Is Suboxone At Odds With Traditional Recovery? Part three.
Posted: Thursday, February 07, 2008
by Jeffrey Junig
Fond du Lac Psychiatry
Part Three: The combination of Suboxone with traditional recovery.
The appropriate relationship between suboxone treatment and traditional recovery becomes clear once one understands the relationship between opiate obsession and character defects. Should people taking suboxone attend NA or AA? Yes, if they want to. A 12-step program has much to offer an addict, or anyone for that matter. But I see little use in forced or coerced attendance at meetings. The recovery message requires a level of acceptance that comes about during desperate times, and people on suboxone do not feel desperate. In fact, people on suboxone often report that 'they feel normal for the first time in their lives'. A person in this state of mind is not going to do the difficult personal inventories of AA unless otherwise motivated by his/her own internal desire to change.
Other Questions (and answers):
-Should suboxone patients be in a recovery group? I have similar reservations about forced attendance, but there is something to be gained from the sense of support that a good group can provide.
-What is the value of the 4th through 6th steps of a 12-step program, where the addict specifically addresses his/her character defects and asks for their removal by a higher power? Are these steps critical to the resolution of character defects? These steps are necessary for addicts in 'sober recovery', as the obsession to use will come and go to varying degrees over time depending on the individual and his/her stress level. But for a person taking suboxone I see the steps as valuable, but not essential.
-Where does methadone fit in? Methadone activates opiate receptors like any other opiate agonist. A newly-raised dosage will prevent cravings temporarily, but as tolerance inevitably rises, cravings will return. With cravings comes the obsession to use and the associated character defects. This explains the profound difference in the subjective experiences of addicts maintained on suboxone versus methadone, and explains why in my practice I have many patients who have switched to suboxone, but none in the other direction.
The downside of suboxone.
Practitioners in traditional AODA treatment programs will see suboxone as at best a mixed blessing. Desperation is often required to open the addict's mind to change, and desperation is harder to achieve when an addict has the option to leave treatment and find a practitioner who will prescribe suboxone. Suboxone is sometimes used 'on the street' by addicts who want to take time off from addiction without committing to long term sobriety. Suboxone itself can be abused for short periods of time, until tolerance develops to the drug. Snorting suboxone reportedly results in a faster time of onset, without allowing the absorption of the naloxone that prevents intravenous use. Finally, the remission model of suboxone use implies long term use of the drug. Chronic use of any opiate, including suboxone, has the potential for negative effects on testosterone levels and sexual function, and the use of suboxone is complicated when surgery is necessary. Short- or moderate-term use of suboxone raises a host of additional questions, including how to convert from drug-induced remission, without desperation, to sober recovery, which often requires desperation.
The beginning of the future.
Time will tell whether or not suboxone will work with traditional recovery, or whether there will continue to be two distinct options that are in some ways at odds with each other. The treatment of opiate addiction has certainly proven profitable, which will cause increased investment in addiction research. At one time we had two or three treatment options for hypertension, including a drug called reserpine that would never be used for similar indications today. Some day we will likely look back on suboxone as the beginning of new age of addiction treatment. But for now, the treatment community would be best served by recognizing each other's strengths, rather than pointing out their weaknesses.
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Jeffrey T Junig MD PhD has worked as a neuroscientist and as an anesthesiologist, and is a psychiatrist in solo, independent practice. Additional information about suboxone including the blog Suboxone Talk Zone can be found at http://subox.info. Dr. Junig is available for patient care, consultations, or educational presentations through http://fdlpsychiatry.com.
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Top-level comments on this article: (3 total)I just celebrated 1 year of sobriety on 1/4/09 from alcohol & opiate addiction. I entered a detox facility 12/31/07 and was discharged 1/4/08 and have been drug and alcohol free since. Suboxone was never discussed. As I begin to share my story and try to help others with similar issues suboxone has been a topic frequently. Although I felt like I was going to die from opiate withdrawl, I didn't. Suboxone sounds to me like it prolongs the inevitable and that opiate addicts are simply changing seats on the Titanic.My own recovery has been sobriety-based as well. But while a fraction of the opiate addicts out there find step based recovery or afford residential treatment, many others are dying. The only way Suboxone could 'sound' as you describe is if you didn't believe, didn't understand, or didn't read the article that you commented on-- because the patients who have found a new life using buprenorphine to induce remission do not feel as you 'hear' at all. From their grateful comments, I know that they feel that they are off the Titanic. And while you are in a lifeboat, they feel that they are returned to shore.
I would also caution you about feeling too smug after only one year of sobriety; my relapse waited seven years before destroying my career as an anesthesiologist. I wrote comments similar to yours at the five year mark, years ago. I was about as sure-headed and wrong then as you are now.
JJ
Suboxone Talk ZoneMy intention was not to offend you. I am simply trying to understand what I am dealing with when suboxone is brought up. Every addict I have talked with recently is "running" in the direction of this medication. It seems to be providing and "easier softer way", when in fact it simply takes away their desperation, as you stated in your article which I did read, and they end up not wanting to go to any length to begin leading a better fuller life. It's unfortunate to be called smug, I am quite aware that we all have only this moment and that although many are much farther away from their last use, they may very well be much closer to the next. I am simply trying to educate myself and maintain an open mind. I do disagree that I am in a lifeboat, I am living on shore today-and most importantly I do not do it alone.previous comment is from MomboHello and thank you all. I was just shy of 7 years of total absience and pickked up pain killers I did not need.. My back had alway bothered me but Thats not why I picked up... Anyway, I found out about Suboxone in an AA meeting by an ex junkie.. I have been on about 2 to 4 mg of suboxone for almost a year.. I tried to get off, through a detox and at six days, My back was in agony... Long story short, it has been a real Identy crisis for me.. Yes I am treated diferrent in AA..Men who I used to listen wine now preach to me.. This entir ordeal has caused me to isolate. NOT RECCOMMENDED. I am close to loosing it all due to no work, depressed and struggling to except me the way I am now... It sucks.. I do not think I can get off it.. I have kicke dope on jails house floors, on the back of a greyhound bus but nothing like this(trying to get off of it) I think I am at the point where I must except Suboxone will be my way... I used to judge men/women like me... AA, recovery was my life... I must say, I feel little support.. I have had to hod my ground, and know where most have been as far as tottaly clean sort of speak.. I now realize the ego of the addict.. I know you too. I have read the books and lived and worked the steps so, I knowme & YOU..lol Get my point.. I do NOT play Dr in the rooms.. Many addicts die doing 12 step programs and total absience.. Many live who do Subxone & meetings. So, you play God & Dr if you want, I suggest you do not do it to someone you love, lie your kid brother.. Life has a way of working like that if you know what I mean.. Like hating a certain race, then your son or daughter marry's them... Live & learn... I am sure the old AA's are like 'what the hell is going on"... But then again, many take meds they do not openly talk about.. My buddy chain smokes while he Tries to lecture me.. I then suggest he take his all that spiritual program and try to get a grip on that cancer stick thats kicking his ass.. Anyway. I am finding my way on this journey. I may loose every material thing I have gained the last 10 years of great recovery doing so but, so be it.. Its been a real conflict for me.. I DO NOT PROMOTE SUB or AA, NA... Thanks for listening, it has helped me.. I just have trouble getting up & out as of late. Once I do, I am ok. I also am having trouble excepting I am dependent.. A real mental Yo Yo I have been.. I feel ike a flake.. One day I want to try a non avaliable re-hab, the next I am excepting this is me.. It is messed up.. Add assholes in a meeting.. i am sure some can identifiy.. Thanks...Dino.. F-spell check lol
I was addicted to pain killers on and off for 10 years. After treatment failed many times, I turned to my doctor for help. I was on suboxone for only 3 months. I gradually reduced my dose and just forgot to take it one day. I am free of cravings and desperation! I am reading this book called Recovering the addicted brain! With the help of medicine and talk therapy, it has been proven that this method is 80 percent more effective then treatment alone!go out and pick up this book! It will answer all of your questions and it will blow your mind!!!
That was a wonderful article! I have lived the NA way, spent years on Suboxone, and now combine the two. I welcome and celebrate any and all paths to a happy healthy life. Now how bout we do something with those draconian drug laws, so so many others don't have to die on the street. As the good doctor said, "theres money to be made here!"
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