Addiction recovery with methadone is still recovery

Opioid addicts enrolled in maintenance programs that replace drugs like heroin with drugs like methadone are 70 percent less likely to die than addicts who are not enrolled in those programs. They're also less likely to spread or contract HIV, and experts from the CDC to the Betty Ford Center agree that these programs save lives, improve quality of life, and should be considered equivalent to cold-turkey recovery. So why, asks Maia Szalavitz at The Knight Science Journalism Tracker, do so many news outlets report the opposite?

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  1. If you understand addiction to be a compulsive use of something (alcohol, drugs, etc.) that reaches the point of being self-destructive, then you'd see methadone as an effective treatment, it's very effective harm reduction.

    Unfortunately, 12 step programs embed a kind of puritanical moralizing about abstinence that redefines addiction as a permanent disease, an innate attribute of the person they are powerless to change, with the puritanical terror of the power of temptation of any intoxication to pull the addict into sin. So the 12 step view is that any kind of intoxication is a complete moral downfall (that will inevitably cascade to death), even if that intoxication is a maintenance drug. Many 12 step participants actually have had sponsors push them off their psych. meds to great harm.

    Because of the way that puritanical moralizing about abstinence got embedded in 12 step programs, and the way 12 step thinking dominates our culture's approach to addiction and recovery, ideas of harm reduction, moderation, self-empowerment to permanently change behavior, and other things that are contrary to the 12 step dogma get very little traction, even when evidence suggests that they can be very effective.

  2. IMB says:

    I think you should do what works for you. I think the point is that there probably isn't a standard issue protocol for everyone.

  3. If it worked for you, that's great. I don't have an issue with 12 step programs existing, only their dominance of the discussion of addiction and recovery when their outcome rates are so low, and their missionary zeal to claim they are the only effective approach.

    There are more evidence based approaches that can be helpful and empowering for some people: SMART Recovery, Rational Recovery, LifeRing/SOS, Life Process, etc. I'd like to see evidence based addiction treatment approaches based on current research available to those trying to recovery from addiction, since religious programs like AA are a poor fit for many (though not all, and I am certainly glad it worked for you).

  4. Any discussion around addiction suffers from a few things, one if which is misinformation. Both the general public, and people in 12 step programs both have a very poor understanding of what drug replacement/maintenance therapy is, and what the different drugs are.

    -Drug replacement therapy for opiates was never meant to be a stand alone option. It has always been meant to be used in conjunction with some sort of private therapy or a structured outpatient program. Unfortunately, this isn't normally the case, because therapy and programs are expensive and in short supply in the US.

    -Methadone and buprenorphine (Suboxone) are both used in opiate replacement therapy, but are very different drugs. Without going into the how they work on the brain chemically, methadone gets you high and buprenorphine doesn't (after a day or so). Further, it's possible to stack additional opiates with methadone to achieve a high, where buprenorphine really bind to the receptors in your brain making it nearly impossible to achieve a high from another opiate. The catch is getting off of long term buprenorphine use is absolutely horrific. Acute withdrawal can last for 28 days, and long term withdrawal up to a year. It is also extremely expensive in the US, and can be hard to get a doctor to prescribe, because special training is required. A second issue is that chemically methadone and buprenorphine are more physically addictive than any other opiate, including heroin. These were meant to be used as short term replacements (especially suboxone) to get the patient through the worst withdrawals and start learning to live without opiates. They have become long term solutions, so people are staying on them for decades. This isn't necessarily a bad thing, but physically, mentally and financially there are a lot of negatives to using drug replacement therapy in perpetuity.

    -"Recovery" This is really a term from 12 step programs - it isn't medical. "Recovery" refers to, in the 12 step context, of being abstinent from drugs AND actively "working the program" (attending meetings, going through the 12 step process). I think a lot of confusion sadly occurs because many people can completely turn around there lives with the help of drug replacement therapy, and stop actively abusing opiates, but people in 12 fellowships, and counselors who recommend them, don't consider these people in "recovery". They are "abstinent", which in the 12 step lens is considered no good.

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