Medicated-Assisted Treatment and 12-Step Programs: Evaluating the Referral Process

Purpose/Background Overdose deaths in the U.S. from opioids have dramatically increased since the COVID-19 pandemic. Although medicated-assisted treatment (MAT) programs are widely available for sufferers of opiate addiction, many drop out of treatment prematurely. Twelve-step programs are considered a valuable part of treatment, but few studies have examined the effect of combining these approaches. We aimed to compare abstinence rates among patients receiving MAT who were referred to 12-step programs to those only receiving MAT. Methods In this prospective study, a cohort of participants from a MAT clinic agreeing to attend a 12-step program was compared to 15 controls selected from a database before project implementation. Eligible participants were diagnosed with OUD, receiving buprenorphine (opiate agonist), and at least 18. Participants were provided with temporary sponsors to attend Narcotics Anonymous, Alcoholics Anonymous, and Medication-Assisted Recovery meetings together. The primary endpoint was the change in positive opiate urine drug screens over 6 months between participants and controls. Results Between March 29, 2021, and April 16, 2021, 166 patients were scheduled at the clinic. Of those scheduled, 146 were established patients, and 123 were scheduled for face-to-face visits. Of these, 64 appeared for the appointment, 6 were screened, and 3 were enrolled. None of the participants attended a 12-step meeting. Enrollment barriers included excluding new patients and those attending virtual visits, the high percentage of patients who missed appointments, and lack of staff referrals. The low incidence of referrals was due to time constraints by both staff and patients. Implications for Nursing Practice Low enrollment limited our ability to determine whether combining medication management with a 12-step program improves abstinence. Failure to keep appointments is common among patients with OUD, and virtual meetings are becoming more prevalent post-COVID. Although these factors are unlikely to be controllable, developing strategies to expedite the enrollment process for staff and patients could hasten recruitment.

Working the Self: Truth-Telling in the Practice of Alcoholics Anonymous

This article interrogates twelve step practice within Alcoholics Anonymous (AA) from the perspective of Foucault’s later work on governance, truth-telling and subjectivity. Recent critical studies of addiction tend to view self-help cultures like that of AA and related twelve step programs as integral parts of contemporary power/knowledge complexes, and thus as agents of the modern “will to knowledge” that Foucault often engages with. In line with the widespread Foucauldian critique of governmentality, addiction self-help culture is thus conceived as one that primarily reproduces abstract, neoliberal norms on health and subjectivity. The argument put forward in this article aims to upset this framework attending to a number of features of twelve step practice that, arguably, bear striking resemblances to Foucault’s later discussions of ethics, care of self and truth-telling. In this, it is suggested that a close study of AA practices, might interrupt assumptions about contemporary addiction discourse and its relationship to issues of truth and power often reproduced in Foucauldian critiques.

Twelve-Step Programs and Spiritual Support at the End of Life

Experts estimate that over 25 million Americans are in recovery from addiction to alcohol and other drugs. Many will be confronted with a serious progressive illness necessitating palliative care or hospice services. In current literature, substance use disorder has mostly been examined in relation to appropriate symptom assessment and management, opioid risk screening, and controlled substance prescribing practices. However, as hospice and palliative care (HPC) clinicians strive to provide whole person care for the seriously ill, awareness and facilitation of healthy psychosocial–spiritual coping strategies for recovering addicts should enhance such care. One of the more common support mechanisms to support recovery is the 12-step program, based on Alcoholics Anonymous. Twelve-step programs have been shown to provide effective coping strategies, not only to help facilitate ongoing abstinence but also to support other psychosocial–spiritual crises. The HPC providers may help to serve those living with addiction disorders better by assessing not only patient histories of substance use/abuse and other addictive behaviors but by facilitating their ongoing support recovery efforts. Here, we use 2 HPC cases to illustrate the value of 12-step recovery programs in patient support and provide recommendations for enhancing such healthy coping in HPC clinical settings.

Using Qualitative Methods to Inform Scale Development

This article describes the process by which one study utilized qualitative methods to create items for a multi dimensional scale to measure twelve step program affiliation. The process included interviewing fourteen addicted persons while in twelve step focused treatment about specific “pros” (things they like or would miss out on by not being involved in twelve-step programs) and “cons” (things they dislike or would benefit from if they did not engage in twelve-step programs). The triangular process used in qualitative research is described, which generated items for the subsequent instrument to measure ambivalence toward recovery programs. Mixed-method strategies included qualitative interviewing to inform scale development and three analytical approaches to produce specific codes, themes, and domains.