| Part Three: How Suboxone and traditional recovery | | | | newly-raised dosage will prevent cravings temporarily, |
| can be used together. | | | | but as tolerance inevitably rises, cravings will return. |
| The appropriate relationship between suboxone | | | | With cravings comes the obsession to use and the |
| treatment and traditional recovery becomes clear | | | | associated character defects. This explains the |
| once one understands the relationship between | | | | profound difference in the subjective experiences of |
| opiate obsession and character defects. Should | | | | addicts maintained on suboxone versus methadone, |
| people taking suboxone attend NA or AA? Yes, if | | | | and explains why in my practice I have many |
| they want to. A 12-step program has much to offer | | | | patients who have switched to suboxone, but none |
| an addict, or anyone for that matter. But I see little | | | | in the other direction. |
| use in forced or coerced attendance at meetings. | | | | The downside of suboxone. |
| The recovery message requires a level of | | | | Traditional AODA treatment specialists are not as |
| acceptance that comes about during desperate | | | | excited about suboxone treatment. Desperation is |
| times, and people on suboxone do not feel | | | | often required to open the addict's mind to change, |
| desperate. In fact, people on suboxone often report | | | | and desperation is harder to achieve when an addict |
| that 'they feel normal for the first time in their lives'. | | | | has the option to leave treatment and find a |
| A person in this state of mind is not going to do the | | | | practitioner who will prescribe suboxone. Suboxone is |
| difficult personal inventories of AA unless otherwise | | | | sometimes used 'on the street' by addicts who want |
| motivated by his/her own internal desire to change. | | | | to take time off from addiction without committing |
| The role of 'desperation' should be addressed at this | | | | to long term sobriety. Suboxone itself can be abused |
| time: In traditional treatment desperation is the most | | | | for short periods of time, until tolerance develops to |
| important prerequisite to making progress, as it takes | | | | the drug. Snorting suboxone reportedly results in a |
| the desperation of being at 'rock bottom' to open | | | | faster time of onset, without allowing the absorption |
| the mind to see one's powerlessness. But when | | | | of the naloxone that prevents intravenous use. |
| recovery from addiction is viewed through the | | | | Finally, the remission model of suboxone use implies |
| remission model, the lack of desperation is a good | | | | long term use of the drug. Chronic use of any opiate, |
| thing, as it allows the reinstatement of the addict's | | | | including suboxone, has the potential for negative |
| own positive character. Such a view is consistent | | | | effects on testosterone levels and sexual function, |
| with the 'hierarchy of needs' put forward by | | | | and the use of suboxone is complicated when |
| Abraham Maslow in 1943; there can be little interest | | | | surgery is necessary. Short- or moderate-term use of |
| in higher order traits when one is fighting for one's | | | | suboxone raises a host of additional questions, |
| life. | | | | including how to convert from drug-induced remission, |
| Other Questions (and answers): | | | | without desperation, to sober recovery, which often |
| -Should suboxone patients be in a recovery group? I | | | | requires desperation. |
| have similar reservations about forced attendance, | | | | The beginning of the future. |
| but there is something to be gained from the sense | | | | Time will tell whether or not suboxone will work with |
| of support that a good group can provide. | | | | traditional recovery, or whether there will continue to |
| -What is the value of the 4th through 6th steps of a | | | | be two distinct options that are in some ways at |
| 12-step program, where the addict specifically | | | | odds with each other. The treatment of opiate |
| addresses his/her character defects and asks for | | | | addiction has certainly proven profitable, which will |
| their removal by a higher power? Are these steps | | | | cause increased investment in addiction research. At |
| critical to the resolution of character defects? These | | | | one time we had two or three treatment options for |
| steps are necessary for addicts in 'sober recovery', | | | | hypertension, including a drug called reserpine that |
| as the obsession to use will come and go to varying | | | | would never be used for similar indications today. |
| degrees over time depending on the individual and his | | | | Some day we will likely look back on suboxone as |
| her stress level. But for a person taking suboxone I | | | | the beginning of new age of addiction treatment. But |
| see the steps as valuable, but not essential. | | | | for now, the treatment community would be best |
| -Where does methadone fit in? Methadone activates | | | | served by recognizing each other's strengths, rather |
| opiate receptors like any other opiate agonist. A | | | | than pointing out their weaknesses. |