Is Suboxone At Odds With Traditional Recovery? Part One.
Posted: Sunday, February 03, 2008
by Jeffrey Junig
Fond du Lac Psychiatry
By now almost every opiate addict has heard of suboxone, the amazing medication for opiate dependence that has taken the using world by storm. I will admit to mixed feelings about suboxone based on what I have seen and heard while treating well over 100 patients over the past two years. I also acknowledge that my opinions are likely influenced by my own experiences as an addict in traditional recovery. While suboxone has opened a new frontier of treatment for opiate addiction, it also threatens to split the recovering and treatment communities along opposing battle lines. Such and outcome would be a huge missed opportunity to improve the lives of opiate addicts.
Different treatment approaches.
At the present time there are significant differences between the treatment approaches of those who use suboxone versus those who use a non-medicated 12-step-based approach. People who stay sober with the help of AA, NA, or CA, as well as those who treat by this approach tend to look down on patients taking suboxone as having an 'inferior' form of recovery, or no recovery at all. This leaves suboxone patients to go to Narcotics Anonymous and hide their use of suboxone. On one hand, good boundaries include the right to keeping one's private medical information so one's self. But on the other hand, a general recovery principle is that 'secrets keep us sick', and hiding the use of suboxone is a bit at odds with the idea of 'rigorous honesty'. People new to recovery also struggle with low self esteem before they learn to overcome the shame society places on 'drug addicts'; they are not in a good position to deal with even more shame coming from other addicts themselves! An ideal program will combine the benefits of 12-step programs with the benefits of the use of suboxone. The time for such an approach is at hand, as it is likely that more and more medications will be brought forward for treatment of addiction now that suboxone has proved profitable. If we already had excellent treatments for opiate addiction there would be less need for the two treatment approaches to learn to live with each other. But the sad fact is that opiate addiction remains stubbornly difficult to treat by traditional methods. Success rates for long-term sobriety are lower for opiates than for other substances. This may be because the 'high' from opiate use is different from the effects of other substances-users of cocaine, methamphetamine, and alcohol take the substances to feel up, loose, or energetic-ready to go out and take on the town. The 'high' of opiate use feels content and 'normal'- users feel at home, as if they are getting back a part of themselves that was always missing. The experience of using rapidly becomes a part of who the person IS, rather than something the patient DOES. The term 'denial' fits nobody better than the active opiate user, particularly when seen as the mnemonic: Don't Even Notice I Am Lying.
The challenges for practitioners lie at the juncture between traditional recovery and the use of medication, in finding ways to bring the recovering community together to use all available tools in the struggle against active opiate addiction.
See Part Two: Drug obsession and character defects.
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More commentsSome of the comments above are just plain silly; Understand that when prescribing Suboxone, there sometimes is the need to 'fire' a patient who is diverting the drug-- selling it to addicts, usually. And when a person is 'cut off' for doing something illegal, the person goes through withdrawal-- and usually blames everything except his own behavior. More and more, Suboxone is being used as a long-term medication for a long-term illness; there is no need to stop taking it, at least until the person is at low risk for relapse, often a number of years. And when that time comes there are ways to taper the medication to reduce the withdrawal. The angry comments above cause me suspicion that the people either were forced to stop, because they were doing something illegal, or they dropped out of treatment for their own reasons. I could remove the comments, but I think I will leave them; after all, everyone is entitled to his or her opinion. But I do urge caution before accepting the comments of the 'angriest poster'-- the one who is often posting the most.I don't know the exact wording of the NA literature, but for AA all that is required is 'the desire to stop drinking'. JB, you don't know what you are talking about!I agree with Mark; I have been attending 12 step programs for 16 years, and the other old timers tend to be more pragmatic than some of the idiots who have 6 months of 'recovery' and think they have all the answers! Yes, Mark-- the important thing IS the saved lives-- not the 'thrill' of carrying around a chip with a 5 or 6 on it! There are certain shallow unfortunates who think recovery is something that gives them 'bragging rights'-- look at the fools who have commented above, and try to find the humility! Odds are that most of them are already using again, given the attitudes that they are carrying around. And while that would be a shame, I have less compassion for them given the harm that they do when they spread that version of 'I'm better than you'. That is really all that they are saying.As for the withdrawal comments, there are blinded studies that clearly show that buprenorphine has less withdrawal than oxycodone. After helping many people through their withdrawal from both drugs, I notice that people coming off oxycodone lie in bed and complain, and people coming off buprenorphine go to work and complain. They both say 'it is the worst ever'-- but the people coming off Suboxone are still going to work every day and functioning.Finally, there is always the comment about 'greed' when the anti-suboxone types leave their comments. After working in medicine for 20 years, I can tell you that there are easier ways to make a buck than prescribing Suboxone! That fact should be obvious-- in most parts of the country you will be hard pressed to find a doc who is accepting patients! If it was such a 'money tree', I guarantee that there would be many more physicians prescribing it!I work with Suboxone for one reason: it works. It induces remission of addiction. My own recovery is step-based, and if a person has the level of desperation that I had-- enough to go into over three months of residential treatment followed by 6 years of weekly group-- then do that. But most people DON'T go into residential treatment, and even those that do often have trouble staying clean. Suboxone offers one more option. And if you want to avoid withdrawal-- stay on Suboxone. Opiate dependence is a chronic, relapsing condition; we don't force people with hypertension off their meds! Stay on Suboxone, stay safe, and enjoy life again.Whether you choose medication OR residential treatment, choose something. Life is passing-- don't waste another year chasing the same dragon.Jeffrey T Junig MD PhDSuboxone Talk ZoneSuboxForumSo instead of getting clean and making your life worth living on your own without medication, you suggest taking another drug to surpress the withdrawals and all the "bad stuff" that comes along with getting clean. Thats goes hand and hand with the "lies" that addicts come up with to continue using the drugs so the dont have to deal with reality. If you use drugs part of the reality is you made a mistake and need to fix it. Not have a pill fix. If you do that than you have not changed anything you are still dependent and not taking responsibility of your actions.Why do people make sobriety some kind of competition? Like some people are more clean then others? Like it matters. I shot dope for twelve long years, trying repeatedly to get anything out of NA or the ridiculous twelve steps. I couldnt stand the people at NA, their holier then thou, our way is the only way, attitude was such a turnoff. Either you became a clone of them, or your an outcast. Judged by a group of people who have no place judging anyone. I have been taking suboxone for seven years now. I've never relapsed since the first time. You would say my life is not worth living because I'm on suboxone. Well, I certainly couldnt convince my mother of that, or my new wife, or my two stepsons, or my brand new baby boy. None of whom I would have in my life without suboxone. Comparing the wonderful life I have right now, the trust of those I once stole from, the love of a woman who would never have looked twice at me when I was getting high, THE JOY OF MY BABY SON!, to sitting around in a church basement listening to a bunch of people bitching about how thier lives still suck even tho they are clean. No contest to me.Are the anti- depressents 45% of the " 12 steppers" take daily mind altering? I've heard "A.A.ers" say they saved there life, and a seritonen ulift is mind altering as are the scyso drugs to keep people from hearing voices mind altering I take 2mg. Of suboxone daily never more never less I admit it in meetings " life on lifes terms " means life changes and just cause I don't do everything you say I'm wrong? Maybe.!! but your right but my life is awesome now N.A. Is a big reason why and it saved my life but without meds I honestly don't think I would have the life I have now good luck with "your program" no mine
I have been on Suboxone for 2 years now......what a wonderful, lifesaving chemical. I look at my use of Suboxone as a way to restore the chemical inbalances in my brain which I believe led to my by opiate addiction in the first place. I'll admit that there are drawbacks......some emotional apathy, ect. But the benefits far outweigh the negatives. I have tried once to wean myself off of Suboxone, without success. I have resigned myself to treatment with this lifesaving drug for the rest of my life, and I don't care what the critics say......it works for me!RogerKudos to you Roger.
George, from south jersey.
PS. How are you paying for it?
I think we all need to take a step back, stop judging those around us, and start judging ourselves. If you are a member of a 12-step group you should know that taking other peoples inventory is frowned upon. My side of the street is just that....MINE. Take care of yours so we can all get along. principles before personalities!!
I have been on suboxone for two weeks now. it works !!! and if the price of a second chance at life is a nasty orange taste every day, so be it. hey maybe taking the subs for 30 years will give a great daily reminder, NOT TO DO THAT AGAIN. with out suboxone i know i would be stuck in the same old hole
I find this debate interesting and very educational. After haviing 2.5yrs up, I busted. I am 21 days clean and on my last foray, I used subutex intraveneously. Not good, I was using my partners medication, in essence. We both suffered. I detoxed in a hospital, lucky for me, it hurt bad. But it, as all things, passed. Now in recovery, my partner now struggles with some of the fellowship on the subject of subby use. I believe, very strongly, that if you are taking a prescibed medication, in the prescibed fashion, you are not, in fact, using! If however you misuse or abuse that or other medication, for whatever "REASON", you are then "abusing" drugs in an addict like fashion. I agree though that at some point in a persons life they will have to become completely drug free. I suffer from depression as a direct result of my using and take medication for it, does this mean I will not be accepted in the fellowship? I think not! The only requirement for membership is the DESIRE to stop using!! I accept that when my Dr and I decicide it is time for me to stop taking antidepressants, I then will.I of course am completely honest with my Dr and genuinely want to live a life completely drug free. Right now though I need all the help I can get!K.Andrew. Brisbane AustraliaNicely said young man I live in Hawaii and feel the same way most ofvthemvare on zoloft or syce meds but subs are wrong I would Ike to talk more to see how your doing if you ever wanna talk let me know! Would love to go to your home group hint hint. Lol
i just wanna say that i was a intravenous herion user that shot about 4 or 5 bags a day and i go to NA and i used suboxone for 30 days and have recently quit suboxone for thee last 5 days and have had no withdrawal symptoms at all now i stay very busy and work out occasionally so this may help but i have to say suboxone saved my life it helped me mentally and physically those first couple days of withdrawal make most addicts want to use again withdrawal scares most addicts from stopping suboxone helps alleave the obsession with teh drug of opiate choose ...keep an open mind times always change and if this drug saves lives like mine than its worth it...i kno have come off suboxone with no withdrawals and as happy as ever ..... god grant you the serenity to accept the things you cannot change the courage to change the things i can adn teh wisdomt ot ell the difference....kkeep going to na it works
yes i found this article tremendously helpful. i am going to a "sub" doctor an a couple of weeks. i too am of a mind that i wouldn't mind being on something long term if it will free my mind of the 800 pound gorilla that is methadone, oxycontin or heroin. i feel better informed now. the more information i have, the better decision i will be able to make. i am in NA openly still using and have found my group to be very understanding of my situation. thank you all
I'm glad I read the article and all the comments. I support all help medically prescribed by doctors who "know" addiction and the addict's mind. The question remains: When all is said and done, what will stand between the addict and using when they decide to stop taking suboxone? Like all of us in recovery, some higher power, whatever we conceive that to be, had to stand between the addict and his substance. I hold no judgement, and never will.
I've been on and off suboxone for 3 yrs. I have relapsed everytime i've tried to come off my sub. I recently been going to N.A meetings and I loved it but i toldmy sponsor about my sub. And she told me i wasn't clean and to share about it in a meeting. It was the worst thingi couldve done. Them people that once loved me turned into judging butt holes. I wasnt picking up any chips until my sponsor broke up with me and i had to get anothr sponser and she told me she would like to see me pick up chips. So i prayed about it and didnt take the decision lightly but after a couple says i picked up my 90 day chip. The result was people harassed me and my sponsor in meeting and online. I also lost my spirit for the program because i felt isolated and singled out for telling the truth and having a different belief than everybody else. So to make people happy i tried to wean myself off my sub. The result was horrible, i relapsed because i did it without my dr.'s supervision and advice and becausw i has very little support in the fellowship. They told me just stop taking it and it was more important to them to prove me wrong than to help save my life. When u go to those meetings and treat people like they are less than u when all they want to do is get clean u r killing them. The reason people go is for support to get clean and u put your personal opinions above helping people u r running them out the doors and may be sending them to their deaths. I hope i can be strong enough to ognore
I am in the fellowship of na also on sobo and spread my mess of my process. I feel a combination of the 2 saved my life I find myself going at it all the time its mostly the people in the room with most time that judge. They need to realze that this dieseise gains power daily and if we ain't willing to adapt and overcome we will lose the battle of addiction its your process.
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