The Bipolarity in the Treatment of Drug Addiction
Statistics, burnt foil and discarded syringes on city sidewalks convince civil authorities and passersby that drug addiction is a problem. Their viewpoint on how to handle the matter, however, swings into discord.
The global organization Narcotics Anonymous (NA) promotes complete and ongoing abstinence as the way forward for someone addicted to drugs. However, even while holding that view, the NA makes a degree of allowance for those incorporating Medication-Assisted Treatment (MAT) or Opioid Replacement Therapy (ORT), otherwise known as drug replacement therapy, when using doctor-prescribed drugs such as methadone or buprenorphine.
Regarding such usage, the NA’s publication NA Groups and Medication says: “It is helpful to remember that our Third Tradition clearly states that membership in NA is established when someone has a desire to stop using or when they choose to become a member, not when they are clean.” However, the same publication goes on to say that “because NA is a program of complete abstinence, groups do sometimes limit the participation of members on drug replacement to ensure the clarity of the NA message. Yet, we must balance this limited participation with the idea that membership in NA comes with a desire to stop using, not abstinence.”
So, while complete abstinence isn't a requirement to join and participate in NA, someone on drug replacement needs to at least have the desire to stop using, which would include a desire to stop using MAT substances such as methadone and buprenorphine. As long as a person has that desire – which they could show simply by wanting to join – they're in.
For other organizations, though, such as the World Health Organization (WHO), the requisite addiction treatment involves a different kind of desire; namely, the desire to get stabilized by means of the drug replacement therapy itself, and not the desire to abandon drug replacement therapy entirely. In a February 25, 2025 news release, WHO stated: “While some 64 million people globally are estimated to live with drug use disorders… WHO recommends the use of a range of treatment options for opioid dependence. These include opioid agonist maintenance treatment (or OAMT) with medicines such as methadone and buprenorphine.” The release further adds: “In the choice of treatment, WHO recommends OAMT to be used for most patients as the intervention with strongest evidence of effectiveness for a variety of outcomes.”
So, whatever you want to call it – ORT, MAT or OAMT – the WHO-backed approach to treating opioid addiction, widely supported in the medical field, is drug replacement therapy – not abstinence. And the argument for this approach distinguishes drug addiction from drug dependency. From that standpoint, if you opted for drug replacement therapy and maintained that regimen, you’d still be considered drug-dependent, but you wouldn’t be viewed as drug-addicted; that is, you wouldn't be viewed as someone dependent on drugs in an uncontrolled, damaging way – the proverbial drug addict. Rather, you’d be viewed as someone who’s simply taking their medicine and who’s now able to function healthily and productively in society.
The book Drugs, Addiction, and the Brain (Koob, Arends, Le Moal, 2014) reveals that “the main principle behind opioid substitution is that an individual with opioid addiction will be able to regain a normal life and schedule while being treated with a substance that stops the person from experiencing withdrawal symptoms and drug cravings… However, there is no reversal of neuroadaptations in the brain, and the individual remains dependent and will manifest withdrawal and severe craving if the substitution drug is abruptly removed.”
So, while the person on drug replacement therapy may have eliminated the abuse of substance abuse, they haven’t truly broken free from the substance of substance abuse. They’re still dependent on drugs. They’ve just exchanged the street drug for one sanctioned by medicine, and the street dealer for one active in medical practice. And this brings the overall subject back to the viewpoint supported by NA. The aforementioned NA publication offers the following hopefulness regarding those combining drug replacement therapy with activity in NA: “It may be helpful for all of us to remember that many addicts on drug replacement eventually do get clean, stay clean, and find a way of life they thought was unobtainable before coming to NA. This process doesn’t always occur when an addict attends his or her first meeting—getting and staying clean is often a decision that’s made after attending many meetings over a period of time.”
Therefore, while someone in drug replacement therapy may no longer be considered a criminal, and while their way of life may now have culminated to a place of newfound health and to a feeling of being truly able to contribute to the community in a way not yet experienced since their drug addiction’s onset, they are nevertheless still viewed, from both the NA-backed and WHO-backed perspectives, as not yet clean.
Photo Source: Narcotics Anonymous
