Are You REALLY Sober if You Use Medication-Assisted Treatment in AA?


By Megan K.

The rooms of AA (and NA, CMA, CA, HA, any-freakin-A) are a lot like real life in that everyone, it seems, has an opinion on just about everything. But perhaps no issue has caused more contention among 12-steppers than the use of medication-assisted treatment (MAT).

  • “They gave her this drug in detox to help with cravings, but she’s still on it. Being uncomfortable is part of being newly sober; there’s no way around that. Trying to medicate it away is part of the problem. But there she is, picking up a 30-day chip.”
  • “These medications consistently prove effective in treating not only opioid addiction but alcoholism as well. Why wouldn’t we want to leverage the best that science has to offer?”
  • “I won’t sponsor guys if they’re taking Suboxone or methadone. This is a program of abstinence from all mind-altering substances. Those are addictive, mind-altering substances. They’re shortcuts.”
  • “Everyone needs to mind their own business. You don’t know what I need. I’ll stay on these meds as long as I want to.”
  • “It’s fine if you need to use them in the beginning, but at some point, you need to get off them. I know someone who’s been on Suboxone for 10 months. At that point, it’s a crutch.”

Are you really sober if you take MATs? Are they shortcuts? Are those who are against them just crotchety old blowhards — or are do they have a valid point regarding our propensity to self-medicate?

Is medication-assisted treatment a beacon of medical and scientific progress that enables more people to recover? Or a crutch?

That’s what we’re exploring in this article. But first, let’s dig into the types of medications we’re talking about.


MAT Defined

The Substance Abuse and Mental Health Services Administration (SAMHSA) defines medication-assisted treatment as the use of medications to treat substance use disorders. It’s mostly used to treat those addicted to heroin and other opioids, but there is application with alcoholics as well.

The drugs reduce withdrawal symptoms, lower cravings and some block the effects of opioids. SAMHSA recommends MAT be used in conjunction with counseling.

Medication assisted treatment in Alcoholics Anonymous

Medications used in MAT

Opioid dependence medications include:

  • Buprenorphine
  • Naloxone
  • Suboxone, the brand name of a medication that combines the above two active ingredients
  • Naltrexone implant
  • Vivitrol shot
  • Methadone

Alcohol use disorder medications include:

  • Disulfiram (better known by its brand name, Antabuse)
  • Acamprosate
  • Naltrexone

For more in-depth information regarding these medications, read our post, Recovering From Opiate Addiction: What Is Suboxone, the Vivitrol Shot & the Naltrexone Implant?

How MAT works

Let’s use a heroin addict named Max as an example.

  • Under the care of a doctor, Max stops using heroin and is given Suboxone.
  • He takes it every day to block his opiate receptors, reduce his urges to use and reverse the effects of opioids.
  • Over several weeks, the doctor lowers his dose, until he is completely weaned off.
  • During this tenuous time period — when so many other heroin addicts will relapse because they cannot effectively fight the overwhelming urge to use — Max gets counseling, attends 12-step meetings, works his steps and builds a recovery support system.

Seems simple enough… right?

A Common-Sense Discussion From the Front Lines

Problems arise when the show doesn’t go off as planned.

Or, in other words, when people are fallible. Which is pretty much always.

Let’s hear from people in the rooms:

Corey H.

There are some people who say that you aren’t sober unless you’re free of all mood- and mind-altering substances. In truth, they’ve created an arbitrary line where caffeine and nicotine are OK, but medication probably isn’t.

If a person is going through MAT and it’s helped them pull their life together, I don’t think it’s important to say they are or aren’t sober; the fact is, they are recovering. According to the dictionary, no, a person taking methadone or Suboxone is not sober. I’ve noticed that most fellowships use “sobriety” as a synonym for “recovery” and not as a synonym for “abstinence.”

Annie B.

I got on methadone about a year ago, and it has saved my life. I was unemployable, homeless and suicidal before I made the decision to get on it. I’m recently out of a halfway house and expect to be fully detoxed within the next four to six months. I’m working, I’m working with a sponsor, I’m doing my steps, and I firmly believe without that tool, I would not have been able to do any of this.

Lori W.

I have had a bad time sponsoring women on MAT. I hate Suboxone and methadone. They didn’t work for me either, personally. I’ve never had one friend who stayed sober — even “pretend sober” — on either one. They never work. Not. One. Time.

Rhonda W.

The steps outline a design for living. It’s not a medical treatment plan. I stay out of giving medical advice and stick to helping others get through the steps.

Jeff M.

I sponsored a guy who had been on MAT for 7 years. During our relationship he told his doctor he was still having cravings, so of course they upped his Suboxone. As we neared the end of his stepwork, I was getting increasingly uncomfortable with the idea of him sponsoring new guys while he had no plans to get off MAT. I prayed on it and spoke to my sponsor, and once I made a decision, I told him that I wouldn’t take him through those last few steps until his doctor thought he no longer needed to be on Suboxone. He hung up on me and never returned my calls and texts.

People find recovery by following many different paths. MAT gets people to level out, so they can find a solution to their problem. If they just stop there, I don’t believe they have recovered. I will never tell a man his sobriety date though! My newcomer chip says, “To thine own self be true.”

Garth K.

A lot of people in recovery use medication to address various issues, so I find it difficult to split hairs over which medications are acceptable and which ones aren’t. Plus, I feel like it’s narrow-minded to tell somebody they are doing it wrong because they’re doing it differently than the way I did it.

Joe G.

Tradition 10 answers this question.

(Tradition 10, depending on which fellowship you attend, looks something like this: “We have no opinion on outside issues; hence our name ought never be drawn into public controversy.”

What Do You Think About Medication-Assisted Treatment?

Let’s keep the discussion going. What are your thoughts on MAT? Would you sponsor someone on MAT? Let us know in the comments or discuss now in our Forum!