs focus on lifestyle changes, setting goals, and acting to reach those goals. If a prescription for methadone, suboxone, or antidepressants helps the participant reach their goals and live a less chaotic, self-endangering lifestyle, then so be it!
What is there left to do??
(Yes, that was an N.A. reference!)
Clients on medication maintenance programs, specifically Suboxone, Methadone, or medical marijuana, should be not only accepted, but tightly embraced into the recovery program of their choosing. Hopefully, by reading this, you will have gained the confidence to carry on with your recovery. If you are dealing with a sponsor who will not accept your choice to incorporate a medication maintenance program into your recovery, move on. Trust me, there are many other potential sponsors who will feel differently. If you cannot find one, check out a SMART recovery meeting. Many SMART members would be more than willing to mentor you, just like a sponsor would do.
As always, please remember, NO TWO INDIVIDUALS ARE EXACTLY ALIKE. Therefore, NO TWO RECOVERIES WILL BE EXACTLY ALIKE. Find your own path and stick to it!