Recovery real-talk, M.A.T. part one

I lived in a medication integrated recovery world since before it was cool. This ‘big-tent recovery’ lip-service that know-nothing rehab marketing professionals gave out… this “we meet ‘em where they’re at!” ...and when they’re waiting for you to show up… you say “come on over here”. I’m not an old dog in addiction treatment but I’ve been hitting it hard since 2009. In those years I’ve seen the spectrum slide around – what does ‘In Recovery’ mean? Right now, in 2024 I’m reflecting on the stigma of suboxone and what we need to get the definition of recovery correct. And please, we don’t need to hear about Mu receptors and neuroavailablity. We need to know how to real-talk the wide world of recovery, especially medication assisted treatment.

It was 2016 and the idea of having someone on prescribed opioids living in the same house as the traditional abstinence-based recovery crew was unpopular to say the least. It was literally laughed and scoffed at by most people. Professionals too, dismissed the concept as impossible without even pausing to imagine it. My boss, who I respect to this day, had decided the stigma associated with suboxone, buprenorphine, methadone, etc., was based on feelings not reality. Furthermore, it was hurting business potential. I was running an Intensive Outpatient Program and found a way to make sense of medication assisted recovery to the sober living population I served. Scientists have confounding and counter-intuitive answers that do not persuade skeptics

“But what is with 'suboxone?' Isn't that just replacing one addiction with another... What I need is someone to real-world explain how someone who is consuming drugs can have the gall to say they're 'in recovery'. If there is some reasonable rationale, please explain it to me in a way that makes sense, leaving out the brain-sciencey gobble-blobble.

In that effort, I’ll ask the reader to take a specific point of view. Imagine you are under the impression the only way to be ‘in recovery’ is to abstain from all mind-altering substances. And the truest, most real recovery means no mental health medicines at all. Imagine you have the pure perspective that harm-reduction is at best a manipulative tactic moving someone toward abstinence, in fact taking buprenorphine or methadone is most certainly still addiction and therefore… not part of a recovery. Remember, this is written for an abstinence based-purist audience, as such I need to clarify some phrases.

‘Not abstinent’. It means the person is using substances that may induce psychological pleasure which may or may not be habit forming. ‘Not abstinent’ includes any and all drugs including of prescribed opioid medications. It can also include street opioids, THC products …any and all other substances including illicit/illegal ones. When a person is not abstinent, they are in some fashion, taking something that gives them a head-change. They are consuming something/doing something to affect their neurological state … maybe achieving a blissful state, maybe relieving a suffering state. We ignore caffeine and nicotine. Some readers will be offended. I included prescribed opioids in the ‘Not Abstinent’ category. I shall remind you of your temporary perspective-taking. I too believe in a clear distinction but the general public or purist will not.

‘Abstinent’. It means the person stopped consuming their drug of choice (DOC) or drugs all-together without any lesser substitute or replacement. The basic premise can be summarized by the sleeping dragon metaphor. Do not disturb the addiction because if it comes out of the mountain, it’s going to ravage the town before it beds back down. They may or may not have internal motivation, but they’re fully ‘clean’, ‘sober’ or ‘clean and sober’; obviously the cultural gold standard or so it would seem.

‘Not in Recovery’. For our purposes, these are people with substance use disorders (acknowledged or not) that are not trying to curtail the problem. The substance user who is ‘not in recovery’ is seeking to get high, buzzed, or otherwise turnt, schwacked, faded, what-have-you. They will prioritize their substance use in a typically problematic way. The reader may inquire: What about people who are not in recovery and it’s because they’re not that bad? Good question with a simple answer. Mild substance use disorder exists and unfortunately most people do not enter recovery until the disorder becomes severe.

“In Recovery”? .... I’ll review that term in depth in the next two parts.