Any addiction professional who has worked with program directors of 12 step-based treatment centers, sponsors in Alcoholics Anonymous (AA), and long-term members of AA has experienced the anti-medication bias harbored by some.
However, there is nothing inherent in the 12-step approach that contradicts the use of medication for craving reduction, abstinence enhancement, or for that matter any psychiatric condition or disorder (Brigham 2003). An interesting side note to history occurred during the 1960s and involved a conversation between Dr. Vincent Dole, co-originator of methadone maintenance for heroin addiction, and Bill Wilson, co-founder of AA. Dr. Dole served as a trustee of AA, became friends with Bill Wilson, and recalled a conversation they had (Dole, 1991) where Wilson expressed his concern over alcoholics who could not achieve sobriety despite repeated attempts through AA:
“At the last trustee meeting (of AA) that we (Vincent Dole and Bill Wilson) both attended, he (Bill Wilson) spoke to me of his deep concern for the alcoholics who are not reached by AA, and for those who enter and drop out and never return. Always the good shepherd, he was thinking about the many lost sheep who are lost in the dark world of alcoholism. He suggested that in my future research I should look for an analogue of methadone, a medication that would relieve the alcoholic’s sometimes irresistible craving and enable him to progress in AA toward social and emotional recovery, following the Twelve Steps.”
This highly revealing anecdote reflects the open-mindedness and recognition by the co-founder of AA that some alcoholics require a pharmacotherapeutic intervention to bridge the gap from initial abstinence to stable abstinence and integration in AA. How unfortunate it is that many ardent believers in the 12-step approach have adopted an attitude of rigidity and dogmatism regarding addiction medicine.
Brigham GS. 12-step participation as a pathway to recovery: The Maryhaven experience and implications for treatment and research. Clinical Perspectives-12 Steps and Treatment. 2003;46:43-52.
Dole V. Addiction as a Public Health Problem. Alcoholism: Clinical and Experimental Research. 1991;15:749-752.