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Shattering the STIGMA: Talking openly about MOUD in 12-step recovery programs.

Steven Klein1, Juan Franco1, Adam Scioli1

  • 1Caron Treatment Centers, Wernersville, PA, United States of America.

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Medications for Opioid Use Disorder (MOUD) remain stigmatized in some recovery communities despite evidence of effectiveness. This perspective calls for embracing MOUD as a vital tool for substance use disorder (SUD) recovery.

Keywords:
12-step programsAddiction medicineAlcoholics Anonymous (AA)BuprenorphineMedications for Opioid Use Disorder (MOUD)Narcotics Anonymous (NA)Opioid Use Disorder (OUD)Recovery stigma

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Area of Science:

  • Addiction Medicine
  • Recovery Science
  • Public Health

Background:

  • Stigma against Medications for Opioid Use Disorder (MOUD) persists in some 12-step recovery communities, such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA).
  • This perspective challenges the notion that MOUD is incompatible with sobriety, despite evidence supporting its effectiveness in treating substance use disorders (SUDs).
  • Historical ambivalence toward psychiatric medications in AA's founding literature and contemporary NA literature contribute to this ongoing stigma.

Purpose of the Study:

  • To explore the tension between life-saving pharmacologic interventions (MOUD) and traditional 12-step fellowship beliefs.
  • To examine the origins and contemporary manifestations of stigma against MOUD within recovery communities.
  • To advocate for a renewed interpretation of fellowship principles that incorporates evidence-based treatment and individual recovery paths.

Main Methods:

  • A clinically grounded, narrative-driven, first-person perspective.
  • Examination of historical AA literature and contemporary NA literature regarding medication use and the term "clean."
  • Analysis of personal experiences as physicians and individuals in long-term recovery.

Main Results:

  • MOUD is stigmatized despite proven effectiveness in reducing cravings, relapse, and overdose deaths.
  • Resistance to MOUD is often reinforced by sponsors, literature, and group norms within 12-step programs.
  • This resistance places patients at risk and undermines the recovery process.

Conclusions:

  • Stigma against MOUD in recovery communities poses a significant barrier to evidence-based treatment.
  • A renewed interpretation of 12-step principles is needed to embrace MOUD and affirm diverse recovery pathways.
  • True sobriety should not necessitate choosing between life-saving medication and community belonging.