Five years ago, Bill White released an enlightening document about the “hazardous territory” between Narcotics Anonymous (NA) and medication-assisted treatment for opioid addiction.
White is an eloquent and thoughtful guy, so reading a summary of his work is a bit like reading the Cliffs Notes of Hamlet.
Two big takeaways
A big question that White probes is whether NA is fundamentally incompatible with the use of maintenance medications to recover from addiction. The jury is still out, he concludes, but the investigation unearthed revealing information.
To me, the most important information was this:
1) In its official literature, NA has taken specific stances on medications for opioid addiction.
Released in 1996 by the NA World Service Board of Trustees, Bulletin #29: Regarding Methadone and Other Drug Replacement Programs states that people on methadone are welcome to attend meetings and listen, but that sharing or leading at meetings “would not be carrying the Narcotics Anonymous message of recovery.” Although, according to the bulletin, NA has no opinion on methadone maintenance as a treatment modality, “Our program approaches recovery from addiction through abstinence, cautioning against the substitution of one drug for another. That’s our program; it’s what we offer the addict who still suffers.”
The 2011 pamphlet “NA Groups & Medication” expresses a slightly softened view, allowing that individual groups may determine the level of participation of a person on “drug replacement therapy.” However, the pamphlet reiterates the idea that drug replacement therapy does not equate to “complete abstinence” as NA understands it.
In short: anti-medication bias in NA is not merely the result of personal opinions and folk wisdom, but is based on official statements from the top down.
But secondly, and also extremely importantly:
2) This is all fluid.
NA’s official stances have changed in the past and will continue to change, reports White. And of course, NA groups differ tremendously. To say that “NA does not accept the use of maintenance medications” belies the incredible diversity of NA members and NA groups. It also doesn’t adequately represent the diversity of people receiving medication-assisted treatment. Plenty of folks (as White shows us) find a place for themselves in NA while using medications to recover.
How to help clients on medications get the support they need
The most immediately useful aspect of the paper were White’s thoughts on how professionals can help clients on medication figure out how to get the support they need. If you are working with a person in methadone, buprenorphine, or naltrexone treatment, consider these suggestions. We’ve boiled them into a simple infographic.
Click on the infographic for a version you can easily tweet, pin, print, and share.