In recent decades the range and patterns of opioids used for extra-medical purposes have changed. The use of pharmaceutical opioids exceeds the use of heroin. In 2017, 63 percent of opioid deaths were attributed exclusively to pharmaceutical opioids, 28 percent to illicit opioids and 8 percent to both illicit and pharmaceutical opioids (aged 15-64 years).
The objective of this report was to estimate the social costs arising from extra-medical opioid use in Australia for the financial year 2015/16. Due to data limitations in most cases we only estimated the costs occurring in this 12-month period. For example, on-going care of chronic conditions was not included. The exceptions to this were for certain harms which occurred in 2015/16 but which had longer-term ramifications, for example premature deaths, where discounted streams of future costs (lost economic activity and lost contributions to household chores) and partially offsetting savings (future health expenditure ’avoided’ by premature deaths) were estimated. The authors also included the long-term costs of road traffic accidents, as were the expected future costs of opioid attributable imprisonment for those sentenced in 2015/16.
This growing issue continues to be overlooked or deliberately discounted by certain sectors. Which means that this, arguably well-meaning, but poorly implemented ‘harm reduction’ mechanism continues to add to the drug using cohort and the increasing harms this ‘pairing’ collectively bring.
We will leave you with a very provocative quote (now 14 years old) but perhaps even more relevant today? A statement that could have only been published then, but with the ‘cancel culture outrage’ in play at present, may well be ignored now and for the very reasons it confronts.
“The medical profession and the addicted community have a complex, symbiotic, mutually dependent relationship that does none of us any good. Basically, they pretend to be ill and we pretend to treat them. And thousands of public employees make a good living out of it. Prescribing for opiate addicts is like throwing petrol on a fire; pointless, counterproductive, stupid, self-defeating. And yet we keep doing it.”
We Do Recover – Excerpt from evidence-based review of N.A and 12 Step Facilitation Programs
Active drug users have a generally positive view of NA and seek help through NA through a variety of influences, including contact with an NA member, referral by a treatment agency, or encouragement from family members. Attraction or aversion to NA depend upon such factors as personality, problem severity, degree of religious orientation, and social network norms.
Dropout rates from NA are comparable to those in AA (approximately 40% at one-year follow-up)60 and are lower than dropout rates of other interventions into alcohol and other drug problems as well as rates of adherence to prescribed management of other chronic health conditions. In the case of addiction treatment in the United States, which usually transpires over 30-90 days, only 43.4% of admitted patients successfully complete treatment. Thirty-four percent of patients admitted to addiction treatment in 2015 either dropped out prior to treatment completion or were administratively discharged by the facility prior to treatment completion. Only 5.2% of admitted patients remain involved in addiction treatment for more than one year,61 and the majority of patients completing a primary course of addiction treatment do not participate in sustained continuing care activities delivered by addiction professionals.
“…freely available AA and NA networks could provide a cost-effective long-term therapeutic adjunct to professional SUD approaches for youth.”104
“Twelve-step programs represent a readily available resource for individuals with substance use disorders. These programs have demonstrated considerable effectiveness in helping substance abusers achieve and maintain abstinence and improve their overall psychosocial functioning and recovery….it is possible to increase twelve-step involvement and that doing so results in reduced substance use.”105
“AA/ NA participation is a valuable modality of substance abuse treatment for teens and much can be done to increase teen participation, though more research is needed.”107
“Though not the only model for post-treatment recovery support, research to date suggests that similar to adults, adolescents’ involvement in 12-step groups predicts improved AOD use outcomes, and greater participation (i.e., frequency, duration, and extent of involvement) predicts abstinence and SUD remission better than attendance alone. Moreover, 12-step participation reduces the associated healthcare costs for adolescents with SUD. Despite these benefits, in 2015 <2% of AA’s and NA’s total membership comprised people under 21 years old.”110
“Manualized AA/TSF interventions usually produced higher rates of continuous abstinence than the other established treatments investigated. Non-manualized AA/TSF performed as well as other established treatments. AA/TSF may be superior to other treatments for increasing the percentage of days of abstinence, particularly in the longer-term. AA/TSF probably performs as well as other treatments for reducing the intensity of drinking (of alcohol). AA/TSF probably performs as well as other treatments for alcohol-related consequences and addiction severity. Four of the five economics studies found substantial cost-saving benefits for AA/TSF, which indicate that AA/TSF interventions probably reduce healthcare costs substantially.”111
In summary, NA studies, NA-inclusive 12-Step studies, and published reviews of 12-Step research (including Twelve-Step Facilitation treatment approaches) all report a strong association between NA participation and reduced drug use and increased rates of abstinence. Confirmation and clarification of this relationship awaits additional studies of increased methodological rigor using larger and more diverse population samples, including non-treatment samples. The available evidence suggests the potential value of NA participation in recovery initiation and long-term recovery maintenance.
Effects of NA Participation on Global Health.
Christo and Sutton compared 100 NA members to a control group of 60 students and found that diminishment of anxiety, improvement in self-esteem, and increased employment linked to duration of NA participation.117
Beygi and colleagues compared the coping styles of NA members and patients in methadone maintenance treatment (MMT) in Iran. NA members had higher ratings for interpersonal relationships, physical health, and positive coping skills than patients in MMT.118
Taallaei and colleagues compared quality of life scores of NA members, members of a therapeutic community and patients enrolled in methadone maintenance treatment in Iran. Participation in all three of the interventions increased quality of life scores, with the NA group scoring highest on quality of life.120
Akhondzadeh and co-investigators compared the personalities of 100 NA members and 100 patients in MMT in Iran. NA members scored lower on neuroticism and higher on agreeableness.121
Mansooreh conducted a study of the quality of life of 110 male NA members in Iran. The authors concluded: “an increase in the membership duration in NA was associated with lower levels of depression and physical pain and higher levels of general health and positive emotions.”124
Azkhosh and co-investigators compared 20 NA members, 20 methadone maintenance patients, and 20 patients receiving acceptance and commitment therapy (ACT) in Iran. The ACT group scored higher on psychological well-being and psychological flexibility.126
Hosseini and colleagues studied the psychological well-being of 368 NA members in Iran. The study concluded: “consistent participation in NA self-help groups can significantly lead to an increase in quality of life.”128
Time is a critical ingredient to achieving effects via NA participation. For example, while reduced drug use and initiation/stabilization of abstinence can occur early within NA participation, recovery of psychological health may take up to five years following cessation of drug use.137 Positive outcomes related to NA participation are dependent on two factors: Intensity of participation and duration of participation
Table 12: Suggested Actions to Increase Youth Participation in NA and other 12-Step Groups
help young people structure their time before and after meetings and monitor their interactions with group members to minimize situations that may lead to relapse;
become familiar with group customs and languages in order to prepare youths for meetings, make appropriate referrals, and clear any misunderstandings;
research the characteristics of local meetings, including age composition of members, so that referrals can be tailored based on youths’ needs, preferences, and cultural backgrounds;
investigate the variety of recovery support groups offered in a given area to provide youths with a menu of options;
recognize that some youths may need to try a diversity of meetings before finding one (or a combination) that feels comfortable;
interact with recovery support group service structures and develop a list of reliable group members to connect youths to the recovering community; and
implement assertive rather than passive referral strategies, including connecting youths to sober social activities sponsored by support groups, helping youths identify and approach sponsors, screening sponsors for appropriateness, monitoring attendance, and monitoring reactions to experiences and program concepts.”233
Conclusion: Systematic reviews of professional treatment of substance use disorders whose primary goals and methods focus on engagement and increased participation and retention in NA (e.g., 12-Step Facilitation) confirm that such an approach is as effective, but not more effective, than other treatment approaches on several outcomes. Twelve-Step Facilitation that includes assertive linkage to NA is recognized as an evidence-based practice by the National Institute on Drug Abuse, the Substance Abuse and Mental Health Services Administration, The National Association of Addiction Treatment Providers, the American Psychological Association, and is listed in the Directory of Evidence-based Practices for Substance Use Disorders.
Alcoholics Anonymous and other 12‐step programs for alcohol use disorder - Cochrane Systematic Review 2020
Manualized AA/TSF interventions usually produced higher rates of continuous abstinence than the other established treatments investigated. Non‐manualized AA/TSF performed as well as other established treatments
Implications for practice: The evidence suggests that compared to other well‐established treatments, clinical linkage using well‐articulated Twelve‐Step Facilitation (TSF) manualized interventions intended to increase Alcoholics Anonymous (AA) participation during and following alcohol use disorder (AUD) treatment probably will lead to enhanced abstinence outcomes over the next few months and for up to three years. Findings also indicate AA/TSF may perform as well as other clinical interventions for drinking intensity outcomes; however, these results are based largely on low certainty evidence and so should be regarded with caution.
Economic analyses suggest probable substantial healthcare cost savings can be obtained when treatment programs proactively and systematically link people with AUD to AA using TSF strategies, such as those used in the studies included in this review. The analyses indicate that the reason for this benefit is due to the ability of the AA/TSF to increase AA participation, and thereby increase abstinence rates. Thus, a relatively brief clinical intervention (AA/TSF) can help people with AUD to become engaged in a long‐term, freely available, community‐based, recovery support resource that can help them sustain ongoing remission.
If people with AUD are opposed to attending AA, despite the strong evidence for its potential to aid recovery, clinicians might consider linkage to alternative mutual‐help organizations as they may confer benefits at similar levels of engagement. Alternatives might also be considered when a patient has made a sustained effort to engage AA, but not derived sufficient benefit from it.
There’s no such thing as a “functioning alcoholic” (or any other addict!)
But maintaining this difference between a functioning addict and a regular addict can be harmful to a person who truly struggles with a substance addiction. The term can act as a barrier to someone deciding to get help. If my drinking or drug use isn’t causing too much harm, and if we’re all casually joking about it, is it really that big of a problem?
The “functioning addict” idea can indeed fuel a lot of delusion. I used to convince myself opiates were performance enhancing for me to the extent I would look down judgmentally on colleagues who drank alcohol at lunch—“Don’t they consider the impact that will have on their work!?” Meanwhile, I’d just been taking heroin in the toilet.
A substance may be functional at first in the sense that it helps you cope. But the addiction is papering over the problem, which is growing and growing all the while. That’s partly why it can be so terrifying to quit—you are confronted with all the problems you tried to escape in the first place, many magnitudes greater by now, with your self-esteem in tatters. From this stems the belief “I can’t cope without it.”
Finally, all aspects of my life spiraled out of control. My performance plummeted, and progressive dysfunction set in…. Sometimes people cling to a romanticized idea of the functioning addict, the creative genius, etc. But the reality is most people’s output slides in quantity and quality as their addiction progresses.
An addict may be “functioning,” but at what cost? What cost to their physical and mental well-being, to their social and professional life, to the well-being of their family?
Prevalence and pathways of recovery from drug and alcohol problems in the United States population: Implications for practice, research, and policy
Conclusions: Tens of millions of Americans have successfully resolved an AOD problem using a variety of traditional and non-traditional means. Findings suggest a need for a broadening of the menu of self-change and community-based options that can facilitate and support long-term AOD problem resolution.
Breaking Free Companion Recovery App: The app has been designed specifically to tie in with the Breaking Free Online treatment and recovery programme. Its main focus is on strengthening peoples recovery and resilience from drug and alcohol difficulties by using mobile technology to bring psychological techniques into real world settings.
To download the android version of the app click here or visit the Google Play Store and search for “Breaking Free Companion” app.