12-Step oriented and abstinence-based programs have been slow to embrace the use of maintenance medications, particularly buprenorphine, but also naltrexone, in the treatment of addiction where the use of opioids is the presenting symptom. The result has been a dichotomy where maintenance prescribers avoid abstinence based ideas and treatments, and abstinence based programs refuse to admit patients on maintenance therapy or oppose starting patients on buprenorphine. The literature supporting both approaches is also robust and specific. So, why can’t these two treatment modalities be combined? This presentation will explore these ideas and present an experience that successfully combines abstinence-based treatment with the use of buprenorphine in an environment where naltrexone and no opioid medication are also provided to patients in the same groups and structure.

• Understand the usefulness of buprenorphine in 12-Step oriented treatment.
• Understand the benefit of 12-Step recovery and treatments in patients taking buprenorphine.
• Mediate controversies between advocates for partial agonist treatment and advocates for abstinence-based treatment.