What do you think of methadone treatment – is it good for me?

Dear Stanton:

I wonder what you think about methadone maintenance. In two years I’ve detoxed from heroin 6 times – I never get beyond physical withdrawal (back using within 10 days, released from hospital after 5 days).

I have decided on methadone maintenance – I look at it like insulin – it is a small discomfort compared to the expense, etc. of using illicit drugs. I find my life is much more balanced and I have no problem maintaining a “normal” life. I know that I am leaning on & depending on methadone & should be able to be a complete person without it. The only discomfort I feel is that my medical insurance won’t pay for it. The stigma from society stinks and I hate having to hide it, also. I do not want to have to struggle physically, anymore. I too many times have had to go back to work with aching joints, chills, gas, diarrhea …get the picture?? I’ll pay $35 per week and run my butt off a little extra to feel 90% “normal” – what do you think of my analogy?

M

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Dear M:

I can’t tell you how to react to methadone. You can tell me. Your story is evidence that methadone helps people. It helps you.

Initially, in Love and Addiction, I opposed methadone for the reasons you outlined. You are still addicted. I was especially influenced by a person whose work I have respected a great deal, Henry Lennard, who wrote Mystification and Drug Misuse, a classic that is now out of print. He published an article in Science with Mitch Rosenthal (“The methadone illusion, Science, 176, 881-884, 1972) that makes the point that the drug does not combat addiction; it simply replaces that object of addiction with one which may be more convenient.

The harm reduction movement in general has made me more sensitive to a point inherent in my work all along-most people have addictive susceptibilities, and we cannot aspire to perfection. If someone is assisted to function, even while addicted, this is a positive step. Our society’s unfortunate prescription against drug use of all kind and insistence on abstinence as the cure for addiction (which I have spent a good part of my career in railing against in the case of alcohol) makes your life harder than it should be. There is no reason for this. You have proven that you can be a heroin addict, and that you can replace that with something that improves your life and is beneficial to society. It is craziness to ignore this positive movement in your life. I am sorry for that.

At the same time, you express your own internal misgivings. I cannot remove these for you. More than this, I share them. Being locked into methadone-even should it be made very convenient for you to take-may be short of your ideals for yourself. You can aspire to do better. There are data about how to do this. Methadone is one of the few drug treatments that has evidence behind it to show it works. However, this evidence indicates that it functions best when combined with social services and auxiliary treatments such as those that enhance skills at coping, internally and externally. (See my list of such skills in my article, “Recovering from an all-or-nothing approach to alcohol“.)

Withdrawal is something people overcome all the time. It is the challenge of leading a drug free life by relying on more finely honed coping responses, ones in which you have learned to be confident, that signals emergence from drug addiction. It can be done, you want to do it, read at my site for ways to accomplish this, and I only wish that the provision and expense of methadone were not obstacles to your efforts to proceed in this direction.

Best wishes, Stanton

References:

A recent volume had a debate between two positions where those on both sides are people I deeply respect. The volume, Taking Sides: Clashing Views on Controversial Issues in Drugs and Society (Guilford, CT: Dushkin, 1996) included articles by Lynn Wenger and Marsha Rosenbaum (a good friend of mine), pro, and Robert Apsler, con, on “Should drug treatment services be expanded.” Apsler’s position is very much like mine, showing that the most popular treatments in America-inpatient and outpatient drug dependence treatment-are ineffective. But he cites data showing that motivated addicts provided with supplementary and directed treatment along with methadone maintenance often show startlingly good results compared with addicts not receiving such treatment. However, Apsler doubts, if methadone treatment is used widely, that such effective supplementary care will be employed. Indeed, to the extent that methadone maintenance is alive today, it is horribly polluted with 12-step propaganda and coercion.

Wenger and Rosenbaum’s article, which appeared in Journal of Psychoactive Drugs (Jan-Mar, 1994), describes a lot of people whose stories resemble yours.