4.  Long term treatment with methadone is better than short term treatment with methadone

Let’s review.  Opiate dependence is a chronic, relapsing condition.  Methadone treats opiate dependence by supporting recovery.  It does not cure opiate dependence.

With this in mind, it should make sense that longer periods of methadone treatment are better than shorter periods of methadone treatment.

Addiction research confirms this.  Treatment for a period of at least two years is recommended.  Methadone is medically safe for long term use.  For many patients, life long treatment is most effective.

This is well settled scientific fact.  Yet people who are in methadone treatment face a lot of pressure to stop their treatment sooner rather than later.

The pressure comes from family members and friends.  It comes from other people who are opiate dependent, both in and out of recovery.  It comes from treatment providers including some people who work in methadone clinics.  It comes from peers at self-help meetings like AA (Alcoholics Anonymous) and NA (Narcotics Anonymous).  And it comes from the little voice in the methadone patient’s own head.

I think that if most people took the time to think about it, they would guess that longer periods of methadone treatment are more effective in supporting long term recovery than shorter periods of methadone treatment.

So why all the pressure, even from people who should know better?

Stigma.  Most of us have internalized social messages that people who use drugs are bad.  That illicit drug use is wrong/immoral/sinful/impure.  That what drug users need is to be “clean.”

By “clean” we don’t just mean free from addiction.  We mean abstinent from all substances we judge to be morally questionable, including some prescribed substances relating to opiate dependence.  But why?

Many of us have internalized social messages that “clean” is a moral, virtuous, pure state.  And to reach this state, the purification of suffering is somehow required.

I know that many people think that suffering motivates people to seek recovery.  And to a limited extent that is true.  But why would people feel that recovery itself should involve suffering?  Isn’t that de-motivating?

I can only conclude that for many, feelings about recovery are complicated by their moral judgments about drug use.

People who feel this way at some deep level often feel that being “clean” with the help of a medication is inauthentic.  It’s cheating.  It’s morally suspect.  It’s too easy.  It’s “trading one drug for another.”  It’s not really being clean.

Compare methadone treatment to residential drug treatment.

Most people would accurately guess that longer periods of residential drug treatment are more effective in supporting long term recovery than shorter periods of residential drug treatment.  This seems obvious.  And it feels right.

But why does it seem obvious and feel right in the case of long term residential treatment, but not long term methadone treatment?

In part, I think it is because long term residential treatment is seen as pure.

Social exile, strict rules, loss of everyday comforts and pleasures create a sense that residential treatment is somehow purifying.  It’s perhaps akin to the feeling that by spending time in jail a person has “paid their debt to society.”   Many probation officers use residential treatment as a de facto sanction or punishment.  In residential treatment, even sex is forbidden.  It’s a place for wholesome and rigorous living, like a convent or a monastery.

If someone relapses during residential treatment, the person is kicked out.  This feels good and right to many people too.  The person who is impure is not fit to live among the pure.  They got what they deserve.  And maybe when they “hit bottom” they will have suffered enough to be given another chance at recovery.

Perhaps you feel I am overstating this.  But what I am trying to do is vividly describe certain elements of the social psychology at work in this context so that it is easier to recognize.

Recognizing the social and psychological forces that put pressure on people to avoid methadone treatment, or to terminate methadone treatment prematurely is important.  It can help us avoid contributing to the pressure, or succumbing to the pressure.

So let’s put the judging away.  Let’s put away the shame and shaming.  Let’s recognize that we are all doing the best we can.  We are all worthwhile human beings with a lot to offer the world.  Let’s be gentle and kind.  And let’s look at the proven facts.

Methadone treatment is the single most effective treatment for opiate dependence.

Longer periods of methadone treatment are more effective than shorter periods of methadone treatment.

People in long term methadone treatment live longer than people in short term treatment.  They are less likely to be the victims of violence.  They are less likely to commit crimes. And they are less likely to experience drug overdose, transmission of HIV and HCV (hepatitis C), incarceration, loss of child custody, unemployment or homelessness.

The metrics all favor long term methadone treatment.

If you are in methadone treatment, recognize that you are doing something that is good for you.  Give yourself credit for that.  Treatment is never easy.  Remember on those days when you would rather stay home than go to the clinic again that you are doing something that is really good for you.

Methadone isn’t right for everyone.  But for many people who are opiate dependent, this treatment is well worth the effort.

If someone you love is a methadone patient, support them in maintaining their treatment.  Treatment isn’t easy, and your loved one needs your support.