Q. A mother writes: My daughter has had many attempts at recovery including inpatient and outpatient treatment. She is now prescribed Suboxone. It’s been 5 weeks, and I’m thrilled that I’m slowly seeing my real daughter again. She has enormous fear/ anxiety about attending Narcotics Anonymous meetings. In the past she got caught up with people she met at the meetings and ended up relapsing. She attends counseling at her doctor’s office twice a month, and her doctor is adamant that she attend meetings to continue in the program. Any suggestions about how to support her in this?
A. First, I would validate your daughter’s feelings. As helpful as 12 Step meetings are for many people, they are not for everyone.
Sometimes it’s because an individual doesn’t believe in what the group teaches about powerlessness, or a higher power. Sometimes it’s because anxiety or social anxiety makes sitting in a group stressful.
Sometimes it’s fear of encountering unsafe people. Some meetings include people who are forced to attend and are not in recovery mode. They may use the meetings as opportunities to buy/sell drugs or make unwelcome sexual advances that put the safety of other members at risk. For some people, the risks of attending 12 Step meetings do not outweigh the benefits.
Sometimes 12 Step meetings are not a good fit because people in medication-assisted treatment are often discriminated against in 12 Step meetings –such as when they are told they can’t speak, or face more subtle judgment or criticism.
An effective recovery plan is client centered. It takes into account the needs and preferences of the individual.
I suggest that your daughter talk to her doctor about what the doctor hopes she can get from the meetings, talk about her concerns, and ask for alternatives. Maybe she can increase the frequency of her counseling at the doctor’s office, or add sessions with an outside counselor. Maybe she can find an alternative group such as a life skills group for women. Even AA may work better for her. Where I live AA groups tend to have older, more stable membership with more people in long term recovery. And AA meetings will likely have fewer people who are opiate dependent and share her risk of relapse to opiate use.
The goal is to make it clear to the doctor that she is…
1. Committed to recovery
2. Protective of her progress and appropriately concerned about a repeat of past relapses associated with NA meetings
3. Willing to work hard –not just trying to get out of something
4. Looking for the recovery supports that work best for her
Try to figure out where the doctor is coming from. Is he or she open to learning what really works best for your daughter? Or is the doctor someone who mistakenly believes that 12 Step groups are necessary or effective for everyone.
Some people have trouble recognizing that one size does not fit all.
Doctors, probation officers and others often require 12 Step group work because they want to see regular participation in activities with a recovery focus. This would be a situation where offering alternative recovery-related activities might work (such as journaling or blogging about her recovery, or more frequent counseling).
12 Step groups are free, often readily available, and don’t require the doctor to go through a formal referral process. This makes them an easy referral and therefore often the default referral. Many doctors aren’t even aware of alternatives. If your daughter prefers another option, she should work to make the alternative just as easy from the perspective of the doctor.
I suggest that she line up some alternative activities and start participating in them. And then tell the doctor about them after she is already showing that she is following through. Then I suggest she continue to raise the issue with the doctor without forcing the issue.
She should continue to express her feelings to the doctor. She should accept it if the doctor refuses to change course immediately (roll with resistance), but use pleasant persistence over time to assert her recovery needs and seek an alternative that better suits her. In the meantime, she could attend meetings with a trusted support person who would help her avoid unhelpful contacts or entanglements.
Sometimes doctors need to feel that the patient is following recommendations. To put it bluntly, doctors sometimes need to feel in control. This is especially true in the area of medication-assisted treatment where doctors often experience patients who push limits. Doctors can get pretty jaded after a while, and one defense they develop is to avoid any bending of “the rules.”
Your daughter is still pretty new to Suboxone treatment, and it may be that the doctor will be more flexible after the doctor gets to know your daughter better and she has had a chance to establish credibility with the doctor.
I’d like to hear what others think. Please leave a comment.
{ 10 comments… read them below or add one }
I couldn’t agree more! I’m surprised that I have not complained about this one yet… Every time I see my doctor he yells at me for not attending 12 step meetings. I do see a one on one therapist every week. I love going to those sessions! I always walk out knowing more about myself and about the person that I’m becoming. It also teaches me a different way of thinking about situations.12 step meetings never did it for me. Often I would meet someone that was not in serious recovery and go and shoot up with them! Thats how weak I was.. I’m positive that I’m not the only one either.
I can’t recommend whether or not to go to some one. It’s not up to me, it’s up to them. This post gives excellent information to decide though.
Keep up the good work!
I am the mother that wrote the piece about my daughters Dr insisting she attend NA meetings as well as seeing a Psychologist at his practice every 2 weeks. We are now dealing with a pregnancy via some guy she met at NA that is a highly regarded member there. It appears that this guy runs a few 1/2 way houses & is actively involved as well & is the equivilant of the ‘quarterback’ in highschool. My daughter is unfortunately the type that has yet to learn to not ever ‘need’ a guy in her life & this one was the one months ago to wholey embrace her into NA . I will always feel had this not been forced on her- to be allowed to continue her treatment- she may not be where she is now with an unplanned pregnancy in that she was NOT ready to be in a situation such as NA. I was crystal clear to her Dr. that she is the type to instantly become close to people with no regard to consequences. Her father & I both agree pushing someone to NA when we as parents know their child is NOT a good idea. By the way..the ‘great guy’ is not involved in any parts of this preganancy as he has since moved on. It takes 2 yet I can only wonder if she had been allowed to wait until she was more stable in her recovery would things be different.
I totally agree with this. My daughter entered Suboxone treatment after abusing opioids for about 8 years. She also has a schizoaffective disorder. She has done soooo well, and as part of her recovery, her Suboxone doctor told her to go to NA meetings. She went every day for about three months, and then she determined that there were only certain meetings on certain days that she would go to (the doctor only recommended a couple a week anyway). The first sponsor she had was really okay; but she could no longer do this for different reasons. Then, my daughter asked another one to be her sponsor. This new sponsor knew good and well that she was on Suboxone. I noted that my daughter seemed to want to pull away from NA, and I never once thought that she was trying to go back to her abuse. She has not missed one appointment with her psychiatrist, Suboxone doctor, or her counselors. Finally at 6 months clean, she announced to everybody that she was going to quit NA. WHY? Because her sponsor constantly told my daughter that she “was not clean” because she “used” Suboxone. In fact, my daughter even tried on her own to decrease the dose because this sponsor made her feel so bad. To make a long story short, I confronted this so-called sponsor myself. My question to her was: If you went into a 3-month rehab, didn’t you use some type of medication or did you not seek medical help? I also learned that this so-called sponsor had had gastric bypass and is also currently on antidepressants. My question was again: Why do you seek medication or medical help for your problems, but you dog a person on Suboxone. In my opinion, Suboxone keeps a person out of expensive (and often unpaid by insurance) long-term rehab, such as this sponsor did. My daughter old me that she was getting really, really depressed by the talk at NA meetings–that all the wanted to talk about was drugs–never anything positive and uplifting. I guess NA helps some people, but the mere idea that you have to be committed to listening to this talk several times a week it seems would be less effective than say healthier outlets such as church, hobbies, exercise programs, etc. It’s strange that these NA members never seemed to have any other social outlets. It almost seems cult-like!!
i need help finding a site to find suboxone meetings for me online
What type of support group would be of help to me? I’ve been in recovery and taking suboxone for almost 3 yrs. Now but am in need of some type of counciling program. Plz help to steer me in the right direction!
Hi Paula –Can you give me some more info? Why are you looking for counseling right now? Would you prefer a group setting or individual counseling, and why? What do you hope to get from counseling. What type of support groups or counseling have you experienced in the past, and was it helpful? Also, please note that 12 Step Groups like AA/NA do not provide counseling.
Things seem to be getting harder than easier and while I know ill never go back to opiates, I feel like I need to talk w others who are using suboxone for their recovery. I also feel the same as what was said in the previous text about pple on sub. Not really clean and maybe I wouldn’t be accepted in meetings as easily. I still have not spoken w any kind of counselor since stopping my use w opiates and have been told by the 1 close person in my life that I could greatly benefit from attending meetings.
Hi Paula –There’s no reason you couldn’t try going to a few different meetings and see if it is something you find helpful (many people do). Maybe you could think about starting a peer recovery group for others in medication-assisted treatment, if one doesn’t exist in your area. Another option would be to look for a counselor for one-on-one support. The trick is to try something out and if it isn’t a good fit just check that one off the list and move on until you find what works for you. You said you will never go back to opiates. That’s great. Be sure and take the time to celebrate that and give yourself credit. But reading between the lines it sounds like you would like more support (never a bad thing). I for one congratulate you. I don’t like the “dirty”/”clean” language and don’t use it myself. But you are clearly in recovery, and it’s working. I wish you all the best in you future.
I really appreciate your responses to my texts. You give me some really good advice and suggestions that I could see working for me. And, I feel so not alone going thru this. That’s the best part. Someone told me that all you have to do is just start asking around because there are a lot of really good pple out there that just want to help. Being a long time abuser of drugs has taught me not to trust so this is very scary to me. I am starting to get it because I don’t even know you and your caring enough to help a stranger gives me such hope thank you for that, it means the world to me!!
Glad I could help, Paula. There are a lot of good people out there and there a lot of people who, like you, are in recovery and benefiting from medication-assisted recovery. I posted the winners of an recovery essay contest on this blog yesterday and at the end of the post is a link to the full essays. I think you would enjoy reading them, and they are pretty inspiring…so if you haven’t already, check them out. Tom
http://www.recoveryhelpdesk.com/2012/01/24/recovery-essay-contest-winners-talk-about-methadone-naltrexone-and-suboxone/