Bridging the Divide: How Medicine & Twelve-Step Can Work Together to Support Recovery

Both medication and Twelve-Step approaches are known to help people achieve recovery from addiction, yet many in the medical and Twelve-Step communities think of their approach as parallel to the other. We assess how these two potentially complementary approaches to addiction treatment might be employed together to improve clinical outcomes through cultivating greater understanding between medical and Twelve-Step communities.

WHAT PROBLEM DOES THIS STUDY ADDRESS?

1. Medication-based, and Twelve-Step-oriented treatments both have much to offer in their capacity to support recovery from substance use disorder.

2. In spite of the founders of Alcoholics Anonymous (AA), and AA’s literature encouraging collaboration with the medical community, there remains attitudinal barriers to the integration of medication into the culture of Twelve-Step-based recovery, particularly in Narcotics Anonymous (NA). Conversely, many in the medical community are hesitant to refer patients to Twelve-Step programs. This is in part explained by differences in philosophy and approach; contemporary medical practice seeks solutions emerging from empirical research, while Twelve-Step programs, which emerged in a time when medical science had yet to develop effective means to support recovery from addiction, are largely based on a spiritual solution. Physicians may, therefore, be hesitant to embrace Twelve-Step’s ‘non-scientific’ approach to recovery, while Twelve-Step practitioners may not be well versed in the potential benefits of pharmacotherapy for addiction, or may be hesitant to engage with the medical community as a result of unproductive previous encounters.

3. In spite of their differences, the two approaches have much to offer individuals seeking addiction recovery. The author explores some ways Twelve-Step programs can complement medical care, and what medicine can offer the Twelve-Step.

HOW WAS THIS STUDY CONDUCTED?

This review article summarizes key aspects of the scientific literature on medication and Twelve-Step addiction treatment approaches, highlighting their respective strengths and weaknesses, and how the medical and Twelve-Step communities often fail to take advantage of the benefits the other offers. The author goes on to make the case that clinical outcomes could be improved, and treatment costs reduced through better collaboration between medical and Twelve-Step communities.

WHAT DID THIS STUDY FIND?

The model of drug and alcohol dependence as a chronic disorder is now well-established in the field of medicine, but only a minority of those suffering from addiction receive formal treatment (e.g., residential care; ‘rehab’) due to limited availability of resources and prohibitive costs. Additionally, of those accessing formal treatment, only a small percentage have access to addiction medications because most treatment facilities in the USA do not have prescribers on staff. As a result, although medication can aid addiction recovery, most who would benefit from pharmacotherapy have limited access to it.

Conversely, Twelve-Step based treatment programs, as well as Twelve-Step meeting attendance are known to support addiction recovery, yet Twelve-Step facilitation is rarely offered in medically operated treatment settings. This is in spite of the fact that a body of empirical research on AA/NA’s utility has now been documented that meets evidence-based medicine’s stipulations for an acceptable treatment.

Integration of the medical and Twelve-Step approaches is contingent on the relative openness of practitioners of each respective approach to that of the other.

WHAT ARE THE IMPLICATIONS OF THE STUDY FINDINGS?

Medication and Twelve-Step approaches have been independently shown to support addiction recovery, yet many in the medical and Twelve-Step community are hesitant to embrace the what the other offers. The paper’s author highlights how this divide may be harming individuals’ chances of recovery, and makes the case that medication and Twelve-Step addiction recovery approaches might augment one another in synergistic ways.

LIMITATIONS

Though it cites findings from numerous high-quality studies, the present review does not provide an exhaustive review of the utility of addiction medications and Twelve-Step treatment/programs.

BOTTOM LINE

For individuals & families seeking recovery: Both medication and Twelve-Step approaches can be valuable components of an addiction recovery strategy. When exploring non-hospital-based residential and outpatient treatment programs, ask if there is a physician on staff and if medication is offered. When seeking treatment in hospital-based treatment programs, ask if Twelve-Step facilitation is provided and/or the program supports access to Twelve-Step meetings.
For scientists: Though medication and Twelve-Step programs are independently known to support addiction recovery, and in theory their combination would yield additive benefits, empirically-driven research is needed to support this premise.
For policy makers:Limited resources directed toward addiction treatment, limited access to health insurance, and prohibitive laws limiting physicians ability to prescribe certain addiction medicines are all significant barriers to individuals accessing medical care for addiction. Policies are needed that can increase individuals’ access to medical care.
For treatment professionals and treatment systems:Both medication and Twelve-Step approaches support addiction recovery, and can likely complement one another in synergistic ways. Many treatment providers and treatment systems, however, endorse one of these approaches, while eschewing the other. Non-hospital-based treatment programs would befit from adding physicians to their staff so as to offer patients medication options when indicated. Hospital-based treatment programs, conversely, would benefit from increasing the availability and access to Twelve-Step for patients open to, or desiring of Twelve-Step support.