Suboxone Doctor Mandates NA Meetings, Creates Relapse Risk

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.

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