While medication assisted treatment (i.e., buprenorphine, methadone) is an accepted & effective treatment for opioid use disorder, there is still some argument against its use among people who support a total abstinence model of recovery.
While medication assisted treatment (i.e., buprenorphine, methadone) is an accepted & effective treatment for opioid use disorder, there is still some argument against its use among people who support a total abstinence model of recovery.
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12-Step programs, such as Narcotics Anonymous (NA), which follow a philosophy of complete abstinence, do not prevent attendance by people on medications, though they may limit participation in meetings by these members. For example, some Narcotics Anonymous (NA) groups may encourage members on medications to not speak during meetings and participate solely through listening (see here).
Since active participation in meetings can improve outcomes over attendance alone (see here), people taking buprenorphine or methadone may miss out on some of the benefits conferred by participating in meetings. It is unknown however, if the conflicting philosophies of Narcotics Anonymous (NA) and medication assisted treatments may result in negative effects such as stigmatization, discrimination, or encouragement to discontinue their medications against medical advice.
This analysis included 300 opioid-dependent African Americans beginning buprenorphine at one of two outpatient programs.
Both of these programs originally followed abstinence-based treatment models but adopted buprenorphine treatment as part of a city-wide initiative to expand services before this study began.
Both programs encouraged NA (or other 12-step meeting) attendance while some participants were required to attend an on-site meeting by their counselor. Abstinence from opioids and cocaine was defined as zero days of self-reported use in the past 30 days and a negative urine test for the specified drugs, while treatment retention was self-reported.
For the qualitative portion of the study, 20 patients (10 from each of the two outpatient programs from which study participants were recruited) were interviewed 3 months after beginning treatment. Interviews asked about patients’ attitudes and knowledge about buprenorphine and treatment expectations.
In the 6 months after BMT initiation, 86% of participants reported attending more than 5 NA meetings. Over three quarters reported that their counselor required them to attend meetings. Of the 209 participants who attended meetings while in BMT, only one third disclosed their BMT status to members. Among those who disclosed their status (n = 68), one quarter reported that someone at a meeting encouraged them to decrease their dose or stop taking buprenorphine all together.
The average number of meetings attended by 6-month follow-up was significantly higher among participants who remained enrolled in buprenorphine treatment (72 versus 37 meetings, respectively). Meeting attendance was also higher among participants who were abstinent from opiates/cocaine at 6 months. The rates of buprenorphine treatment retention and past 30 day abstinence at 6 months were 63% and 33%, respectively.
Main themes emerging from the qualitative portion of the study were:
This very timely study found that NA meeting attendance did not have a negative impact on buprenorphine treatment retention and was also associated with increased likelihood of abstinence at follow-up.
Despite the conflicting viewpoints on medication use between 12-step groups and buprenorphine programs—which was reiterated by participants in the qualitative study—there appears to be a benefit in attending meetings among patients also engaged with medications.
As noted above, each additional Narcotics Anonymous (NA) meeting attended per week was associated significantly with a 2% increase in the odds of treatment retention and a 1% increase in the odds of abstinence at 6 months. Negative attitudes toward buprenorphine may begin to shift as medication-assisted treatment becomes more widely accepted as an evidence-based treatment for people seeking recovery.
Counselors may play a role in helping patients in buprenorphine treatment maintain engagement in 12-step groups, but this has not been examined empirically. Understanding counselors’ attitudes toward simultaneous use of BMT and 12-step groups is thus important as well.
This study by Monico and colleagues explores this issue among African Americans with opioid use disorder in Baltimore, Maryland. As a community greatly influenced by the 12-step philosophy and with recent expansion of buprenorphine treatment for low-income residents, Baltimore serves as an ideal location to examine whether the combination of both approaches is possible and even helpful.
Referring patients in buprenorphine treatment to attend Narcotics Anonymous (NA) or other 12-step meetings DOES NOT have a detrimental impact on treatment outcomes. While requiring attendance did not improve abstinence or buprenorphine treatment retention results, patients may benefit from this free and widely available community recovery support resource.
Monico, L. B., Gryczynski, J., Mitchell, S. G., Schwartz, R. P., O’Grady, K. E., & Jaffe, J. H. (2015). Buprenorphine Treatment and 12-step Meeting Attendance: Conflicts, Compatibilities, and Patient Outcomes. J Subst Abuse Treat, 57, 89-95. doi:10.1016/j.jsat.2015.05.005
l
12-Step programs, such as Narcotics Anonymous (NA), which follow a philosophy of complete abstinence, do not prevent attendance by people on medications, though they may limit participation in meetings by these members. For example, some Narcotics Anonymous (NA) groups may encourage members on medications to not speak during meetings and participate solely through listening (see here).
Since active participation in meetings can improve outcomes over attendance alone (see here), people taking buprenorphine or methadone may miss out on some of the benefits conferred by participating in meetings. It is unknown however, if the conflicting philosophies of Narcotics Anonymous (NA) and medication assisted treatments may result in negative effects such as stigmatization, discrimination, or encouragement to discontinue their medications against medical advice.
This analysis included 300 opioid-dependent African Americans beginning buprenorphine at one of two outpatient programs.
Both of these programs originally followed abstinence-based treatment models but adopted buprenorphine treatment as part of a city-wide initiative to expand services before this study began.
Both programs encouraged NA (or other 12-step meeting) attendance while some participants were required to attend an on-site meeting by their counselor. Abstinence from opioids and cocaine was defined as zero days of self-reported use in the past 30 days and a negative urine test for the specified drugs, while treatment retention was self-reported.
For the qualitative portion of the study, 20 patients (10 from each of the two outpatient programs from which study participants were recruited) were interviewed 3 months after beginning treatment. Interviews asked about patients’ attitudes and knowledge about buprenorphine and treatment expectations.
In the 6 months after BMT initiation, 86% of participants reported attending more than 5 NA meetings. Over three quarters reported that their counselor required them to attend meetings. Of the 209 participants who attended meetings while in BMT, only one third disclosed their BMT status to members. Among those who disclosed their status (n = 68), one quarter reported that someone at a meeting encouraged them to decrease their dose or stop taking buprenorphine all together.
The average number of meetings attended by 6-month follow-up was significantly higher among participants who remained enrolled in buprenorphine treatment (72 versus 37 meetings, respectively). Meeting attendance was also higher among participants who were abstinent from opiates/cocaine at 6 months. The rates of buprenorphine treatment retention and past 30 day abstinence at 6 months were 63% and 33%, respectively.
Main themes emerging from the qualitative portion of the study were:
This very timely study found that NA meeting attendance did not have a negative impact on buprenorphine treatment retention and was also associated with increased likelihood of abstinence at follow-up.
Despite the conflicting viewpoints on medication use between 12-step groups and buprenorphine programs—which was reiterated by participants in the qualitative study—there appears to be a benefit in attending meetings among patients also engaged with medications.
As noted above, each additional Narcotics Anonymous (NA) meeting attended per week was associated significantly with a 2% increase in the odds of treatment retention and a 1% increase in the odds of abstinence at 6 months. Negative attitudes toward buprenorphine may begin to shift as medication-assisted treatment becomes more widely accepted as an evidence-based treatment for people seeking recovery.
Counselors may play a role in helping patients in buprenorphine treatment maintain engagement in 12-step groups, but this has not been examined empirically. Understanding counselors’ attitudes toward simultaneous use of BMT and 12-step groups is thus important as well.
This study by Monico and colleagues explores this issue among African Americans with opioid use disorder in Baltimore, Maryland. As a community greatly influenced by the 12-step philosophy and with recent expansion of buprenorphine treatment for low-income residents, Baltimore serves as an ideal location to examine whether the combination of both approaches is possible and even helpful.
Referring patients in buprenorphine treatment to attend Narcotics Anonymous (NA) or other 12-step meetings DOES NOT have a detrimental impact on treatment outcomes. While requiring attendance did not improve abstinence or buprenorphine treatment retention results, patients may benefit from this free and widely available community recovery support resource.
Monico, L. B., Gryczynski, J., Mitchell, S. G., Schwartz, R. P., O’Grady, K. E., & Jaffe, J. H. (2015). Buprenorphine Treatment and 12-step Meeting Attendance: Conflicts, Compatibilities, and Patient Outcomes. J Subst Abuse Treat, 57, 89-95. doi:10.1016/j.jsat.2015.05.005
l
12-Step programs, such as Narcotics Anonymous (NA), which follow a philosophy of complete abstinence, do not prevent attendance by people on medications, though they may limit participation in meetings by these members. For example, some Narcotics Anonymous (NA) groups may encourage members on medications to not speak during meetings and participate solely through listening (see here).
Since active participation in meetings can improve outcomes over attendance alone (see here), people taking buprenorphine or methadone may miss out on some of the benefits conferred by participating in meetings. It is unknown however, if the conflicting philosophies of Narcotics Anonymous (NA) and medication assisted treatments may result in negative effects such as stigmatization, discrimination, or encouragement to discontinue their medications against medical advice.
This analysis included 300 opioid-dependent African Americans beginning buprenorphine at one of two outpatient programs.
Both of these programs originally followed abstinence-based treatment models but adopted buprenorphine treatment as part of a city-wide initiative to expand services before this study began.
Both programs encouraged NA (or other 12-step meeting) attendance while some participants were required to attend an on-site meeting by their counselor. Abstinence from opioids and cocaine was defined as zero days of self-reported use in the past 30 days and a negative urine test for the specified drugs, while treatment retention was self-reported.
For the qualitative portion of the study, 20 patients (10 from each of the two outpatient programs from which study participants were recruited) were interviewed 3 months after beginning treatment. Interviews asked about patients’ attitudes and knowledge about buprenorphine and treatment expectations.
In the 6 months after BMT initiation, 86% of participants reported attending more than 5 NA meetings. Over three quarters reported that their counselor required them to attend meetings. Of the 209 participants who attended meetings while in BMT, only one third disclosed their BMT status to members. Among those who disclosed their status (n = 68), one quarter reported that someone at a meeting encouraged them to decrease their dose or stop taking buprenorphine all together.
The average number of meetings attended by 6-month follow-up was significantly higher among participants who remained enrolled in buprenorphine treatment (72 versus 37 meetings, respectively). Meeting attendance was also higher among participants who were abstinent from opiates/cocaine at 6 months. The rates of buprenorphine treatment retention and past 30 day abstinence at 6 months were 63% and 33%, respectively.
Main themes emerging from the qualitative portion of the study were:
This very timely study found that NA meeting attendance did not have a negative impact on buprenorphine treatment retention and was also associated with increased likelihood of abstinence at follow-up.
Despite the conflicting viewpoints on medication use between 12-step groups and buprenorphine programs—which was reiterated by participants in the qualitative study—there appears to be a benefit in attending meetings among patients also engaged with medications.
As noted above, each additional Narcotics Anonymous (NA) meeting attended per week was associated significantly with a 2% increase in the odds of treatment retention and a 1% increase in the odds of abstinence at 6 months. Negative attitudes toward buprenorphine may begin to shift as medication-assisted treatment becomes more widely accepted as an evidence-based treatment for people seeking recovery.
Counselors may play a role in helping patients in buprenorphine treatment maintain engagement in 12-step groups, but this has not been examined empirically. Understanding counselors’ attitudes toward simultaneous use of BMT and 12-step groups is thus important as well.
This study by Monico and colleagues explores this issue among African Americans with opioid use disorder in Baltimore, Maryland. As a community greatly influenced by the 12-step philosophy and with recent expansion of buprenorphine treatment for low-income residents, Baltimore serves as an ideal location to examine whether the combination of both approaches is possible and even helpful.
Referring patients in buprenorphine treatment to attend Narcotics Anonymous (NA) or other 12-step meetings DOES NOT have a detrimental impact on treatment outcomes. While requiring attendance did not improve abstinence or buprenorphine treatment retention results, patients may benefit from this free and widely available community recovery support resource.
Monico, L. B., Gryczynski, J., Mitchell, S. G., Schwartz, R. P., O’Grady, K. E., & Jaffe, J. H. (2015). Buprenorphine Treatment and 12-step Meeting Attendance: Conflicts, Compatibilities, and Patient Outcomes. J Subst Abuse Treat, 57, 89-95. doi:10.1016/j.jsat.2015.05.005
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