3rd August 2017

Adding medication-assisted treatment to 12-step programs

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), when medications are used in addition to behavioral therapy to treat people with substance use disorders (SUDs), patients tend to demonstrate a dramatic improvement. SAMHSA highlights that medication-assisted treatments (MATs) are especially effective for individuals with severe SUDs, such as opioid use disorders (OUDs).

Traditional 12-step programs, on the other hand, focus more on the guidance and support that participants need to receive throughout the distinct levels of recovery. According to the American Society of Addiction Medicine (ASAM), 12-step programs remain “a tried-and-true proven approach” to treating addiction.

The new research — conducted by Dr. Marc Galanter, a professor of psychiatry at New York University School of Medicine and chair of ASAM’s Action Group on 12-step recovery who has authored over 200 peer-reviewed articles on addiction — aimed to find out how the two aforementioned approaches to treating addiction can be used together to enhance the overall results of those in recovery.

In addition to adding his own experienced opinions to the research, Galanter reviewed a number of previous studies and works regarding available treatment options in residential addiction treatment facilities and ambulatory settings. He analyzed problematic scenarios with long-term rehab treatment; pharmacologic limitations; and the potential associated with MATs and 12-step programs separately and simultaneously.

The research, published in the American Journal of Drug and Alcohol Abuse, described 12-step programs and modern medical practices as opposing and conflicting cultures. Alcoholics Anonymous (AA) was founded in the 1930s before effective medical support for alcoholism existed, Galanter explained, so its approaches can often be perceived to operate separately from established modalities of medicine.

But multiple studies have shown links between participation in 12-step programs and better outcomes in clinical addiction treatment, he stated, before highlighting a particular study that found that people who voluntarily used AA saved about 45 percent more than those who sought professional outpatient addiction treatment — but the outcomes were similar for both groups.

According to the study, another element of medical care that can be greatly improved in addiction treatment is the stigma seen among physicians. Galanter stated that they need to “overcome the stigma of their own treatment of OUDs” and that the U.S. should be looking at countries like France where increased MAT use has promoted a decrease in opioid overdoses of more than 50 percent.

Galanter concluded that health care providers who practice MAT and 12-step treatment specialists need to start communicating better and that criteria for the development of evidence-based approaches for combined treatment should be created.

Galanter’s positions follow statements made by a group of ASAM physicians, who have said they are concerned that the benefits of 12-step programs are not taught to professionals entering the addiction treatment field. Yet, ASAM’s medical director supports the conclusions of the new research and has stated that the combination of MATs with 12-step programs “has shown to be invaluable in appropriate cases.” 

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