Combining Medications With 12-Step Model Treatment Improves OUD Outcomes

(Part 2 of 2)

The continued use of medications in the absence of the nonmedical use of addictive substances is consistent with full recovery. It encourages the use of medication-assisted treatment (MAT) in abstinence-based programs where it can improve program retention and long-term outcomes, according to a recent Rx Drug Abuse & Heroin Summit virtual session. Similarly, integrating recovery support and including 12-step fellowships from the first days of treatment, can improve long-term patient outcomes in MAT.

In this video, Robert Dupont, MD, Institute for Behavior and Health, Inc., Rockville, Maryland, also discusses his goal to help the 2 treatment camps work together and find mutual respect to aid patient recovery as part of a proposed “peace plan”.

In Part 1 of this video, Dr. Dupont, who is also on the Rx Summit Advisory Board, explains the successes and shortcomings of the 2 treatment categories.

Read the transcript:

The 12-step-oriented recovery programs started with residential care, but there are now many intensive outpatient variations of this model which almost always involve long-term recovery support. In other words, there often is an initial intensive period of treatment followed by long-term community recovery support. Mostly that recovery support is AA and NA, but there are endless other recovery support options.

How can these two often hostile treatment approaches come together to give patients more options and to make good use of their differences? The key steps are to bring long-term community-based recovery support into MAT programs so that everybody who is in MAT participates in recovery support from the day they enter treatment. That way, no matter if patients successfully stay in or prematurely leave MAT, they still have established connections within the 12-step and other community-based recovery support available to them. MAT needs to recognize that the treatment goal for health is not just about reducing or even just stopping the use of opioids; it's about ending any drug use, including alcohol and marijuana. That is a sea change.

On the other side, the 12-step-oriented model of addiction treatment needs to add medication as a fully respected, long-term option for patients with opioid use disorder. That is a huge step for them to take. Not all OUD patients will choose MAT, but having it available to them is in the patients' interests.

The Hazelden Betty Ford Foundation is pioneering this new hybrid approach. When people go into the HBF program, if they have problems with opioids, they are actively encouraged to use medications as part of this 12-step recovery-oriented system of care.

My goal is to help our two treatment camps to stop fighting with each other and to work together in mutual respect. Reach out your hand to the other folks and bring them in with you – into what you're doing. We are dealing with one disease involving many different drugs. Millions of addicted people need help. There is no one right way. There are many different paths to sustained recovery that need to work together to achieve the goals that none alone can achieve.

The most important development during my 50+ years working in addition to treatment is the emergence of a huge recovery population. Recovery has been defined as “a voluntarily maintained lifestyle characterized by sobriety, personal health, and citizenship.” Twenty-three million Americans are now in recovery from alcohol, opioids, and other drugs. Those people are our teachers. They have the wisdom of successful experience. Some used medicines to get into recovery and some did not. Some got into recovery with no formal treatment at all. We need to learn from all of them how they got there, how they live in recovery, and how they prevent and, if necessary, deal with relapse. They are the best “evidence” for what works.

I hope you take away from this message that together we need to end the war between the major addiction treatment modalities. Here is a strong, positive peace plan that is in the interest of our patients. It has a clear focus on the goal of long-term recovery, including long-term recovery support. It is perfectly compatible with continued use, even lifetime use, of medication—including methadone, buprenorphine, or naltrexone.

That is the message I gave at the 2021 Rx Summit. That's my message in this short, written message. Both are based on my work in this wonderful, empowering, lifesaving field of addiction treatment.

I thank you for your time.

Robert L. DuPont, MD has been a leader in drug abuse prevention and treatment for over 50 years. He was the first Director of the U.S. National Institute on Drug Abuse (1973-1978) and the second White House Drug Chief (1973-1977). From 1968-1970 he was Director of Community Services for the District of Columbia Department of Corrections. From 1970-1973, he served as Administrator of the District of Columbia Narcotics Treatment Administration. In 1978 he became the founding President of the Institute for Behavior and Health, Inc., a non-profit research and policy organization that identifies and promotes powerful new ideas to reduce drug use and addiction. A graduate of Emory University, Atlanta, Georgia, Dr. DuPont received an MD degree in 1963 from the Harvard Medical School, Boston, Massachusetts. He completed his psychiatric training at Harvard and the National Institutes of Health in Bethesda, Maryland. Dr. DuPont maintains an active practice of psychiatry specializing in addiction and anxiety disorders and has been a Clinical Professor of Psychiatry at the Georgetown University School of Medicine since 1980. 

His most recent book is Chemical Slavery: Understanding Addiction and Stopping the Drug Epidemic published in 2018. 

For more about Dr. DuPont’s work and the Institute for Behavior and Health, Inc. visit www.IBHinc.org, www.StopDruggedDriving.org, and www.OneChoicePrevention.org.