Buprenorphine and Dynamic Character Defects

This is an important discussion, and I hope people will take a moment to follow the link I’ll get to in a moment. When I started this blog in 2008 I received a great deal of pushback from the sober recovery crowd. This article in particular stirred some animal spirits.

I would prefer that people use the link and read the longer version, where I explain my reasoning in greater detail. My point was that many studies have reported associations between personality disorders and addictive disorders. Likewise ‘recovery’, at least in 2008, usually followed a step-based model that emphasized character defects and the need to identify them, share them, and address them in order to find sustained recovery.

For some time after buprenorphine (a.k.a. Suboxone, Zubsolv, and generic buprenorphine or buprenorphine/naloxone combinations) was popularized many prescribers insisted that their patients attend twelve step programs.

I’m in recovery myself for over 20 years now after ‘old fashioned’ rehab, but I never saw value in pushing AA meetings on my patients. Why? Because I don’t believe anything is gained from forced AA attendance. A person forced to attend is much more likely to view meetings and attendants negatively, and much less likely to ever seek out such growth possiblities on his/her own.

The forced attendance was based on the idea that all addicts had something in them that needed to be changed, and they would never find that change on their own. That was completely inconsistent with my experience with hundreds (over 700) buprenorphine patients, most of whom experienced drastic life improvements over time on buprenorphine.

My post makes the argument that character defects in addiction are more dynamic than people understand. I don’t remember if I wrote this – but as an example, I saved a drowning woman at considerable risk to my own life when I was 19. Did I become a sociopath during my 8 months of addiction? If so, am I still? I did some very shameful things during those 8 months. But I thankfully I never considered myself irredeemable.

I wrote that it was the craving to use, and perhaps consequences of repeated episodes of character-defeating attempts at abstinence and withdrawal that create many of the ‘defects of character’ associated with addiction. And while personality disorders are generaly thought of as static, people who participate in ‘association studies’ are often involved in active addiction. I am not familiar with personality studies of people who have been in sustained remission for twenty years.

Please take the time to read that old post, and comment if you feel up to it. And if you see this on Linked IN, I read today that the way to get posts to spread on linked in is to comment with the phrase ‘Commenting for Reach’, so if you like my idea but have nothing to say, consider just saying that. I’m curious if it works, and if I’ll move up over where I usually rank there..