How the 12 Step program and its decades-old philosophy are exacerbating the opioid crisis

14 Dec 2018

The applause rang out in the drab meeting hall across the river from David Hockenbury’s hometown of Louisville, Kentucky. David’s heart was pounding, and he felt his cheeks flush under the gaze of the large group gathered there on a spring night in 2016. It had been 30 days since he had last flexed his arm, found a vein, and spiked it with a dose of heroin—and now, in a ritual common to many Alcoholics Anonymous groups, he was being called on to receive his first sobriety chip.


David got up from his folding chair. Several people reached out to shake his hand or slap him on the back as he passed. Everyone in the room knew how tough it was to achieve that first month of sobriety. But as the little red medallion was handed to him, the question that had haunted him for the last month flashed across his mind: “Am I a fraud?”

David had a secret. After years of failing to kick his addiction, he had finally been prescribed Suboxone, a pill to ease his cravings and help him recover. The pill helped. For the first time since engaging in heavy heroin use, he was managing to stay clean. But David knew that many in the recovery community would not consider him truly sober if they knew he was taking medicine. “Most people look at Suboxone and think you are cheating, that you are getting high somehow, that you are taking the easy way out,” he told us. “There is this junkie pride where you are supposed to go through detox and withdrawal. Suffer it out. Cold turkey.”

As David walked back from the podium, he felt confused and alone. Should he trust his doctor, who had told him that Suboxone was an effective way of treating opioid addiction and akin to an antidepressant? Or his peers, who preached complete abstinence, even from medication—and honesty, no secrets, as the only pathway to recovery? In the support group people had shared their darkest secrets as part of the 12 Steps to recovery. Some had told the group that they had been molested as children. One had even confessed to David that he had committed a murder. “But I didn’t even feel comfortable to say that I was on Suboxone,” David said.

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