MAT (medication-assisted treatment) and AA (Alcoholics Anonymous) are both options for people who are working to overcome addiction. Both approaches have their pros and cons.
The two options could potentially work together, but many in AA feel there is no place for MAT in the 12-step program.
There are controversies associated with each approach to recovery, but each can be effective to help people achieve and maintain sobriety.
What is MAT?
The medications are generally combined with behavioral therapies. This ensures that the person goes through a comprehensive program to help them find sobriety.
When looking at opioid use disorder, MAT has been shown to do the following:
- Improve survival rates of clients who use this treatment option
- Reduce illicit use of opioids
- Improve birth outcomes among those who are pregnant and struggling with a substance use disorder
- Reduce criminal activity among people struggling with a substance use disorder
- Increase retention in treatment so that people do not leave prematurely
- Increase a person’s ability to find employment after they achieve sobriety
People who use MAT tend to have lower rates of HIV, hepatitis, and similar issues related to substance abuse. They also have lower rates of relapse.
What is AA?
AA is a type of fellowship that is present all over the world. It is focused on helping people overcome a drinking problem.
There is a similar group called Narcotics Anonymous (NA) that focuses on people who experience a narcotic-related substance use disorder.
The AA program started in 1935. Any person can join, as there are no criteria people have to meet. Meetings are open to the public, but there are also closed meetings throughout the world that require people to be members.
This program focuses on getting people through 12 steps to recovery. These steps allow people to recognize that they have an alcohol use disorder, create better habits, and make amends with people they wronged as a result of their addiction.
All people start with the first step and progress to the next step after thoroughly finishing the previous one. The steps don’t necessarily progress in a completely linear process. People might need to revisit an earlier step at some point in the process.
People can also have others in the program sponsor them to provide an additional layer of support. Sponsors are generally those who have been in the program for longer periods.
How Do MAT and AA Relate?
Both recovery approaches are vastly different. They can complement each other, but AA has historically not been particularly welcoming to those using MAT.
When a person is using MAT, the medications can lessen cravings for drugs. However, medication does not address the mental and emotional elements of addiction. While AA doesn’t replace therapy, it can provide a vital layer of support and accountability.
The two programs can play into one another. Both provide a type of support that can be reinforced by the other. Addiction treatment that includes MAT and AA with other types of biopsychosocial interventions can be invaluable for some people.
Like all addiction treatments, neither MAT nor AA will be effective for everyone. There are people who have used both MAT and AA at the same time and maintained sobriety over the long term. The key is assessing what works best for the individual.
Can AA and MAT Work Together?
The AA versus MAT debate is a common one. There are some people who believe that one is considerably better than the other and that the two cannot work together. However, the foundation of addiction treatment is tailoring an individual’s program to meet a person’s specific needs.
For some people, a tailored program can include both AA and MAT. Some people use MAT to get them through the withdrawal process and for some time after to reduce their risk of relapse. These medications help to address the physical needs of recovery.
Some people in AA don’t approve of MAT. They view any use of drugs, even medications that support sobriety, as wrong. In some AA groups, people on MAT might be made to feel unwelcome.
Inevitably, a new 12-step group, called Medication-Assisted Recovery Anonymous (MARA), was established for those in recovery who are using MAT.
Based in religion
One of the biggest concerns with AA is that it is largely based on religion. Five of the 12 steps mention God. Those who follow a different faith or no faith at all may believe that AA cannot work for them due to the emphasis on Christian-based faith.
Another controversy involves failure. Some people believe that AA has no gray area. You either succeed with the program, or you fail. When people give in to temptation and have a drink, the feelings of failure may overwhelm them and cause them to feel too ashamed to seek out treatment again.
Other people believe that AA never updated its science as new information about the brain and addiction was discovered. AA was started in 1935. At this time, knowledge about how the brain works, especially related to addiction, was in its infancy.
There is no conclusive data about the efficacy of AA due to the anonymous nature of the program. One rough estimate states that the success rate of AA is somewhere between 5 and 8 percent.
Lack of screening
There is no screening process for people who attend AA meetings. This has some concerned about people joining just to prey on the vulnerabilities of others. There have been cases where people have been targeted for relationships by those who attend the meetings to look for victims specifically.
- Replacing one drug with another: Some people believe that MAT just replaces one drug dependence with another. MAT is not widely used, and some think that this is due to the stigma of replacing one drug with another.
The two drugs most often used as part of MAT are buprenorphine and methadone. Both are opioids, so this is where the idea of replacing one drug with another comes from.
Research shows that using MAT reduces the risk of relapse. People who undergo relapse and do not receive any follow-up medications have relapse rate as high as 90 percent.
Some people have deeply held beliefs regarding complete abstinence from drugs to achieve and maintain sobriety. Some believe that taking these drugs still makes them addicted to a substance, and they cannot achieve full recovery until they are not taking any drugs.
Doctors and addiction treatment professionals disagree that MAT means swapping out one drug for another. However, this is a belief that is widespread throughout some recovery circles.
- Aversion therapy with Antabuse: Antabuse is a medicine that might be given to people working to remain sober from alcohol use disorder. Antabuse aims to prevent people from consuming any alcohol. When someone takes this medicine, their body can no longer break down the alcohol compound acetaldehyde. This results in unpleasant physical reactions when someone drinks because the compound can accumulate in the body. These reactions are meant to cause people to avoid drinking, so they do not become unwell.
Antabuse is considered a type of aversion therapy. When someone takes Antabuse as intended, and they consume alcohol, they can experience the following:
- Skin flushing
- Nausea and vomiting
- Increased blood pressure
Some people believe that Antabuse only causes drinking cessation because the person fears drinking. They believe that people will just stop taking the medicine and go back to consuming alcohol.
Another issue is that some people believe that MAT does not address the root of a person’s addiction issues. However, most addiction centers that use this treatment make it part of a comprehensive plan that includes therapy, so the person’s emotional and mental health are also taken into consideration.
When someone is battling an addiction, AA and MAT are two options they might consider to support their recovery journey. The choice of which is best should be made in consultation with the person’s supervising physician.