In recovery circles (both in-person and online), I hear people say, “MAT is just a crutch!” Here’s where they’re wrong … and how they could be right.
You may have heard the phrase, “MAT is just a crutch,” thrown around in a derogatory way, as if those using medication-assisted treatment (MAT) to recover from substance use disorder somehow have some kind of second-rate recovery, or that their efforts are less-than. Or maybe you encounter this phrase about a specific medication. “Suboxone is just a crutch!” naysayers shout. “Naltrexone is just a crutch,” people write in bitter Facebook comments. As a person using MAT, this can be hurtful, but it’s also downright silly for a number of reasons. But as I was thinking about this accusation, I realized that it can be used to provide some useful ways to think about recovery, as well.
Why this metaphor is a problem
Calling something “a crutch” in this sneering way is really dismissive and Ableist. Ew. Just ew. Whether you’re in recovery yourself, have a loved one who is, or work in the field, it’s likely you’ve encountered all kinds of stigma yourself. You know how stigma feels, and what kinds of effects stigma can have on mental health. If you want to know more about the effects of Ableism on mental health, this blog is a good place to start.
For many of us, recovery is a matter of life and death. Judging someone’s path to recovery can be actively harmful to their ongoing recovery and health.
The real problem with this analogy isn’t the term “crutch” itself. The problem is that it’s used in a derogatory or demeaning way, rather than as a thoughtful lens to consider recovery. But if we open our minds, this analogy can be used in a more useful way.
Using the “crutch” metaphor:
A “crutch” is a medically necessary device
Most often the sentiment, “It’s just a crutch,” is used to imply that MAT shouldn’t be used at all. However, crutches serve a very real and valid purpose and can be medically necessary in a number of different scenarios. Think about it like this: “If my leg were broken, of COURSE, I would need a crutch!” Crutches serve two main purposes: They allow a person freer movement, and they keep the weight off of a hurt leg or foot, so it has a chance to heal unimpeded.
Pretending that addiction and mental health are not every bit as real as other conditions, or that they don’t themselves have a physical component, is as damaging as it is common. We use all kinds of assistive technology when treating physical ailments (crutches, slings, defibrillators, etc.) and don’t give them a second thought. Why is it so difficult to accept that there are tools that assist in mental health needs as well? In addiction recovery, medication relieves cravings and withdrawal symptoms so that an individual can recover and heal from their substance use. It’s not logical for a tool like that to be treated with skepticism and disdain.
Crutches are used for varying lengths of time, based on the need
There are many opinions out there on what the ideal amount of time to stay on MAT is—perhaps as many opinions as there are people utilizing MAT! But there is no single answer; treatment is not “one-size-fits-all.” After all, the duration crutches are used is based on the injury or disability. A knee sprain might only require someone to use crutches for a week, while a broken ankle might need 6 weeks, or a shattered femur 12 weeks or more. And there are those who sustain injuries or have congenital conditions that may require the use of crutches for the rest of their lives. Just because someone is using crutches, that does not mean they are any less of a person, nor does it invalidate their struggles or path to healing.
Similarly, some people find they need the support of MAT for a relatively short time, while others will use it for years … or for the rest of their lives. Research shows that stopping MAT too soon is far more damaging than staying on it long-term.
Duration of therapy is not an indication of how “strong” your recovery is
Some people may find themselves trying to come off of crutches only to realize that they are not healed yet. Others may wind up re-injuring themselves and requiring crutches again after having been off of them for a while. Some may also discover that their injury is too great, or that the risk of re-injury is so high and disastrous that it is safer to continue to use crutches for an extended period of time. At the end of the day, everyone’s path is different, and these are decisions best left between each person and their medical provider. It is not our place to judge this decision, but rather to remember that their needs may be different from our own.
It may also be helpful to think of the duration of use being dictated not by how “well” someone is able to heal, but rather the extent of the damage done. After all, crutches may be needed longer for a broken ankle than for a sprained ankle, and longer still if it has been broken multiple times.
A person who happens to heal up quickly and set their crutches or walking stick aside is not more valuable or valid than someone who needs support for longer. Nor is a person who stops MAT quickly stronger or better in their recovery than a person who uses buprenorphine, methadone, naltrexone, or acamprosate long-term.
The next time you hear someone say something like, “It’s just a crutch!”, take a moment to look past the judgment implied and remember how useful the analogy can be. Pause and remember that there is nothing wrong with crutches.