I should have seen the battle between medication-assisted-treatment and 12-Step programs coming but – silly me – I thought they complimented each other beautifully. 

The medical community and government grant funders insist that MAT programs include therapy. What could be better therapy for recovering addicts and alcoholics than 12-Step programs?

What could possibly go wrong?

Plenty. 

You have pro-MAT folks dissing 12-Step programs. Abstinence-based programs – like AA and NA – don’t work for opioid addicts, they say. Die-hard 12-Steppers insist that you aren’t clean and sober if you take drugs like buprenorphine, naltrexone and vivitrol – drugs that curb addicts’ cravings for drugs like heroin.

Meanwhile, you have addicts who just want to get clean. They are desperate.  They’re not interested in this debate. They don’t want to get dope sick and they don’t want to stick another needle in wherever they can find a vein. They want a roof, bed and food. A toothbrush. A shower. A shred of compassion. 

We have treatment centers and sober homes that won’t treat and house addicts on MAT. And we have addicts on MAT who can’t talk about their treatment at 12-Step meetings and can’t find a sponsor who condones MAT.  What we have is ignorance on both sides.

MAT proponents often know little about the 12-Steps, how they work, how addicts work them and -most importantly – that they work. The 12-Steps are much more than sitting in a circle in a church basement, reminiscing  about our drinking or drugging careers, holding hands and saying the Serenity Prayer. 

They don’t know the angst the 4th Step induces, the humility required for the 5th Step or the planning and rehearsal that goes into a 9th Step. If they did, they would understand that the 12-Steps are cognitive behavioral therapy – CBT – exactly what addicts and alcoholics need. 

Twelve-step therapy jibes perfectly with MAT. Peer support. Highly experienced “therapist/sponsors.” A structured program, with assignments and tasks. Fellowship. Available 24/7, 365-days a year on the internet and in nearly every country in the world. Unlike therapy in a therapist’s office or clinic, the 12-Steps provide a lifetime of therapy – for free.

Twelve-Step therapy teaches us how to deal with the wreckage of our past – guilt, shame, remorse. We learn to police our thoughts and actions. We learn humility. We learn to make amends.

What hard-headed 12-Steppers don’t understand is that opioid abuse alters an addict’s dopamine pathways. The massive spikes in dopamine that occur every time an addict shoots up damages the body’s ability to naturally create dopamine – the chemical in your brain released when you do something that feels good. 

Dopamine is nature’s way of making sure we eat when we are hungry, put on a coat when we are cold and have sex to sustain the human race. Opioids flood the brain with so much dopamine that addicts constantly chase that high. For some addicts, MAT cuts those cravings and prevents them from going into withdrawal.

The highs are far more intense than those induced by alcohol and do far more damage to the brain. For some addicts, MAT enables them to stop long enough for their brains to re-establish healthy dopamine pathways. Then, they can be weaned off MAT.  

A successful MAT program requires