There are several approaches to addiction treatment and with good reason. Addiction is a complicated disease that comes with a wide variety of causes and consequences. Plus, people are different and respond to different types of treatment. Two prevailing treatment approaches today are medication-assisted treatment and 12-step abstinence. To some, these approaches are at odds. One emphasizes complete abstinence from drugs. The other may use a type of drug a person is addicted to treat substance use disorders. However, the best approach to treatment may be more nuanced than choosing one type of treatment over another. Learn more about these different approaches and how they compare.
As one of the first methods of treating addiction, 12-step programs are a time tested approach to drug and alcohol addiction. Alcoholics Anonymous was founded in 1935 and became the first of many different 12-step programs that would spread all over the world. The program was founded by Bill Willson and Dr. Bob Smith, two men that had struggled with alcoholism for years. The core philosophy was born out of two major influences.
A friend of a friend of Wilson named Rowland Hazard was also struggling with alcoholism and sought help from seminal psychologist Carl Jung. After treatment and relapse, Hazard asked Jung if there was any hope for him. He responded with, “No, there is none — except that some people with your problem have recovered if they have had a transforming experience of the spirit.” Spiritual change and revitalization became a core tenant of AA.
The other major influence was that Wilson attended a Christian fellowship of men seeking moral betterment called the Oxford Group. This group formed some of the core philosophies that would later be adopted by 12-step programs, including the need for a person to surrender their life over to God or a “higher power” in order to facilitate change. It also emphasized community connections as a way to address individual problems. After the number of people seeking help with alcoholism grew, Wilson and Smith broke off and formed AA.
AA came up with the original 12 steps, which include principles like admitting that addiction is out of control, surrendering to a higher power, taking a moral inventory, admitting wrongdoings, seeking to make amends for past mistakes, and continuing to help others of the same.
These same 12 steps have been used to apply a wide variety of issues, including narcotic drugs, and other forms of addiction. 12-step programs typically require its members to abstain from using the drugs and alcohol they’re seeking freedom from. For that reason, there has been some debate within 12-step programs as to whether people going through medication-assisted treatment qualify.
The evidence for 12-step programming effectiveness is mixed with some studies finding positive effects while others find negative ones. A 2009 review found two positive studies, one negative one, and one that was neutral. However, the common consensus among addiction treatment professionals is that 12-step programs are helpful when used alongside other forms of addiction treatment. 12-step programs are often recommended after treatment has ended, and they are even incorporated into some treatment programs. However, there is no one treatment plan that works for everyone, and that includes 12-step programs.
The best treatment programs that incorporate 12-step programs should also include other therapy options like cognitive behavioral therapy, individual therapy, and dozens of other options. 12-step programs are expressly focused on spiritual healing. That means it can be an excellent supplementary treatment option alongside other treatment approaches that address medical, social, financial, and legal issues.
MAT, or medication-assisted treatment, is an approach to addiction treatment that’s newer than other treatment options like 12-step. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), MAT combines behavioral therapies and medication to address a substance use disorder. Most addiction treatment uses some type of medication during the detox phase, from mild pain relievers to medications to control nausea and other discomforts.
However, MAT medications typically refer to substances that are specifically approved to treat addiction. Currently, there are only medications approved to treat opioid, alcohol and depressants, and smoking addictions. For opioids, medications can include methadone, buprenorphine, and naltrexone, which act on opioid receptors.
MAT often involves using medications to curb cravings and withdrawal symptoms or to make using drugs or alcohol less desirable. When it comes to opioid MAT, methadone and buprenorphine are opioids that are used to satiate cravings without causing significant intoxication. The goal of MAT, in these cases, is to allow a person to come out of a life of active addiction and free them to pursue treatment, employment, and other important facets of life. MAT has been controversial because of its association with maintenance programs.
Maintenance refers to the use of opioid addiction medication indefinitely with no clear plan to eventually wean off of it. For instance, methadone maintenance may require a person to return to a clinic daily with no requirement to attend treatment. However, opioid medications can also be used as a way to encourage addiction treatment, where clients are given opioid medication so long as they attend addiction treatment.
Drugs like methadone and buprenorphine are also regulated closely because they can be abused. However, medications like suboxone can be used to avoid medication abuse. It’s a combination of buprenorphine and naloxone, a drug that reverses an opioid’s effects in your system. If the drug is abused or taken in a way that’s not intended, the naloxone becomes active and sends a person into opioid withdrawal.
According to SAMHSA, MAT has shown to improve patient survival, increase treatment retention, decrease illicit opioid use and criminal activity, and increase a patient’s ability to maintain employment, and improve birth outcomes among women struggling with substance use disorders while pregnant. However, MAT does mean the long-term chemical dependence on medication.
It can be used to stave off withdrawal and cravings while you go through an addiction treatment program, but that can mean taking an opioid medication for months or years. Getting off of an opioid medication can also be a difficult withdrawal process, even compared to typical detox from illicit drugs like heroin. MAT is often used when typical detox and abstinence have been attempted several times unsuccessfully. Then, it’s best paired with other treatment options like cognitive behavioral therapy.
The best approach to addiction treatment is one that’s tailored to individual needs. MAT and 12-step programs don’t need to be mutually exclusive. 12-step programs are often used as a way to continue to pursue recovery after you complete formal treatment. It’s a free, community resource that helps you to connect with other people that can fill out your support system. Both 12-step and MAT are evidence-based treatment options, which means they are backed up by scientific evidence of their effectiveness. If you or someone you know is struggling with addiction, learn more about these approaches to treatment, and find out what might be best for your needs.
Alcoholics Anonymous. (1981). The Twelve Steps of AA. Retrieved from https://www.aa.org/assets/en_US/smf-121_en.pdf
Kaskutas, L. A. (2009). Alcoholics anonymous effectiveness: faith meets science. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2746426/
National Institute on Drug Abuse. (2018, January). Cognitive-Behavioral Therapy (Alcohol, Marijuana, Cocaine, Methamphetamine, Nicotine). Retrieved from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/evidence-based-approaches-to-drug-addiction-treatment/behavioral
Substance Abuse and Mental Health Services Administration. (2019, May 7). Medication and Counseling Treatment. Retrieved from https://www.samhsa.gov/medication-assisted-treatment/treatment#medications-used-in-mat
Substance Abuse and Mental Health Services Administration. (2019, September 9). Medication-Assisted Treatment (MAT). Retrieved from https://www.samhsa.gov/medication-assisted-treatment
The New York Times. (1993, December 3). Jung's Insights Formed Basis of A. A. Retrieved from https://www.nytimes.com/1993/12/03/opinion/l-jung-s-insights-formed-basis-of-a-a-101693.html