Buprenorphine Treatment and 12-step Meeting Attendance: Conflicts, Compatibilities, and Patient Outcomes

Abstract

This analysis examines patient experiences and outcomes with 12-step recovery group attendance during buprenorphine maintenance treatment (BMT), two approaches with traditionally divergent philosophies regarding opioid medications for treatment of opioid use disorder. Using quantitative (n=300) and qualitative (n=20) data collected during a randomized trial of counseling services in buprenorphine treatment, this mixed-methods analysis of African Americans in BMT finds the number of NA meetings attended in the prior 6 months was associated with a higher rate of retention in BMT (p<.001) and heroin/cocaine abstinence at 6 month follow-up (p=.005). However, patients whose counselors required them to attend 12-step meetings did not have better outcomes than patients not required to attend such meetings. Qualitative narratives highlighted patients’ strategies for managing dissonant viewpoints on BMT and disclosing BMT status in community 12-step meetings. Twelve-step meeting attendance is associated with better outcomes for BMT patients over the first 6 months of treatment. However, there is no benefit to requiring meeting attendance as a condition of treatment, and clinicians should be aware of potential philosophical conflicts between 12-step and BMT approaches.

Challenges on the road to recovery: Exploring attitudes and experiences of clients in a community-based buprenorphine program in Baltimore City

“…Clients internalized this pressure and stigma, and often stopped medication in an attempt to recover without it, which can subsequently increase risk of relapse or overdose. This barrier has been observed in other studies, and often serves as a persistent deterrent to long-term OAT maintenance (Monico et al, 2015; Cooper & Nielsen, 2017). In an effort to combat this, it has been suggested that there is a need for recovery groups that recognize individuals on medication as being in recovery and destigmatize medication use to treat OUD (Krawczyk et al, 2018).…”

Personal and Socioeconomic Determinants in Medication-assisted Treatment of Opioid Use Disorder in Adolescents and Young Adults

“…64 Youth who attend treatment groups or live in residential facilities are frequently discouraged from using MAT to treat OUD. 65 For adolescents participating in such programs, lack of support may cause them to either forgo MAT, potentially placing them at greater risk for relapse, or to leave programs early, also placing them at risk for relapse. Youth seeking a sober support network often express feeling unwelcome at 12 step programs or not being "sponsored" until they are "sober" (meaning no MAT or other medications).…”

“…Youth seeking a sober support network often express feeling unwelcome at 12 step programs or not being "sponsored" until they are "sober" (meaning no MAT or other medications). 65,66 Without peer support, the risk of relapse or mortality significantly increases. 65…”

Combining medically assisted treatment and Twelve-Step programming: a perspective and review

“…This deficit in research on TSF as a potentially useful aftercare resource is underlined by an acknowledged deficit in combined medication and follow-up services for persons discharged from privately operated opioid-related hospitalizations; only 11% of such facilities reported providing this needed complement to their treatment programs (59). The potential utility of such research for opioid dependence was illustrated in one study, which revealed that NA meeting attendance prior to initiation of buprenorphine treatment was found to be associated with a higher rate of retention in treatment (60). Clearly, there is a need for well-controlled research to ascertain whether this modality would improve outcomes on patients studied after buprenorphine maintenance is terminated, given high drop-out rates reported in buprenorphine studies on adults (61) and adolescents as well (62).…”