If you have ever read The Fix’s comment section, or other threads where the position of 12-step abstinence collides with harm reduction, then you know the vitriol both parties tend to lob at one another. It gets ugly.
The two positions are as follows: on one end of the spectrum, abstinence from all psychoactive drugs through a 12-step program is the goal toward which recovery must be aimed; whereas the goal on the opposite end is to reduce negative consequences related to drug use, offering practical ways to use drugs safely, while not condemning the use of drugs entirely.
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Both philosophies are movements unto themselves, each with a bevy of passionate advocates. But must the two camps be in diametric opposition to one another? Can one consider him or herself a member of the 12-step community while also advocating for harm reduction, that is, without being crushed by the weight of profound dissonance?
Meet Chad Sabora, a former heroin user who kicked his habit through the 12 steps and is now a harm reduction activist in St. Louis, Missouri. He founded The Osiris Project, which brought harm reduction to Missouri, giving wide access to naloxone (the opioid overdose antidote) along with a clean needle program. Through a grant from AIDS United and the Elton John Foundation, he co-founded the Missouri Safe Project, which gives access to clean syringes, as well as resources for those with HIV and Hepatitis C. Indeed, Sabora has found a unique space in which he has successfully fused the two positions together.
In between 12-step meetings and operating the Missouri Network for Opiate Reform and Recovery, Sabora is busy legislating 911 Good Samaritan Laws and third party naloxone access, which just passed both Missouri’s House and Senate, and is expected to receive the Governor’s approval. He is also working on legislation to fund needle exchanges, more funding for treatment, and a bill that would require insurance companies to follow the Mental Health Parity and Addiction Equity Act.
Below is an interview with Sabora, where we discuss how he went from an anti-medication espousing 12-stepper to spearheading a grassroots harm reduction movement in St. Louis.
Let’s start by clearing the air. You consider yourself of a member of the 12-step community, correct?
In accordance without violating Traditions 10 and 11, I can only say that I belong to a 12-step program of recovery. So yes, I consider myself a member of the 12-step community.
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You also advocate for harm reduction policies such as naloxone distribution, needle exchanges, as well as the use of medication to treat opiate dependence. Are these two stances difficult to reconcile with one another?
Not in the least bit, at all. In order to be an effective advocate I have to close my eyes to what I see on a daily basis through my limited experience with people on medication-assisted treatment. I have seen people that have been strung out on methadone. I won’t lie, I have seen people strung out on Suboxone. They exist. I’ve also seen people, probably more people, fall out of the rooms of 12-step meetings. No path is perfect and no path is right for every person on the planet.
As I close my eyes and read the research, you can see people on buprenorphine have a 70 percent retention rate at a 12-month period when they’re engaged in treatment. Compare that to a 20 percent retention rate with abstinence-based models. By ignoring that evidence I would not be doing the community, whether it be in activism or the addiction field, any good. I have to read the data and ignore some of the things I’ve seen.
What was your stance before diving into the empirical literature?
Five years ago I was anti-medication. I was pro 12-step abstinence only, but I was also operating on a little bit of an ego. And I was just beginning to delve into this world of policy reform, advocacy, and outreach and helping people. The more I got into the world of helping people the more I read the research and the more I kept an open mind. What 12-steppers have to remember is that our spiritual principles apply to all aspects of our life. One of those spiritual principles is open-mindedness. That doesn’t mean you’re just open-minded about the program of recovery. We practice these principles in all our affairs. So if I’m going to be a true person that works the 12 steps and I’m going to be a true advocate on the street, I have to keep an open mind.
So I started talking to people on Suboxone, started talking to people on methadone, I started reading the research, I started visiting MAT outpatient clinics. What I saw was the massive success rate they were having, which is bigger than I thought they would have. Then I took my ego out of the equation and I had to see what was best for each client on an individual basis.
Today, when someone comes to my office and has an ASAM diagnosis, I will take that person to a 12-step meeting, a Suboxone doctor or to a methadone clinic, all just as easily. But I won’t lie, five years ago I was hardcore: it has to be abstinence. I was wrong.
Jordan Hansen recently wrote an article that received a lot of attention. He wrote, “It is time that those of us in the abstinence-based community attempt to make amends for our arrogance and stubborn resistance to what is now an avalanche of proof that MAT works.” You spoke of practicing the principles in all of your affairs, and he speaks to making amends, both critical aspects of the 12 steps. What other parts of 12-step are useful to advocating for MAT?
One of the biggest precepts with 12 steps is the phrase: “contempt prior to investigation.” If you’re hardcore anti-MAT, then you are guilty of violating that precept key to AA. If you truly do a thorough investigation and look at the research, talk to the doctors, you’re going to realize that some people need medication, maybe for a lifetime, to treat their addiction.
So much hypocritical philosophies going on. But I don’t have any hard feelings for the hardcore 12-steppers, I mean, they truly believe it and that’s great for them. That said, I’ve seen situations where sponsors—who are not doctors, psychiatrists, don’t have the education—are having sponsees come off methadone or Suboxone. Don’t do that! If they’re doing well, why mess with it? Just so they can fit in your definition of recovery?
I sponsor guys on methadone and Suboxone all the time, I would never tell them to get off their medication.
Chad and Drug Czar Michael Botticelli at UNITE to Face Addiction in Washington, DC
At the 12-step meetings you attend, are people on MAT allowed to participate? People have said at some meetings people on MAT are treated like “second class citizens.” They can make coffee and fold chairs but not share their stories.
Every group is autonomous so some do some don’t, however the stigma is on the person on MAT no matter what group they are attending. It is a topic I bring up in rehabs during my harm reduction classes, letting them know that if they are leaving rehab on medication it does not define their recovery and I tell them not to let anyone in the rooms make them feel less than. People like me will sponsor them on MAT. We have MAT 12-step style support groups at our outreach center, just to ensure that people on meds have somewhere to go where they are not judged.
Was anyone there for you, someone you looked up to who held your hand while you began to transform and advocate for harm reduction?
Kathie Kane-Willis took me under her wing. She opened my eyes to all of this stuff. She got clean through methadone. She would send me research and we’d talk about it. Then my best friend, who co-founded the Missouri Network with me, started working at an outpatient medication-assisted treatment facility here in St. Louis. It’s one of the best in the area; and also this psychiatrist from Wash U (one of the top schools in the country). All these people showed me the research and I just looked at the numbers.
I recently read that there were 23 million people in recovery in the United States, from alcoholism or drug addiction. Only four million of those people attributed their recovery to a 12-step program. That leaves 19 million people who found recovery through a different path. You can’t argue with those numbers. But, to play devil’s advocate, since we can never get an accurate sampling of 12-step, let’s double that four million. That still leaves millions of people who found a different way. To ignore that would mean I’m not doing my job. My job is to help the still-suffering addict and their families by providing the best resources possible, and the best changes in our current drug policy. We also have to hear from the experts like WHO, CDC, NIDA, SAMSHA, all of them are pushing for more access to medication.
If the people that are anti-MAT typically are your hardcore 12-steppers—with all due respect, because 12-step programs saved my life, no doubt about that, and they save my life on a daily basis because that’s my path—you can’t listen to those people over the doctors and psychiatrists. There is a reason why this research is being done and a reason why we have all these studies. There is a reason why the federal limit on the number of patients a doctor can prescribe Suboxone to is being lifted. We have to start moving forward with science.
Where both camps appear to have common ground is the goal of reducing suffering, but they have different ideas about how to go about that. If “recovery” is a possible shared goal, how do you define recovery?
Did you harm another human being today? Did you put a needle in your arm? Whatever role you play in society, husband, wife, father, did you play that role? Did you do something to help another person today? Are you going to work every day? Are you a productive member of society? That’s the definition of recovery. It’s not do you take any medication? That’s absurd if you actually think about that as the definition of recovery.
If it’s truly a disease, a disorder, whatever you want to call it, there are many ways to treat it. It’s hypocritical to say there is only one way.
Shifting gears, you co-founded the Missouri Network for Opiate Reform and Recovery. There is a brick and mortar center that provides services to the community. Can you describe its aim and what you do there?
Our aims are manyfold. We want to make it cool to be in recovery in St. Louis. We offer a bunch of free services: Kung Fu, yoga, meditation, Buddhist recovery, just a multitude of free things you can do if you’re in recovery, or even if you’re using you’re welcome.
We run a harm reduction clinic, syringe access, HIV and Hep C testing, narcan training, and a 24/7-drop zone so people can get off the streets. We always have food in the fridge, sweets, if you’re kicking and feeling a little sick, you can come and get something to eat.
We do work with families who have lost loved ones. We want to provide a cathartic way to work through grief by helping others. The families come and help out, like when we feed people on the street, when we do legislative work. A lot of these parents have lost their children and they can help us get laws passed. They may have lost their kid but now are involved in an activity that can save someone else’s kid. That gives them more peace than I can ever explain. It makes me feel very good that we’re able to give some of these moms and dads peace. I’ve grown very close with them over the years and I almost look at them like foster parents because both of my parents have passed away.
You were a lawyer in Chicago but addiction got in the way. Want to talk about that?
Right after I finished law school my parents passed away from cancer about 18 months apart. I started my career as a prosecutor, my father had just died and my mother was terminally ill. During that grief is when I got hooked on prescription pain pills, which led to a heroin addiction. That then led to an arrest in February 2008 and my law license was suspended. I am in the process of getting reinstated. I was just struggling with addiction until I got clean on June 9, 2011.
I do understand the legal side of this, the criminal justice side, and the addiction side, too. Every angle.
Did the 12 steps help you grieve?
They did help me with some acceptance. And being able to do a living amend to my parents. But, like I said, my dad passed away in 2005, my mom passed away in 2006, and I didn’t get clean until 2011. So much time had passed, by the time I started feeling my emotions, they had been gone for so long. I have to live with the fact that I never got to grieve their death properly. I never got to feel the hurt of missing them. I still do on a daily basis but I was so used to them not being there. It sucks that I never got to experience that pain they deserve. They were amazing parents.
What do you want people to take away from our talk?
We will not make real progress if the different schools of recovery—methadone, Suboxone, 12 steps, psychotherapy, etc.—continue to waste time and energy tearing each other down. They are all guilty of this and the only thing it does is perpetuate stigma and hurt the ones out there struggling with addiction. We have to find a way to all work together or at least live in harmony with each other.
Zachary Siegel has been a regular contributor to The Fix since 2013.
This content was originally published here.