I’ve shared my history many times, including mention of my ‘spiritual awakening’ in 1993 that kicked off about 5 years of active AA invovlement.  After struggling with an obsession to use opioids for months, a meeting with a psychoanalyst sparked the ‘awakening’ on my drive home.  I was suddenly very tired of what I was doing– the lying, hiding, desperately searching for something to stop the withdrawal, fighting with my wife… and running from psychiatrist to psychiatrist, trying to find one to agree with MY version of the world, who I would agree to see for treatment.  I now realize, by the way, that ‘change’ by definition appears foreign, wrong, and inappropriate;  a patient who sees a therapist who agrees with everything the patient says is guaranteeing the ABSENCE of change!  On the day of my ‘awakening’ I saw an analyst who told me I was full of BS, and I suddenly realized that he was totally correct.  I pulled off highway 41, crying, confused, and simply done with fighting the advice I had received from others.  I decided that I had to put myself into the hands of the experts and just listen, and do as I was told.  And I realized that I had no ‘will power’ over opioids (later learning that I had no will power over ANY psychoactive substances).  The amazing thing that felt like a miracle was that the desire to use suddenly disappeared.  I didn’t touch opioids again until my relapse, 7 years later.  And I didn’t need any ‘will power’ at all;  what I needed was to remember that I HAD NO will power.  Keeping that at the forefront of my mind was very easy– and very difficult– to do.  Other AA’ers will know what I mean by that comment.
Since then I have tried to look at the twelve steps ‘scientifically;’ to determine the essence of the program that leads to such incredible change in SOME cases.  With the introduction of buprenorphine maintenance, my opinion holds that the only way to live a clean life OFF buprenorphine is to adopt a life based in the steps.  The problem is that finding real ‘change’ through the steps (or through any other program) requires that the person abandon his/her former way of living, and that requires desperation.  And unfortunately, once on buprenorphine, addicts are no longer desperate.  I do not see any solution to this stale-mate situation.  Desperation is needed for change, and buprenorphine eliminates desperation.  So the addict must stay on buprenorphine to avoid using, and to avoid desperation.
The question that comes to mind is whether it is a good idea to stop the buprenorphine, thus bringing on the desperation required to change?  In some cases yes– when the person is using multiple substances and life is careening out of control, I think that buprenorphine might only prolong the agony, and the appropriate action is to stop it and allow the person to feel the consequences of his addiction.  But for pure opioid addicts I have a harder time recommending that they discontinue buprenorphine for the sake of bringing on desperation, because the risk of death during overdose is simply too high.
My philosophy for buprenorphine treatment is to try to add the elements of recovery that I found in the steps– to somehow pass them on to the patient without desperation.  I don’t know if that can be pulled off, but that is what I try to do.
I want to share this interesting story about the mechanism of AA from Wired magazine: http://www.wired.com/magazine/2010/06/ff_alcoholics_anonymous/5/


Kitt10 · July 10, 2010 at 4:33 pm

Started a group on Facebook over a year ago regarding opiate addiction.
We need to join forces…… as stated it’s epidemic!

Kire30 · July 10, 2010 at 9:59 pm

For me, Suboxone didn’t eliminate despiration…it only eliminated cravings for drugs.
Although I have only been on Suboxone for about three months….I feel desprate to change the way I have been living for most of my life.
I am in my late 30’s though and I have been through alot. I know that if I go back to using drugs again I will loose my husband and kids, my job, and will end up in jail or dead. I know that everytime I start using again it gets worse. I have LIVED it so I know its true.
I finally came to the realization that DRUGS DONT MAKE ME FEEL BETTER!!!! (well, maybe for 5 minutes) But after that, I begin using daily and my life goes to hell. Real hell. So I’m thinking…There has to be a better way to live! A better way for me to be happy!
So I went through detox and was going right into Inpatient treatment (again)….no plans for Suboxone….but something got messed up with my insurance and I ended up having to go to IOP instead. They were worried about me continuing with w/d when I got home, so they hooked me up with an AWESOME Suboxone doctor and I got on it without much knowledge about what it was.
Now I am SO greatful things happend this way. I was desprate before I started Suboxone so maybe that has something to do with it too.
I keep telling my Suboxone doctor that I rarely even THINK about drugs. This is after thinking about drugs almost every day since I started using at age 13! I told him I am not sure if it is the suboxone or the willingness for me to do anything to stay drug free. He laughs and says its the Suboxone….but I am not so sure!
I am also using AA, the steps and a sponsor. I refuse to let them make me feel bad about being on Suboxone. I am finally experiencing REAL change in my life…I think with Suboxone and traditional recovery I have a fighting chance.
I can see that a younger person would not feel desperate on Suboxone though, and I see the stale-mate situation you are talking about….I guess you just keep doing what you’re doing. Because right now you are one of the few doctors who really seem to “get” addiction. I have said this before to you in an email…but thank you so much for all you do. Kire

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