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Unread 01-09-2012, 12:41 PM   #1
missionwahm
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Default I'm in an interesting debate on FB about Suboxone & NA....

So, I'm in an interesting debate on FB with a recovery community. Someone asked the opinions of the community on suboxone use. I shared my story and how it helped me. I was then surprised to see responses telling me that I was never sober or you aren't clean until you stop all drugs.... etc. They also went on to say that NA doesn't support the use of DRT. Curious how you guys would respond to topics like this. I don't par take in NA meetings because I always felt like I was being judged. Now that I"m off the suboxone, I'm not sure if I should consider it again or not.
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Unread 01-09-2012, 01:13 PM   #2
TIM
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Hi missionwahm,

Prejudice against evidence-based treatments stem from a fundamental misunderstanding of the problem. Some mistake the problem as “drugs” instead of “addiction” when they do this they are unable to reconcile using drugs to treat drugs, become confused and label the treatment as controversial. The reason scientist, doctors, pretty much the entire medical community, and most patients here disagree with that position is we all recognize the problem as addiction not drugs. Millions of people take all kinds of drugs for all kinds of ailments and live better and longer lives as a result. Addiction is a behavioral disorder caused by fundamental changes to the brain which manifest as an influence on behaviors such as inability to control drug use, drug use despite harm, compulsive drug use in the presents of cravings. People stable in buprenorphine treatment experience none of these symptoms and therefore no longer meet the diagnosis of addiction, instead they are in sustained addiction remission.

Words like sober, clean, dirty add to the confusion because they were coined before evidence based treatments and are not compatible with modern treatment. Whether or not someone is clean, dirty or sober is irrelevant due to the inconsistent definitions of the terms. As a medical condition, active or remission are more accurate descriptors.

Being drug-free is not necessary to be addiction-free. At one time they meant the same thing but with the advent of medication-assisted treatment one can be addiction-free while taking a medication, such as buprenorphine. Being free from the compulsive drug taking and seeking, free from cravings, free from uncontrollable drug use is what matters, not whether or not a medication is required to achieve this. What matters is stopping the addiction. If that can be accomplished without medication, that of course is preferable, but if medication is needed so be it.

People who are anti-evidence-based treatments are doing harm to those around them by discouraging lifesaving treatment to someone who may need it. Clearly nobody is suggesting anyone should be on medication if they are able to just stop all medications and be fine. Medication is only for those who would relapse without it.

This paper goes into deep detail about the psychology of the anti-evidence-based crowd. The causes, beliefs, and misunderstandings run deep. http://atforum.com/addiction-resourc...dTreatment.pdf

Tim
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Unread 01-09-2012, 02:31 PM   #3
missionwahm
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Thank you for clarifying it for me! I agree with you 100 percent. It's sad because I felt like I was being attacked for using suboxone to treat my addiction. It really discourages me from attending the meetings now and that sucks!
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Unread 01-09-2012, 03:13 PM   #4
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Yea well said tim, i would be very weary about anything intelligent and positive coming from a facebook disscusion.

If a opiate addict can quit using just 12 steps then great! If a opiate addict can quit using suboxone and consueling then great!
Either way the person quit! Everyone is different.

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Unread 01-09-2012, 03:16 PM   #5
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I agree it is sad. I’ve read many accounts from people who said they left the meeting in tears because they felt so judged and rejected. Lack of understanding is the cause; maybe you could educate your group? Even though your group didn’t understand the treatment, you still might be able to get some benefit from in person support. Support from people who understand some of what you are going through, is helpful, but it can be obtained in other ways such as online forums like this one. It all depends what works best for you. Congratulations of reaching the medication-free stage of addiction remission!!
Tim
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Unread 01-09-2012, 03:24 PM   #6
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Quote:
Originally Posted by alanw View Post

...If a opiate addict can quit using just 12 steps then great! If a opiate addict can quit using suboxone and consueling then great!...


Alan w
...and if someone can quit with just 12 step, they shouldn't be on Suboxone in the first place because they don't need it. I think sometimes the anti-science proponents think people have the choice to just stop and be fine or use medication, but the reality is the only people who are taking medication should be those who were unable to just stop on their own so the real choice for them is medication or relapse.
Tim
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Unread 01-13-2012, 09:48 PM   #7
soveryblessed
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Thanks Tim for another great post about the science of addiction. I have been trying to explain my choice of medication assisted treatment to my husband and other family members for over a year and a half now. I copied your "defending your choice of treatment" post and gave it to my family. It was so helpful in starting the dialogue. My husband was of the "exchanging one addiction for another" belief but at least he is starting to see that I am NOT addicted to buprenorphine. I take my prescribed dose in the morning and it honestly doesn't even come to mind during the day. I do not organize my activities around it, lie to get it, bankrupt us to pay for it, steal it from family members or friends, break the law obtaining and using it, obsess endlessly about how to get it, worry I won't have enough to get through the day, or walk around in a stupor because of it. I don't hate my life because of it. You may not remember this but you are the one who pushed me hard to get mental health treatment last summer. I did and thanks to that my behavior has changed allowing the pathways in my brain to change. Without buprenorphine I am sure the withdrawal symptoms would have pushed me to relapse. I'm even starting to taper now. How far down I will be able to go and how soon is uncertain but I am starting to be able to see a drug-free life down the road for me. Assuming I haven't done irreparable damage to my brain and it can go back to producing the necessary chemicals in the right balance that I feel ok. I don't mean to sound casual about it - I know that I can't take it or leave it. I am dependent on subutex and if I stopped taking it suddenly I would be in real danger of relapse or else I'd be really sick. But I am so grateful that it is available and "it found me" because without it I don't know where I'd be. My husband has come to the realization that he is an alcoholic and has started going to AA. His sponsor is on suboxone in fact and has also defended his choice to my husband. Really that he is coming around is making life so much better.
Please keep the information coming. If you can suggest any studies that compare the success (no relapse) rates of mat and abstinence/12 steps long term that would be very helpful. Thanks again for all that you do for us! :]
kristi
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Unread 04-10-2012, 11:08 PM   #8
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I felt the same disenfranchised feeling in NA, but I actually went there because my DOC was suboxone and I personally felt that I was not really clean and sober being on suboxone. But that's only my experience - sub was like a drug for me complete with personality change and cravings. I know it's not like that for everyone and if it's a stepping stone, then go for it! But, I have to say that I talked to a relative who's an alcoholic (over 30 years) about cravings and he said "what is a craving?" "I don't have alcohol cravings." I told him that was because he never tried stopping drinking.

It's too bad that NA can't be more welcoming. People are weird and ignorance is everywhere, not just in 12 step programs. I mean, my NA sponsor told me she had 5 years clean but just gave up xanax and fentinyl (sp?) a year ago?? I heard people talk about needing their anti-anxiety meds (not sure what they meant, but clearly it is medication) in NA. Most people who have good recovery and a good head on their shoulders will tell you that it is up to you to decide the terms of your recovery - for some it is suboxone, for some it is not. Just like HPs. Find your own and leave mine alone! So, find those people in the program and stick to them - they do exist. And stay away from the judgmental, black and white thinkers. Life is gray, after all.
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Unread 07-30-2012, 09:59 AM   #9
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What Tim says is true. Personally, however, I had a revelation recently. I forgot who or where, but someone said, subutex is a heroin substitute. That was the first time I had heard these two words used in the same sentence. Before that I would always say or hear, "opiate substitute" and that suited me fine. But the day I heard "heroin substitute" it had a chilling effect on me, I felt shamed by it. Why? Because the statement is of course true. Now this doesn't necessarily tie directly into what Tim said, but as patients we do self-stigmatize about our treatment. But I digree.

I think that where Tim may be incorrect, at least where it applies to me, is that bupe is a drug, and we are addicted to it. If you want to use the word "dependent" that's fine, but it's all the same in the end. Personally I live in deep, deep shame because of subutex, and it's impacted my life. I've become a recluse, I hardly see anyone, and I feel like people are glaring me in the street, judging me. I wish I were sober. My psyche is kind of ****ed up as a result of this. Loss of confidence..
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Unread 07-30-2012, 01:34 PM   #10
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rogan,
Itís unlikely that your reclusiveness is a function of the buprenorphine although may have been uncovered by it. But that is expected and desired as it gives you the opportunity to remedy the issue without simultaneously suffering the cravings and withdrawal associated with addiction. This is the purpose of buprenorphine and how itís different than heroin and incorrectly characterized as simply a lateral move from one drug to another. By stopping the addiction (uncontrollable compulsive behavior) while maintaining physical dependence (the point of tolerance in which absence of the drug results in withdrawal symptoms) buprenorphine allows the patient to identify and fix mood disorders along with changing behavior currently associated with active addiction. This is very different than ongoing addiction, where issues like this remain suppressed and the life-destroying addictive behavior continues.

It sounds like a great deal of your concerns come from the stigma associated with addiction and addiction treatment. The shame you accept is not necessary and not justified given the facts of the situation. Addiction is biological at its source which manifests as a behavioral disorder. Although there may be some justifiable shame associated with the development of addiction depending on your circumstances, treatment is nothing to be ashamed of. Actually, not pursuing treatment would be more shameful, now that effective evidence-based treatments exist. There is nothing morally superior about suffering through a never ending detox/relapse cycle thatís repeated until death. However the alternative, buprenorphine along with behavioral changes, can not only stop the addiction but over time, and with effort, reverse some of the biological damage of addiction. Thatís nothing to be ashamed of, itís something to be proud of.

The difference between successful treatment and unsuccessful treatment lies in what the person does while in treatment. Buprenorphine only sets the stage for recovery by suppressing symptoms of cravings and withdrawal. The real recovery is in making the right behavioral; and environmental changes in your life. This link shows the phases of treatment to help people navigate the whole process. http://www.addictionsurvivors.org/vb...ad.php?t=23809

One last thing, addiction is the uncontrollable compulsion to take drugs. Patients stable on buprenorphine donít take bupe compulsively in fact many for the first time in years are able to take the medication as prescribed. So they are not addicted to the bupe. This link explains the significant difference between addiction and physical dependence further: http://www.naabt.org/faq_answers.cfm?ID=1

Tim
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Important disclaimer: Any information in this post is not and does not constitute medical advice under any circumstances. Addiction Survivors, Inc. does not warranty or guarantee the accurateness, completeness, adequacy or currency of the information contained in or linked to the Site. Your use of information on the Site or materials linked to the Site is entirely at your own risk. Voluntary Disclosure: Timothy L. is the President of The National Alliance of Advocates for Buprenorphine treatment. (NAABT.org) The views and opinions of Timothy L., or any poster, are not necessarily the views of AddictionSurvivors.org. NEVER take any online advice over that of a qualified healthcare provider Any information you read here should only serve to inspire you to investigate further with credible, verifiable referenced sources or your doctor.
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Unread 07-30-2012, 04:37 PM   #11
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NA has no opinion on suboxone period! However, sad as it is, many members and even groups are not responding to their own tradition of "AA/NA has no opinion on outsides issues hence the AA/NA name ought never be called into controversy.

Yes the uninformed or misinformed have made it so that (in my opinion) I feel it best to leave my medical history and psychairtric history as well out of telling my story. I'd find a decent sober member who knows the traditions as well as the steps and maybe tell him/her (I'd prefer to tell of my use to a sponsor but I'm near 25 years sober and not at all affected by the misinformed judging my sobriety so I tell anyone who "needs" to know) An example may be a still suffering person who asks about the suboxone program (who better then you to help?)

I'd suggest not throwing the baby out with the bathwater and take the good part (fellowship and spirituality) and leave any judgements to yourself (even then be careful). So stay the course and "bring" what you can rather then always think of what you get out of it. (not trying to be dramatic but among fellow sufferer's is where you can be of use perhaps your story can mean life for another by them choosing suboxone over worse alternatives)?

In a nutshell-Sub treatment is none of AA/NA's concern-it is individual members who judge and, unless there is good reason as I showed above, keep your manner of sobriety to non-specific's.

Good luck and remember you have a voice of reason in NA


Glen

Last edited by theswan; 07-30-2012 at 04:37 PM.. Reason: syntax
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Unread 07-31-2012, 03:52 PM   #12
missionwahm
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I'm so sorry for being MIA for so long from this thread. I've read so much useful information from all of you and I"d like to thank you from the bottom of my heart. I do have some rather good news to share since my first post. I actually ended up being in the position to have to stop suboxone within a 2 month period tapering myself (due to financial issue and my doc wouldn't give me a script or help me do it without the money) starting at the 8 mg I was taking daily. I must say this was one of the most challenging a uncomfortable things I've ever done. That being said, it's been since October 2011 and I'm still FREE OF SUBOXONE. It took a long time to finally start feeling better. These days (knock on wood) I haven't craved yet and continue to take baby steps toward a new and more improved ME. Once again thanks to everyone for the kind tips and advice. Also, I am happy to share my tapering tips or ways I was able to find some relief during that hell!!
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Unread 07-31-2012, 09:03 PM   #13
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Welcome back of course we'd like to hear of your taper. Sharing the taper makes it easier for the next person.

My taper was like 50X slower then you'rs but I had near zero WD's so slow seems the best if one is able.

God bless

Glen
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Unread 08-03-2012, 09:50 PM   #14
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I'm sorry to disagree with the swan, but NA does indeed have an opinion on suboxone and methadone. I know because it has caused me problems in online NA support groups. In bulletin 29 NAWS (Narcotics Anonymous World Services) addressed the issue of using opiate based medications as a treatment for addiction and said that it is considered to be drug replacement therapy and that the person is considered to still be using. As such the person should be welcomed with open arms into a meeting, but just as anyone else who has used in the last 24 hours it is suggested that they listen and not share and that they do not pick up chips for clean time. People on maintenance medications are not to hold service positions etc. In short, NA believes that we are not abstinent and therefore cannot practice the NA program. I don't post this to be argumentative and it is by no means my opinion or the opinion of many members of NA. It is however the opinion of Narcotics Anonymous World Services and many NA purists. If you mention your treatment with suboxone in many face to face NA meetings you will be told that you are still using and welcome to listen, but don't share and that's if they're nice. Hence the need for groups like steps without stigma. I post this only to keep someone from being attacked like I was, because if I hadn't already had a wonderful support network I'm not sure how I would have handled it.

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Unread 08-03-2012, 10:09 PM   #15
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I'm sorry to post again, but I left out the fact that working the 12 steps of NA combined with using suboxone appropriately has saved my life. There are wonderful f2f NA fellowships out there who only want to see people in recovery, regardless of how they're recovering. With most things in life you have to take the good with the bad. The spiritual principles I've learned in the rooms of NA are the basis for my recovery and for my life. I have taken from NA what helped me and I have left the rest. I won't allow anyone to invalidate my recovery, because the life I have now is a complete validation of that recovery. I don't just talk the talk, I walk the walk. Not NAWS or anyone else can take that from me, unless I'm willing to give it to them. I've found that the attacks I've endured from NA purists say far more about their program than mine, and I pray for them daily that their minds may be opened and that they may be relieved of the self righteousness that leads them to attack my recovery. I also pray that I may continue to have the ability to take what helps me and leave the rest behind.
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Unread 10-09-2012, 05:34 AM   #16
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I have heard/read so many stories of people who are "not allowed" to speak at meetings if on opioid replacement/suboxone therapy. I am so pleased that my little home group is so open minded. There's no judgement if somebody uses suboxone or methadone. Some do, some dont. Some use other mind altering chemicals (such as anti-depressants). It seems with my group that the end result is what matters. Are we still lying, cheating, stealing and generally dishing out bad karma or are we in the solution to our problem? I know where I would rather be.
Of course, we are all bonified members of NA because we all have a desire to address our addiction problems.

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Unread 10-09-2012, 03:52 PM   #17
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OK I was judging by my AA expirence and we have traditions that mandate how we handle outside issues. We have had issues with people on "antabuse" not being allowed to speak for a group and other issues as well and general services brought people back to our "primary purpose" which is to carry the message of AA.

To broaden even that "liberty" we have, we do not throw out wet drunks unless very disruptive because they need us and we need them-poor examples also serve as "carrying the message"

I am very sad to read what you wrote (Cleanserene) But since I no longer go to NA I will accept what you say as true.

My bottom line happens to be this "keep you buprenorphine story to yourself unless you are sure another may benefit from knowing" We can have a perverse pride in being on sub and thus "stick our tougue out" at Authority or worse, try and make everyone agree with you. Why muddy the waters?

Sad that one can not be truthful and be a member when there are users who hide their use and are held in high esteem because they talk a good talk.

Too bad AA cannot break it's tradition "ONLY requirement for membership is a desire to stop drinking" I guess one can skirt this issue by having a beer or two and then stopping but that would be dishonest

God bless y'all

Glen
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Unread 10-13-2012, 05:45 PM   #18
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So basically the people in charge of NAWS are ignorant, close minded idiots that don't know or care to know the difference between medication and drugs. Sounds like they don't even know what addiction is......and who cares if an anonymous person doesn't think I'm "clean"?? These people need to worry about their own recovery... wow...I can barely write this, I'm so wasted on my 1mg of sub. HAHA
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Unread 11-29-2012, 08:22 PM   #19
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what NA and AA dont know wont hurt them. thats how i feel about those meetings. i have had more acceptance from AA than NA. everyone in NA seemed very hypocritical to me. alot of them also looked high as shi$$ during the meetings too so having one of them tell me that im not sober is complete BS and i told them exactly how i felt before i walked out the door.
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Unread 12-27-2012, 10:31 PM   #20
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Quote:
Originally Posted by missionwahm View Post
...went on to say that NA doesn't support the use of DRT.
NA itself has no opinion. Sub use is considered an "outside" issue, so the program stays out of the controversy ~ but the fellowship (aka the people) have their own opinions, varying from one extreme to the other. The world services put out a statement a few years ago stating this (that NA as a whole has no opinion).
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Unread 01-15-2013, 01:28 PM   #21
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......"because the life I have now is a complete validation of that recovery"...I couldn't agree with you more! Well said and I wouldn't trade anything for the life I have now. Thank you!
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Unread 01-16-2013, 11:03 AM   #22
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Since I have successfully gotten off of Suboxone, I went back to NA (which was a week ago.) I have a sponsor who I am able to be honest with and advises me on approaching this subject with those in twelve step recovery who have such negative opinions on medication assisted recovery. It was those opinions that chased me away from NA five years ago and kept me here. The last meeting I attended, I very openly told my story, and some balked. I do not care today, I know in my heart where I belong-in recovery.

Whether those naysayers become too much for my mental health again remains to be seen, I have to protect my recovery at all costs because I worked very hard for it and I refuse to let anyone else take it away from me. I do not believe in concealing your treatment entirely, but it is honestly YOUR treatment, YOUR recovery.

My best hope for the future in twelve step meetings is that with my honesty, others in this circumstance will not fear rejection from the place they should feel safest. There is a dire need for Steps Without Stigma in every state in the U.S. and that can only happen if we heal ourselves and help another recovering person in the process. That is what recovery is all about.
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Unread 02-05-2013, 09:55 PM   #23
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Don't fret about na and subs. My last NA mtg had about 25 people , 150 tattoos and an IQ lower than 100. Stick with the winners, sounds like you're doing that . Congrats.
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Unread 07-10-2013, 04:54 PM   #24
Temporalanalogsofparadise
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Quote:
Originally Posted by missionwahm View Post
So, I'm in an interesting debate on FB with a recovery community. Someone asked the opinions of the community on suboxone use. I shared my story and how it helped me. I was then surprised to see responses telling me that I was never sober or you aren't clean until you stop all drugs.... etc. They also went on to say that NA doesn't support the use of DRT. Curious how you guys would respond to topics like this. I don't par take in NA meetings because I always felt like I was being judged. Now that I"m off the suboxone, I'm not sure if I should consider it again or not.
Hi Mission - Buprenorphine is a semi-synthetic partial agonist opiate made from a natural analog of opium called thebaine which is the same thing oxycodone is made from. It is molecularly very small with a long half life and has a high binding affinity to the classical opiate receptors, particularly the mu. There is no mistaking the fact that it is a very powerful opiate that is just as addictive as full agonist opiates/opioids, some would argue more so. So it is clear that if a person has quit using which ever opiate/opioid they were dependent on and switched over to Buprenorphine that they are in no way "clean" or drug-free. Anyone who argues this fact has been misled or is uninformed.

Now having said that, does this mean that Buprenorphine is not an useful tool on the road to recovery? Of course not! Drugs like Methadone and Buprenorphine can allow a person dependent on opiates/opioids to become stable in their personal lives while they prepare for long-term treatment. I believe that it can be useful for people with moderate to severe dependency. Unless a person has made up their mind to live their life with the condition of opiate/opioid dependency that these drugs have no value long-term IMO. I believe eventually all things opiate become unmanageable. It seems to me that there are a lot of doctors prescribing these drugs to anyone who says they are an opiate addict. IMO these drugs should be reserved for more severe cases while a plan is being developed for long-term abstinence.

As far as aa/na is concerned the problem I have with the organization is that every particular drug is unique and each requires a separate treatment modality under a medical environment only. I view dependency as a medical condition period. Psychological issues in an aftercare setting are something intirely different. I do not mean to disrespect anyone who attends NA at all. If it works for you great! Go nuts. Whatever it takes to remain clean.

I'm a former 20+ yr hardcore addict. I have used both Buprenorphine and Methadone (200mgs for yrs). They allowed me to get my personal life in order prior to entering treatment. I was finally able to kick after 12 days of noribogaine. It wasn't a magic bullet, but it was a hundred times easier than cold turkey. It never ceases to amaze me at how prejudice and ill-informed people are on the subject. The admin at the facility told me that out of 900 patients that I was twice as bad as the worst addict they had treated. I had to fly with two arms lined up with 100 mcg. Fentanyl patches just to maintain. For anyone reading this please know that you can do it too!!! It takes time for your bodies endogenous neurotransmitters time to return to normal function as well as GDNF-related healing, but eventually it will happen! NEVER GIVE UP! God bless you all.

Disclaimer: I am not a medical doctor. These are my opinions based on years of research and personal experence as well as first hand accounts of other people's experiences. Talk to your doctor to discuss a treatment plan that is right for you.
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Unread 07-11-2013, 11:51 AM   #25
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...There is no mistaking the fact that it is a very powerful opiate that is just as addictive as full agonist opiates/opioids, some would argue more so...
If this were true, the overwhelmingly majority of people who take buprenorphine would be unable to control their use of it, craving it uncontrollably, taking it compulsively, and taking it despite doing harm to oneís self or others (all hallmarks of addiction). But instead we see the opposite, even when most have already shown a history and predisposition to addiction. We often hear people say that for the first time in years they are suddenly able to take their medication as prescribed and not run out of a month long prescription in days like with other opioids which you say are as addictive or even less addictive. I think you are conflating physical dependence with addiction. See this page for the difference: http://www.naabt.org/addiction_physical-dependence.cfm

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Unread 07-11-2013, 12:02 PM   #26
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...Buprenorphine is a semi-synthetic partial agonist opiate made from a natural analog of opium called thebaine which is the same thing oxycodone is made from.....
Naloxone is also made from thebaine and has the opposite properties of oxycodone. It has no addiction liability, causes no opioid effect and even blocks and reverses the effects of full agonist opioids. So your implication that because buprenorphine is derived from the same compound as oxycodone shows that it must also share the same addiction liability is false.
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Unread 07-11-2013, 12:10 PM   #27
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...So it is clear that if a person has quit using which ever opiate/opioid they were dependent on and switched over to Buprenorphine that they are in no way "clean" or drug-free. Anyone who argues this fact has been misled or is uninformed....
Now here’s something I can agree with. If you are taking a medication and a medication is a drug then you are not “drug-free”. But being drug free is not the point of addiction treatment; no more than being insulin free is the goal of diabetes treatment. The goal of addiction treatment is to be “addiction-free”. Being free from addiction means you no longer have uncontrollable cravings, use despite doing harm, use compulsively, or are unable to control your drug use; none of which are experienced by the stable buprenorphine patient meaning they are addiction-free.

“clean” has no medical meaning and was coined before the advent of modern evidence-based addiction treatment. Now it just adds to confusion because it’s based off the false premise that the goal of addiction treatment is to be drug-free. Nobody should waste a minute of their life worrying if they qualify as “clean” in the eyes of anyone, it’s irrelevant today..or maybe I'm uninformed.

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Unread 07-12-2013, 10:42 AM   #28
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I've been coming here for years. This same argument has been going on without end. Since Sub based treatment and NA are so diametrically opposed, why doesn't each leave the other alone?
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Unread 07-12-2013, 02:24 PM   #29
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I've been coming here for years. This same argument has been going on without end. Since Sub based treatment and NA are so diametrically opposed, why doesn't each leave the other alone?
Hereís whyÖ
Doctors, counselors, and peers still tell people to go to NA without first checking one out locally. Sometimes people are attacked and brought to tears because they revealed that they are in medication-assisted treatment. In extreme cases the peer pressure is so great people discontinue treatment prematurely, to reach the status of ďcleanĒ only to relapse and die weeks later. Leaving these groups alone to put more people at risk is not going to solve the problem. If they havenít figured it out by now they wonít, and will continue to zealously pursue pushing their ďcleanĒ anti-medication agenda, which is also not supported by the evidence as 90% of those who choose ďcleanĒ instead of evidence-based treatment relapse some fatally.

Itís only through education and arming people with an alternative viewpoint based in fact which gives them the confidence to think for themselves that will help them make the right decisions about their life. Yes it gets monotonous but as long as this problem exists, we need to warn people.

If caregivers and supporters would stop sending people to predominately abstinence-only NA groups it wouldnít be a problem. But as long as the support suggested is contrary to the evidence-based treatment, this problem exists.

I need to add that not all NA groups are so anti-science. It all depends on the people in the group which could change meeting to meeting. Some are pro modern addiction treatment and are supportive. Some patients have found AA groups to be more understanding, but again it varies, and no caregiver should recommend NA or any support groups unless they themselves have attended and know for a fact that the kind of support provided is beneficial to the patient.

I can relate to your frustration about this argument, its been going on for years with no end in sight. I wish it werenít the case.

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Unread 07-12-2013, 03:42 PM   #30
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Thanks Tim. You are so right. I never cared for NA, to me it consisted mostly of immature, self righteous know it all's. I even watched some go there high. It has been many, many years since I been to NA. When I do decide to go to a meeting, I go to AA. There is so much more maturity in AA and more experience. And they accept people who are "addicts" at least all different meeting I have attended. Julie
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Unread 07-12-2013, 05:59 PM   #31
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From my experiences alcohol has been a trigger for some of my friends relapse into drugs like heroin etc.
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Unread 07-12-2013, 08:19 PM   #32
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I haven't been to a twelve step meeting in almost two decades. I'm not a big book thumper. I get irritated with the people from NA that want to change med based treatment just as I get tired of those from med based treatment that want to change NA. The energies involved could be re-directed towards each other's respective treatment method.
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Unread 07-17-2013, 08:56 AM   #33
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If this were true, the overwhelmingly majority of people who take buprenorphine would be unable to control their use of it, craving it uncontrollably, taking it compulsively, and taking it despite doing harm to oneís self or others (all hallmarks of addiction). But instead we see the opposite, even when most have already shown a history and predisposition to addiction. We often hear people say that for the first time in years they are suddenly able to take their medication as prescribed and not run out of a month long prescription in days like with other opioids which you say are as addictive or even less addictive. I think you are conflating physical dependence with addiction. See this page for the difference: http://www.naabt.org/addiction_physical-dependence.cfm

Tim
Hi Tim - I thank you for your reply and I agree with some of what you said. I believe it's important to distinguish the difference between having a compulsive behavior pattern whether it be to food, exercise, sex, drugs, ect. which are all related to primarily dopamine reward and a physical dependency to chemicals. Sure, the antagonist effect of bup does place somewhat of a ceiling on tolerance because of its lack of reward due to the antagonist effect, but to say that just because of this action it is not physically addictive from a physiological aspect is just simply false. Having said that I assure you that I do understand the difference between physical dependence and addiction which I agree are often confused. I also agree that both Methadone and Buprenorphine can enable people to become "stabilized" in their personal life and I believe that this should be viewed as its main purpose in most situations. For people who want to live a life free of all opiates which does include buprenorphine, long-term abstinence is the only solution. Tim I'm certainly not saying you advocate a lifetime spent on Bup and I think we would both agree that would be far better than using any classical agonist. I just encourage people who would like to stop using to make long-term abstinence the goal regardless the form of treatment you choose. God bless.
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Unread 07-17-2013, 09:14 AM   #34
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I've been coming here for years. This same argument has been going on without end. Since Sub based treatment and NA are so diametrically opposed, why doesn't each leave the other alone?
Hi Dan - I hope that I didn't leave the impression with anyone that I oppose Buprenorphine treatment or judge anyone regardless of their form of treatment because I definitely do not. It was instrumental in my own personal recovery. I'm just trying to point out to people who are maybe new to seeking treatment that just because their is lack of a pleasurable reward involved does not mean it is not physically addictive. I basically believe that as long as ANY form of treatment allows someone to meet their own personal goals that is a wonderful thing.
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Unread 07-17-2013, 09:37 AM   #35
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Naloxone is also made from thebaine and has the opposite properties of oxycodone. It has no addiction liability, causes no opioid effect and even blocks and reverses the effects of full agonist opioids. So your implication that because buprenorphine is derived from the same compound as oxycodone shows that it must also share the same addiction liability is false.
Tim
Tim surely you are not saying that because Naloxone is also synthesized from Thebaine that Buprenorphine isn't physically addictive? Whether or not the liability is as high as Oxycodone is debatable, but I personally believe its just as high or higher. It Isn't nessesary to read scientific journals to realize this fact. Anyone who has tried to stop cold turkey is very well aware of this. I think it's extremely important before starting any treatment that people are well aware of risk/reward.
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Unread 07-17-2013, 10:10 AM   #36
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Now hereís something I can agree with. If you are taking a medication and a medication is a drug then you are not ďdrug-freeĒ. But being drug free is not the point of addiction treatment; no more than being insulin free is the goal of diabetes treatment. The goal of addiction treatment is to be ďaddiction-freeĒ. Being free from addiction means you no longer have uncontrollable cravings, use despite doing harm, use compulsively, or are unable to control your drug use; none of which are experienced by the stable buprenorphine patient meaning they are addiction-free.

ďcleanĒ has no medical meaning and was coined before the advent of modern evidence-based addiction treatment. Now it just adds to confusion because itís based off the false premise that the goal of addiction treatment is to be drug-free. Nobody should waste a minute of their life worrying if they qualify as ďcleanĒ in the eyes of anyone, itís irrelevant today..or maybe I'm uninformed.

Tim
The point that I'm trying to get across is that I believe physical dependency to opiates is a medically reversible illness, not a disease such as diabetes which carries an intirely different treatment protocol. To equate the two is pointless. Fundamentally speaking, I also believe that MOST people who receive treatment regardless of type would like to live a life free of ALL drugs and that in essence should be the goal we all promote. Tim you do provide some very good information and I'm not sure that either of us are really in disagreement. We are all very passionate when it comes to this subject because of the hell involved and I commend you for all of the great information you provide in helping people. Lets both get back to the reason I believe we are both here which is support ok. Peace brother
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Unread 07-17-2013, 02:49 PM   #37
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To start a little background:

I am 60 and got sober in AA in 1987. I belonged to as tough as group as one can find. They were also the most loving, caring group of people I ever met. We had a lot of "Big book thumpers" and I was one for a time. This is a natural phase for some who feel they have been saved by AA and not altogether a bad thing. One will usually grow out of it. As far as NA, well I went to many meetings because I worked with youth at risk who had addictions and took them to the NA meetings. I'd indentify as "I'm Glen and I'm powerles" in respect to their no alcohol posture.
The meetings were decent but I just liked AA better. I went up and down the ladder of service being at the top a coffee maker then GSR, DCM and then Area special needs chairperson. I read and re read the traditions and did not even see a clause that excluded anyone unless they had no desire to stop drinking. I have been active for many years and now have slowed down a lot. I went to a meeting two months ago and will go now and again mostly to see friends and hopefully help a new comer.

My life was turned upside down by chronic pain from a birth disability and an auto accident, surgery and football injuries. I have been on most every narcotic and feel a great debt to suboxone. I take it now for pain but have "proved" it is not a horror drug one can never get off of. I decided to get to a "set point" with my pain and see if I could control it without bupe or any opioid. So I tapered, had little WD to speak of and stayed off for a year before returning to bupe for pain.

So what do I think about NA and their policy? Well it kinda sucks but they have a right to be as they want to be. I feel however as a fellowship that they break the tradition of the only requirement. A group as they traditions suggest can bend and even break traditions except for I believe, affilation. However, the entire fellowship not allowing a person to share because of a drug, well it smacks me as wrong but they have the right to be wrong except as said in affiliation.

I have also said what is wrong with keeping this to ones self? Do we really need to spout out our medical history? My hunch is sharing a subject we know will be met with controversy, is purposely stirring the pot! I mean to what end do we share? Do we really say, "by the way, I take suboxone" to be of use? or are we just trying to bend others to our way of seeing things?

Here is my deepest feeling on a person using sub as a tool or even as a "crutch".......So freaking what???!! Who really cares? I came in to recovery living in a 12X8 foot room sharing a bathroom with several others, with a broken nose, with a black eye and with my hopes of ever having a normal life near zero! I was either drinking or planning a drink or getting the drugs to allow me to function after a bender. The thought of drinking was almost always in my head. I was just starting to hear voices, had not had a girlfriend for 7 years and had severe anxiety that was even happening as I drank (then what does one do?) I can in AA and recovery a shell of a person and what about now?


Today I have a beautiful life, a wife that loves me deeply, I have my family and I ahve decent health. I no longer get beat up nor do I beat people up. I own a lot of "stuff" and this is good but most of all, I have my dignity, my God and have discovered (as gravy on top of it all) That I have a decent voice and I sue it as a cantor and in the choir of my beloved Church.

Oh, yeah and my pain is well controlled by bupe. So what? I kinda think I have earned through my horror story and recovery story to have a say in a twelve step group. If they do not, well who's loss is it?

Keep it between you and your doctor unless you feel you'd pick up a drug/drink then tell your sponsor or better yet find a sponsor who is sober and will not judge

Glen
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Unread 07-17-2013, 02:54 PM   #38
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The point that I'm trying to get across is that I believe physical dependency to opiates is a medically reversible illness, not a diseaseÖ
Gonorrhea is a medically reversible illness, so by your definition itís not a disease?? I donít like to use the term disease either because itís not understood the same way by everyone, but it is medically correct. Hereís why the disease classification is accurate for addiction (not for physical dependence which is neither an illness nor a disease)- Addiction is classified as a disease because it negatively alters the biology of the brain from an otherwise healthy state. It's considered a chronic disease because the changes are long-lasting.

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Tim surely you are not saying that because Naloxone is also synthesized from Thebaine that Buprenorphine isn't physically addictive?
Of course thatís not what Iím saying. I was showing you that YOU canít make the conclusion that just because it comes from a compound which drugs with high addiction liabilities are derived from that it too must be as or more addictive, because that is what you were saying.

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Whether or not the liability is as high as Oxycodone is debatable, but I personally believe its just as high or higherÖ.Anyone who has tried to stop cold turkey is very well aware of this.
You say you know the difference between addiction and physical dependence but you continue to conflate the terms. Acute withdrawal upon stopping has nothing to do with addiction, thatís physical dependence. Remarkably few people become addicted to buprenorphine, meaning they lose control of their drug use, use buprenorphine compulsively, and crave it. We hardly ever see it, which is especially amazing since nearly everyone taking it has shown a history of addiction to opioids in the past. Itís absolutely amazing that they can suddenly control the use of this opioid. That is more accurately characterized as the opposite of addictive. People with decades of addiction to every opioid imaginable can within weeks gain control of their buprenorphine use, how could you possibly say that it as or even more addictive? If it were people would not be able to control the use of it.


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ÖFundamentally speaking, I also believe that MOST people who receive treatment regardless of type would like to live a life free of ALL drugs and that in essence should be the goal we all promoteÖ
Isnít it obvious that if someone no longer needs a medication that they shouldnít keep taking it? Clearly nobody wants to take any medication for any condition and would prefer to be perfectly healthy. I think that is so obvious it doesnít need mentioning so that canít be what you are saying. But you are insisting that people push abstinence. You must be saying that someone who needs the medication to prevent relapse should stop anyways and be abstinent? Thatís a very dangerous position which has led to many deaths. What matters is stopping the addictive behavior because that and that alone is whatís destructive about opioid addiction. Whether or not a medication is needed to achieve this is unimportant. I doubt you hold the position that people should become abstinent even if a relapse is imminent. So you must think that there are people taking buprenorphine who donít need it, and would do fine without it but just donít know any better. For almost a decade weíve been telling people the correct dose is the lowest dose that suppresses cravings and withdrawal. Anyone who follows this advice will not take buprenorphine any longer than needed nor will they discontinue treatment prematurely.

Some people will find they will always need some buprenorphine to stop cravings and withdrawal and have any quality of life and making these people feel like theyíve fallen shy of the goal you set (abstinence) ignores the accomplishments they have made in getting their lives back and putting their addiction in remission.

Stopping the addiction is what matters, not whether someone needs medication to achieve that. I wish you would stop making people feel guilty for not being one of those people who can be abstinent, not everyone can, and itís not that important. The focus needs to be on the problem, which is the addictive disorder, not the treatment medication.


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I think it's extremely important before starting any treatment that people are well aware of risk/reward.
The risk of not getting treatment is death. Most people who remain addicted to opioids die from it, or complications of it. While most people in buprenorphine treatment not only survive, but lead improving lives. So you think itís prudent to talk someone out of lifesaving treatment because of some unsubstantiated myth that it might be as addictive as the stuff about to kill them? The stigma surrounding addiction causes many bad decisions, thatís why itís important to look at addiction through an evidence-based lens so it can be considered objectively as a medical condition without the street lore, rumor and myth that commonly surrounds it. We agree that people should know as much as possible before starting (or stopping) treatment, but we disagree on what the risk is, I say its active addiction, you appear to believe itís the lifesaving treatment.

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I just encourage people who would like to stop using to make long-term abstinence the goal regardless the form of treatment you choose.
So according to you, the people who will always need a medication to maintain addiction remission can never reach the goal. These are the kinds of attitudes we hope to change with education and help people realize that even if they always need a medication they have still succeeded because what matters most is stopping the addiction and enjoying a quality of life. Just as some people with diabetes will be able to control their disease with diet and exercise, some people with addiction will be able to taper off. Those who will need insulin (even though they would prefer not to need it) they have control of their diabetes and thatís what matters, just as those who need buprenorphine for life, or for an very long time, (even though they would prefer not to need it ) have gained control over their addiction and thatís what matters.

Iíve seen too many stories of people leaving NA meeting in tears because they werenít ďcleanĒ only to stop and relapse soon after. Abstinence is not a viable option for everyone, and your position is unfair to those people. I wish you would reconsider your position.
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Unread 07-17-2013, 03:38 PM   #39
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Gonorrhea is a medically reversible illness, so by your definition itís not a disease?? I donít like to use the term disease either because itís not understood the same way by everyone, but it is medically correct. Hereís why the disease classification is accurate for addiction (not for physical dependence which is neither an illness nor a disease)- Addiction is classified as a disease because it negatively alters the biology of the brain from an otherwise healthy state. It's considered a chronic disease because the changes are long-lasting.


Of course thatís not what Iím saying. I was showing you that YOU canít make the conclusion that just because it comes from a compound which drugs with high addiction liabilities are derived from that it too must be as or more addictive, because that is what you were saying.



You say you know the difference between addiction and physical dependence but you continue to conflate the terms. Acute withdrawal upon stopping has nothing to do with addiction, thatís physical dependence. Remarkably few people become addicted to buprenorphine, meaning they lose control of their drug use, use buprenorphine compulsively, and crave it. We hardly ever see it, which is especially amazing since nearly everyone taking it has shown a history of addiction to opioids in the past. Itís absolutely amazing that they can suddenly control the use of this opioid. That is more accurately characterized as the opposite of addictive. People with decades of addiction to every opioid imaginable can within weeks gain control of their buprenorphine use, how could you possibly say that it as or even more addictive? If it were people would not be able to control the use of it.



Isnít it obvious that if someone no longer needs a medication that they shouldnít keep taking it? Clearly nobody wants to take any medication for any condition and would prefer to be perfectly healthy. I think that is so obvious it doesnít need mentioning so that canít be what you are saying. But you are insisting that people push abstinence. You must be saying that someone who needs the medication to prevent relapse should stop anyways and be abstinent? Thatís a very dangerous position which has led to many deaths. What matters is stopping the addictive behavior because that and that alone is whatís destructive about opioid addiction. Whether or not a medication is needed to achieve this is unimportant. I doubt you hold the position that people should become abstinent even if a relapse is imminent. So you must think that there are people taking buprenorphine who donít need it, and would do fine without it but just donít know any better. For almost a decade weíve been telling people the correct dose is the lowest dose that suppresses cravings and withdrawal. Anyone who follows this advice will not take buprenorphine any longer than needed nor will they discontinue treatment prematurely.

Some people will find they will always need some buprenorphine to stop cravings and withdrawal and have any quality of life and making these people feel like theyíve fallen shy of the goal you set (abstinence) ignores the accomplishments they have made in getting their lives back and putting their addiction in remission.

Stopping the addiction is what matters, not whether someone needs medication to achieve that. I wish you would stop making people feel guilty for not being one of those people who can be abstinent, not everyone can, and itís not that important. The focus needs to be on the problem, which is the addictive disorder, not the treatment medication.




The risk of not getting treatment is death. Most people who remain addicted to opioids die from it, or complications of it. While most people in buprenorphine treatment not only survive, but lead improving lives. So you think itís prudent to talk someone out of lifesaving treatment because of some unsubstantiated myth that it might be as addictive as the stuff about to kill them? The stigma surrounding addiction causes many bad decisions, thatís why itís important to look at addiction through an evidence-based lens so it can be considered objectively as a medical condition without the street lore, rumor and myth that commonly surrounds it. We agree that people should know as much as possible before starting (or stopping) treatment, but we disagree on what the risk is, I say its active addiction, you appear to believe itís the lifesaving treatment.



So according to you, the people who will always need a medication to maintain addiction remission can never reach the goal. These are the kinds of attitudes we hope to change with education and help people realize that even if they always need a medication they have still succeeded because what matters most is stopping the addiction and enjoying a quality of life. Just as some people with diabetes will be able to control their disease with diet and exercise, some people with addiction will be able to taper off. Those who will need insulin (even though they would prefer not to need it) they have control of their diabetes and thatís what matters, just as those who need buprenorphine for life, or for an very long time, (even though they would prefer not to need it ) have gained control over their addiction and thatís what matters.

Iíve seen too many stories of people leaving NA meeting in tears because they werenít ďcleanĒ only to stop and relapse soon after. Abstinence is not a viable option for everyone, and your position is unfair to those people. I wish you would reconsider your position.
Look Tim this is getting ridiculous bro. I greatly appreciate all the great information you provide here and I highly respect your opinion. I think we both can agree that debating the nuances of these issues is a complete waste of time. There are too many sick desperate people who at this very moment are being dragged through the bowels of hell and are in need of our loving support. I wish you nothing but the best Tim. May God and peace be upon you. Mike
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Unread 07-17-2013, 03:51 PM   #40
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To start a little background:

I am 60 and got sober in AA in 1987. I belonged to as tough as group as one can find. They were also the most loving, caring group of people I ever met. We had a lot of "Big book thumpers" and I was one for a time. This is a natural phase for some who feel they have been saved by AA and not altogether a bad thing. One will usually grow out of it. As far as NA, well I went to many meetings because I worked with youth at risk who had addictions and took them to the NA meetings. I'd indentify as "I'm Glen and I'm powerles" in respect to their no alcohol posture.
The meetings were decent but I just liked AA better. I went up and down the ladder of service being at the top a coffee maker then GSR, DCM and then Area special needs chairperson. I read and re read the traditions and did not even see a clause that excluded anyone unless they had no desire to stop drinking. I have been active for many years and now have slowed down a lot. I went to a meeting two months ago and will go now and again mostly to see friends and hopefully help a new comer.

My life was turned upside down by chronic pain from a birth disability and an auto accident, surgery and football injuries. I have been on most every narcotic and feel a great debt to suboxone. I take it now for pain but have "proved" it is not a horror drug one can never get off of. I decided to get to a "set point" with my pain and see if I could control it without bupe or any opioid. So I tapered, had little WD to speak of and stayed off for a year before returning to bupe for pain.

So what do I think about NA and their policy? Well it kinda sucks but they have a right to be as they want to be. I feel however as a fellowship that they break the tradition of the only requirement. A group as they traditions suggest can bend and even break traditions except for I believe, affilation. However, the entire fellowship not allowing a person to share because of a drug, well it smacks me as wrong but they have the right to be wrong except as said in affiliation.

I have also said what is wrong with keeping this to ones self? Do we really need to spout out our medical history? My hunch is sharing a subject we know will be met with controversy, is purposely stirring the pot! I mean to what end do we share? Do we really say, "by the way, I take suboxone" to be of use? or are we just trying to bend others to our way of seeing things?

Here is my deepest feeling on a person using sub as a tool or even as a "crutch".......So freaking what???!! Who really cares? I came in to recovery living in a 12X8 foot room sharing a bathroom with several others, with a broken nose, with a black eye and with my hopes of ever having a normal life near zero! I was either drinking or planning a drink or getting the drugs to allow me to function after a bender. The thought of drinking was almost always in my head. I was just starting to hear voices, had not had a girlfriend for 7 years and had severe anxiety that was even happening as I drank (then what does one do?) I can in AA and recovery a shell of a person and what about now?


Today I have a beautiful life, a wife that loves me deeply, I have my family and I ahve decent health. I no longer get beat up nor do I beat people up. I own a lot of "stuff" and this is good but most of all, I have my dignity, my God and have discovered (as gravy on top of it all) That I have a decent voice and I sue it as a cantor and in the choir of my beloved Church.

Oh, yeah and my pain is well controlled by bupe. So what? I kinda think I have earned through my horror story and recovery story to have a say in a twelve step group. If they do not, well who's loss is it?

Keep it between you and your doctor unless you feel you'd pick up a drug/drink then tell your sponsor or better yet find a sponsor who is sober and will not judge

Glen
Hi Glen - I couldn't agree more and I think its so wonderful that you have found peace and happiness. I've never attended AA/NA, but I agree that's its very wrong to tell someone that they are diseased for life and incurable. There are many paths to healing and people should never judge what may work for others.
Mike
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Unread 07-17-2013, 06:15 PM   #41
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Look Tim this is getting ridiculous bro. I greatly appreciate all the great information you provide here and I highly respect your opinion. I think we both can agree that debating the nuances of these issues is a complete waste of time. There are too many sick desperate people who at this very moment are being dragged through the bowels of hell and are in need of our loving support. I wish you nothing but the best Tim. May God and peace be upon you. Mike
Iím sorry but you basically called me a liar and IMO spread misinformation, obligating me to set the record straight. There are people reading this who are about to make life changing decisions about their treatment and I felt some of what you posted was inaccurate and could lead people to delay or forego evidence-based addiction treatment. Iíd prefer not to have to post this as we have an entire site dedicated to addiction education.

These are not nuances we are talking about the fundamental basic understanding of the disease state. If you are not interested in what I have to say, thatís fine, but I have an obligation to correct misstatements of fact for others who may be reading. I will not allow this site to be used to perpetuate the stigma and misinformation weíve been working to correct.

Without understanding the disease we cannot possibly create an effective treatment plan. All the loving support in the world isnít helpful if the person is on the wrong path. We started NAABT to help people cut through the myth and stigma so they could make good decisions about their future.

Thereís an entire industry ready to take advantage of people seeking treatment for opioid addiction (ultra-rapid detox for example) and they bank on the fact that most people donít have a good understanding of addiction or what constitutes good treatment.

Itís a complicated subject compounded by stigma, street lore, and misinformation. By cutting through all that and providing the facts about addiction and evidence-based treatments hopefully the people that come here can not only get support, but be armed with the facts to make good decisions particularly when faced with misinformation or abstinent-only proponents.

Tim
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Unread 07-18-2013, 05:18 AM   #42
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Tim I do agree with most of what you say I just happen to have a different opinion on a couple of things. We could debate these issues all day long with a roomful of Phds and half would disagree with us both on a variety of issues. I respect your opinion please respect mine. It's very selfish for us to hijack a thread that isn't about our personal beliefs so lets move along shall we? Thanks and all the best to you bro.
~Mike
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