9.  Methadone-assisted recovery is real recovery

People in the recovery community often have strong feelings about methadone.

I guess everyone is entitled to their own opinion.  But people are are not entitled to their own facts -especially when their misrepresentation of the facts harms other people.

People in methadone treatment often face discrimination, even within the recovery community.  Some are told they are not allowed to speak in 12-step meetings.

Many “sober houses” do not accept people in methadone treatment.  There is sad irony in this given the fact that most sober half-way houses experience high turnover due to relapse, and methadone treatment limits relapse.

Uninformed talk suggesting that people in methadone treatment are not “really sober,” or are not in “real recovery” results in serious harm to already vulnerable people.  That kind of talk discourages people from participating in a proven treatment that often literally saves lives.  This is serious stuff.

Let me state clearly that methadone-assisted recovery is real recovery.  Very real.  And yes, that is a fact.

Let me walk you through this:

Opiate dependence is diagnosed and defined under the DSM-IV TR (Diagnostic and Statistical Manual of Mental Disorders) by the existence of a “maladaptive pattern” of opiate use leading to “clinically significant impairment or distress.”

The diagnostic term “opiate dependence” is a term of art that is really about more than just physical dependence on the drug.

Opiate dependent people use opiates in an unhealthy way, and they persist in this unhealthy pattern of use in spite of negative consequences.

Most of us call this “addiction.”

This is why the person recovering from surgery who is physically dependent on opiates (they would go into physical withdrawal if they abruptly stopped taking opiates) would not be diagnosed as “opiate dependent” under the DSM-IV TR.  The surgery patient is taking the opiates in a healthy way that results in positive consequences -not in a maladaptive way that results in negative consequences.

Negative consequences linked to opiate dependence include financial hardship, loss of employment, loss of child custody, incarceration, homelessness, overdose, and health problems including abscesses, HIV and hepatitis C.  These consequences also often include estrangement from significant others, family and friends.

Substances in the opiate family generally do not cause, in and of themselves, serious damage to the body (unless the person overdoses).  This is true even for long term opiate use.

This isn’t to say that a maladaptive pattern of opiate use does not result in harm.  It’s just that the harm associated with opiates is really less about harm to the body caused by the substance itself, and more about how maladaptive use interferes with social functioning, or how use results in injection-related harm.

Methadone is a medication that supports opiate dependent people in ending the unhealthy pattern of opiate use. Just as importantly, methadone helps opiate dependent people recover from the harm they have already suffered because of their unhealthy pattern of opiate use.  And it helps them avoid suffering new harm.

For example, the heroin addict loses her job, and the methadone patient finds she is able to hold a job again.

The opiate dependent person shares syringes and becomes infected with hepatitis C; while the methadone patient stops injecting, and finds his life is stable enough to participate in medical treatment for hepatitis C.

Oxycontin misuse lands the opiate dependent person in jail; while the methadone patient finds that she no longer is driven to crime, and is able to successfully complete probation.

This is called recovery.  And it is real.

Let’s take a closer look.

I like to say that “real recovery” is safe and sustainable.  How does methadone-assisted recovery stack up?

Methadone-assisted recovery reduces risk and enhances safety.

Statistics show that opiate-dependent people in methadone treatment are less likely to overdose, and are less likely to become infected with HIV or hepatitis C.  They are also less likely to experience homelessness, joblessness, violence, incarceration or loss of child custody.  They live longer.

Methadone improves treatment retention, limits relapse, and enhances stability in recovery.

Involuntary discharge and drop-out rates are high for most other forms of treatment for opiate dependence.  This results in unstable recovery.

This is true of detox programs, outpatient counseling programs, 12-step programs, short term residential treatment programs and long term residential treatment programs.

This isn’t  to say that these other forms of treatment don’t have value.  Each works for some people some of the time, and each is a recovery tool that has value when used properly as part of a comprehensive recovery plan.

The important point to notice is that people in methadone treatment often stay in treatment for years or decades -all the while enjoying the health benefits of recovery, and all the while avoiding the relapses and destructive cycles that are so common in other forms of treatment.

The healing that flows from recovery can only happen if the treatment results in long term stabilization.

Relapse places people at serious risk.  Constant cycling between chaotic use, incarceration, detox, and residential treatment contributes to instability in recovery, and exacerbates many of the harms associated with opiate dependence.

Methadone helps create the conditions necessary to build a safe and sustainable recovery.

Methadone promotes REAL RECOVERY!