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Opiate dependence, character defects, buprenorphine, and the steps

Posted Oct 12 2009 10:02pm

A year or so ago I wrote an article about the relationship between Suboxone maintenance and traditional recovery.  The article has been reprinted in several forms with minor changes from one  copy to the next, but the general points are repeated here.  I have received occasional comments from people who agree with me and from people who disagree, and from people who hate Suboxone and people who say that Suboxone saved their lives.

I received a thoughtful e-mail the other day that deserves re-posting to a broader audience.  For those who are interested in the relationships between addiction and character defects, and the impact of buprenorphine or the twelve steps on these character defects, I suggest that you first read the original article, and then read the e-mail response printed below.  As always, your contributions to the discussion are appreciated, either at the bottom of this post or at Suboxone Forum.

The response:

Dear Dr. Junig,

I found your article ” Is Suboxone At Odds With Traditional Recovery?” to be an excellent piece, very informative and very helpful as we (my wife and I, both recovering alcoholics for 22 and 21 years, respectively) are working with a friend dealing with a pain pill addiction.

Just by way of background, though not a physician myself, I worked 18 years at ###### Medical School  and as a result have had considerable exposure to medical curricula, practitioners and research in medical education. That and my own personal experience, I am sure, are reasons I find the article compelling.

I would add just one note to your discussion: while addicts (of all types) do acquire “character defects” as a direct result of their addictions — a point you make and it is well taken — you do not allow very much for things that may have been wrong in their make-up PRIOR to addiction.

In other words, if I grew up in a “goodfellas” or any type of heavily dysfunctional family, I might have picked up some bad habits on the way to becoming an alkie or a junkie and just added more bad attitudes and behavior on top of the mound I had already built. Of course, all this is gradual and intertwined, but I believe you get my point.

So the person I brought into my addiction needed reparative attention long before the onset of the addiction, that so-called line we cross over.

I completely agree that a large set of people who might become pill pain addicted might likely be more “normal” than alkies-in-development, still they may have issues and we have found the step programs to be useful to anyone.

Certainly that set might be less aware or less motivated to do the work on themselves (might easily have greater denial, especially if they get into comparing) but they still likely have the need. Can’t hurt, as they say.

I hate to say this (only because 12-step programs are parsed into such small groups and subpieces) but I think a Pain Pills Anonymous that acknowledges the differentiation would be a great resource to the population you focus on.

Thanks for your attention to this.

-B

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