Syringes to Sobriety

Stories and Advice from a Real Heroin Addict

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.

Sober Living House

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:

  1. No exceptions.  Even Advil taken for a headache is prohibited.
  2. Exceptions only for prescription drugs with no mind- or mood-altering effects
    1. Allowances made for prescriptions like
      1. antidepressants for mood disorders
      2. lithium for bipolar disorder
    2. Prohibited prescription examples:
      1. Adderall for A.D.D.
      2. Valium for generalized anxiety disorder
  3. Case by Case Bases
    1. Sponsors decide whether to take on a potential sponsee on a case by case basis
    2. Willing to trust medical professionals to prescribe the right medications
    3. 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:AA and Medication

  • 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 bodyWitch Trials 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! 

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8 comments on “AA and Medication

  1. You share a lot of information about sobriety here and I think this blog is really a great way for people who are struggling with addiction to learn what is right and acceptable. All too often people are stirred in the wrong direction only to end up right back where they started. As a worker in the pharmacy I use to have to draw a lot of methadone syringes and I always wondered if it was a good choice for addiction because of it’s addicting qualities itself. IS this true? Could one get addicted to methadone? Just a question. I think that sponsors shouldn’t be able to tell recovering addicts not to take their medications, if it’s putting them in a position that could hinder them then why take that chance? Thanks so much for sharing this info, I will pass it along to a few friends I have. I think it’s well worth the read.

    1. Thank you for a great question! Methadone is an opiate, so it does have an addictive quality. However, it is a longer lasting opiate than pain pills or heroin. As a result, a user can take a methadone dose, preventing withdrawal from and staving off the urge to use heroin, and not need another dose for at least 24 hours. With heroin, users may crave another hit as little as twenty minutes after their initial fix.

      Once a user feels comfortable with their methadone dose, they are able to stop using heroin completely without worrying about withdrawal. At this point, a user finds they have significantly more time in their day for recovery. Coupled with meetings(12-step, SMART etc…) and counseling, methadone is a powerful tool.

      When ready, a user can slowly taper off the methadone. This can happen in as short as a week, depending on the dose the taper begins at, which is dependent on how heavy the person was using before entering a program.

      Under proper medical supervision, a methadone patient will have no withdrawal symptoms during or after the taper.

      Stay tuned this week for a post on withdrawal, the different ways it is done, and how effective each way is.

  2. Hi Ashley,

    Outside of own research, I don’t know too much about the in-workings of facilities outside of Australia, however, the general stigma around prescription medications seem to be universal.

    Medications for depression, anxiety and so forth aren’t a long-term solution for one’s mental awareness but they are certainly there to help with stepping stones in the right direction. It’s what they do and what they were designed to do, and they do it well.

    It’s oddly amusing though – on a different spectrum – that people can be accepting of the above prescriptions and understand when your doctor tells you that it’s unwise to suddenly stop taking them and to come off and/or change them slowly. Yet will scowl at users who cannot stop or switch to something approved to help them stop. Much like “FDA approved” medications, users need to progress to sobriety slowly and be weened of gradually just as much so, if not more so than prescription medications. Alcohol, narcotics and alike make us do silly things, and the human brain does not respond well to loss or hopelessness, which in essence can lead to panic and desperation.

    I like that you have a voice. 🙂 Please don’t ever lose it.

    1. Absolutely agree with you, Sarah! Users do not become addicted overnight, so why do we expect them to kick the habit in a few days? It makes NO sense.
      I think most of the pressure on users to stop cold turkey is rooted in fear. Society fears if a user does not just stop right away, their next high may be their last. This is less common than people think, however. Although it is possible for a user to O.D. at any time, a chronic drug user has a very high tolerance and it would be unlikely to see an overdose as they ween down.

      Another issue, and the reason I will never endorse cold turkey detox without medical advice and supervision, is there are many risks, from seizures to death, to abruptly stopping any abused narcotic. It is very dangerous. The thinking around this needs to change.

      A substance abuser expressing a desire to change and stop using should not be made to suffer. The sentiments ‘you got yourself into this mess, so deal with it’ or ‘you need to feel the hell of detoxing so you won’t want to use again’ are not helpful for recovery. Real recovery only happens when a user stops punishing themselves and feeling punished by those around them.

      Thank you for reading and your feedback!

  3. Hi Ashley
    Very insightful article. I work a Police Office in Sydney Australia and see the effects of drug and alcohol addictions every day. I have a lot of respect for the clinics and organisations that try to help addicts beat their addictions. I only get to deal with the effects of their street crimes and there is nothing I can do to help them or their families. Keep up the good work.
    Regards
    Steve

    1. Thank you Steve! You have no idea how much respect drug users have for officers that see us as human beings. It is unfortunate that society pits drug users and police against each other, almost as mortal enemies. Both sides are to blame for this misconception as mistakes have been made by users and officers alike. However, it is so refreshing to hear a police officer express empathy and understanding for the struggle of users and the families of users.

      Unfortunately. drug use too often resorts in petty crimes, shoplifting, trespassing, loitering, etc. It seems most of these offenses are nonviolent. I hope more resources are put in place for officers, working in the U.S., to help users caught committing these types of crimes. Incarceration does not encourage recovery. In fact, it may be having the opposite effect.

      In the states, users are often arrested for felonies(most of the time nonviolent) they never would have committed if they were not hooked on drugs. Once labeled a felon, it becomes very difficult to get gainful employment. I would love to encourage all users in recovery to apply for their dream job. After all, doing something you are passionate about is a great way to stay sober. Unfortunately, as I found out the hard way, this is just not realistic for those of us with felonies.

      I understand officers are there to enforce the laws so there is not too much to be done on that side of things. However, I hope the correct legislators read this. Something has got to change. If users cannot reconnect with society in a meaningful way while in recovery, recovery will not last and the opioid epidemic will continue to defeat us.

      Thank you again for stopping by Steve! Happy Easter.

  4. Great website and very informative! I always get annoyed and feel my time wasted when I see articles that give little advice. My mind still wants to understand the reason why and how things work before I can take any information. I really like how you have explained: ” If you are dealing with a sponsor, who will not accept your choice to incorporate a medication maintenance program into your recovery, move on. Many other potential sponsors will feel differently.” Your article had value in every sentence for me, and I am grateful. Thank you.

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