Everyone seems to agree that we have a profound opioid epidemic throughout our country. However, there remains a high level of controversy regarding how to treat opiate addiction. This is particularly the case when discussing medical assisted therapy (MAT) and 12-step facilitation.
Many people maintain that these two approaches are incompatible–with MAT viewed as “harm-reduction” and the 12-step model as “abstinence-based”.
I hold the radical view that MAT and 12-step facilitation therapy are not only compatible, but when used together provide patients with robust, evidence based treatment for a potentially fatal disease. Providing only psycho-social-spiritual support without physical/medical intervention and vice versa is universally considered inadequate treatment. Sadly, it happens all too often that a person receives one or the other and not both/and!
Anonymous SCH Patient Perspective “One of the best things about Dr Kim is the fact that she had been there herself, and she gets it. She understands better than anyone that there is no universal treatment that works for everyone. We all need and deserve to be treated with the sincerity and openness that Dr Kim brings to treatment.”
Much of the controversy between the two lies in semantics. All forms of treatment are fundamentally harm-reduction and can also be considered abstinence-based—that is, when we use a more sophisticated definition of abstinence than “using no substances,” and a more sophisticated definition of harm reduction than “still using substances.”
For example, a person abstinent from alcohol in AA is reducing harm to their physical, emotional and spiritual health by not drinking. The fact that the person is abstaining from alcohol does not necessarily mean that other self-destructive thoughts and behaviors have been extinguished. The abstinent person early in recovery usually has a long road of emotional, physical and spiritual healing ahead in order to let go of other problematic ways of thinking and behaving.
In my view, the person with an opiate addiction who no longer shoots heroin from a street dealer but takes an opioid replacement medication from his addiction psychiatrist as prescribed, and engages in mutual self help groups, is abstinent. He is reducing harm to his well-being, reducing morbidity, and is abstinent from getting drugs from a dealer with no training or investment in the individual’s well-being.
An alternative, perhaps more accurate, definition of abstinence than “I don’t ingest anything that affects me from the neck up [imagine this being said with conviction by a “sober” man drinking a coffee and smoking a cigarette outside a 12 step meeting],” is “using no illicit substances or drugs other than those prescribed by a doctor who is equipped to treat people with the disease of addiction.”
And doctor-prescribed medication only takes care of the physical aspects of this multidimensional disease called addiction. Unless the other dimensions–psychological, social and spiritual—are addressed as well, the treatment is insufficient.
Anonymous SCH Patient Perspective: “The team at SunCloud is incredibly passionate and I feel like they actually care about my recovery. They didn’t label me when I walked in the door, they take the time before during and after treatment to help me and my family and they treat us all like individuals whose paths are unique and special. I wouldn’t go anywhere else. Dr Kim deserves the reputation she has earned over the years.”