Secular Addiction Recovery is for Everyone

August 29, 2019

We at CFI haven’t said much about this lately, but one of our legislative advocacy issues is ensuring access to secular, science-based addiction recovery support programs across the United States. In too many communities, faith-based, “twelve-step” programs are the only peer-support group option for people recovering from addiction.

Sometimes people with addictions suffer run-ins with the law that are related to addictive behavior. When this happens, the person may be ordered by a judge to receive substance use treatment including mandatory attendance at peer-support addiction recovery meetings. Unfortunately, many judges seem to lack familiarity with our constitutional right to freedom from religion. When this has happened, courts have ruled time and again that courts must provide a secular option when mandating peer-support group attendance. In the most notable case, an obviously exasperated U.S. Ninth Circuit Court awarded damages to Barry Hazle, who was refused a secular option after being required to attend an addiction recovery program as a condition of his parole.[1] At the time of this ruling in 2013, the Ninth Circuit Court had already issued numerous rulings in favor of plaintiffs who were coerced into religious 12-step addiction recovery programs.

Anyway, as part of my preparation to discuss the issue with Capitol Hill lawmakers, I assembled some evidence that, compared to behavioral therapy alone, Medication-Assisted Treatment (MAT) reduces overall health care costs. It does so by reducing the risk of relapse, which often necessitates costly detoxification and inpatient treatment. There’s research demonstrating that MAT reduces health care costs, both for patients using the commercial health care market and for Medicaid patients.

  • [Nationwide, the risk of relapse associated with opioid use disorder (OUD) was lower for both commercial health care patients and Medicaid patients who adhered closely to a buprenorphine regimen than for patients who did not adhere closely to the regimen.
  • In the commercial health care system, the most adherent patients had an average total health care cost nearly 30% lower than the least adherent patients ($17,519 in the year following treatment compared to $24,431).[2]
  • In Massachusetts Medicaid beneficiaries, opioid agonist therapy (OAT) with either methadone or buprenorphine was associated with a relapse risk less than half that of behavioral therapy alone. OAT treatment was associated with lower health care costs ($153-233 less per month) than behavioral therapy alone.][3]

Admittedly, this is far from a comprehensive analysis. But the causal theory is plausible enough and the association between MAT, relapse, and costs are direct enough that I’m comfortable using these data to support legislative action on secular addiction recovery.

So that’s it. To “fiscally conservative” members of Congress, this may be the definitive case for supporting secular, science-based addiction recovery support. While I believe that all lawmakers should support MAT in principle, I also know well enough to address the concerns of my audience. So, to lawmakers on both sides of the aisle: help save lives by strengthening secular, science-based addiction recovery support! It will uphold the separation of church and state, improve public health, and save money.


[1] Hazle v. Crofoot. 727 F.3d 983 (9th Cir. 2013)

[2] Ronquest, Naoko A., et. al. “Relationship between buprenorphine adherence and relapse, health care utilization and costs in privately and publicly insured patients with opioid use disorder.” Substance Abuse and Rehabilitation. 2018:9 59–78

[3] Clark, Robin E., et. al. “Risk Factors for Relapse and Higher Costs among Medicaid Members with Opioid Dependence or Abuse: Opioid Agonists, Comorbidities, and Treatment History.” Journal of Substance Abuse Treatment. 2015 October; 57: 75–80.