8.  Methadone treatment requires a strong commitment to recovery

Methadone treatment is a lot of work.

But many people make the effort because the treatment works for them and they decide it’s worth the effort.

Commitment to overcoming stigma

The methadone patient must overcome the stigma that surrounds methadone treatment.

They have to get past family and friends who try to tell them that they are “trading one drug for another” or that they aren’t “really in recovery.”

They have to get past the voice in their own head that worries that maybe the naysayers are right.

They have to get themselves educated enough to know the facts, and recognize misinformation and myths about methadone that may prevent them from benefiting from the single most effective treatment for opiate dependence -methadone.

Commitment to treatment

Methadone is a treatment that helps people successfully manage opiate dependence as a chronic and relapsing condition.

Methadone prevents withdrawals, eliminates major cravings, and blocks the effects of other opiates.  But only as long as the treatment continues.  For many people, treatment may be most effective if continued for a period of years or decades.

This takes commitment.

Commitment to abstinence

Methadone clinics provide abstinence-based treatment.

Patients will not be permitted to stay in treatment if they do not demonstrate a commitment to abstinence.

Methadone provides strong but limited support for maintaining abstinence from opiate use.

It takes real effort to make the significant behavioral and psychological changes necessary to maintain abstinence from opiates during methadone treatment.  And these are the changes that increase the likelihood of maintaining abstinence if at some point the patient chooses to discontinue methadone treatment.

Methadone is a powerful tool for recovery, but it is not a magic bullet or an easy “cure.”

Methadone is a treatment for opiate dependence.  But people with opiate dependence often use other substances too, including cocaine and alcohol.  Many continue use after they begin methadone treatment.

This is to be expected given the biological basis of addiction, the complexity of people’s lives, the fact that there are real reasons people use drugs, and the difficulty of changing psychological and behavioral patterns of long standing.

Using cocaine, alcohol or other drugs with methadone increases drug overdose risk.   And use of other substances may make it more difficult for people to achieve the kind of stability in their lives necessary for sustainable recovery.

Methadone clinics monitor use of a range of substances, and methadone patients who do not demonstrate a commitment to abstinence face discharge.

Commitment to clinic-based treatment

Patients seeking methadone treatment for opiate dependence have to go to clinic-based programs.

This type of treatment is not available through private doctors in office-based settings (private doctors may only prescribe methadone for the treatment of pain in most cases).

New patients are required to go to the clinic to take their dose under observation every single day.  Going to a clinic every single day (even on weekends) without a break, and  for a long time takes real commitment.

Some days the visit is just to take the medication.  Other days the patient must also provide a urine sample for a drug test.  And other days the patient must participate in counseling.

“Clinic fatigue” is a real problem, and can become a barrier to treatment.

Patients can get a single take home dose for holidays or other days the clinic is closed.  Beyond that, take-home doses have to be earned.

The medical director of the clinic is required by federal law to take into account certain criteria in deciding if a patient may be granted take-home doses.

Criteria include abstinence from use of drugs including alcohol, regular clinic attendance, lack of behavioral problems at the clinic, lack of known recent criminal activity, stable home environment and social relationships, length of time in treatment, and assurance of safe storage of the medication at home.

Once the patient is determined to be eligible for take-home doses, federal limits on the number of take-home doses are applied (state and clinic limits may also apply).

Under federal limits, patients are limited to a single take-home dose per week during the first 90 days of treatment.  This increases to two per week during the second 90 days in treatment, and three per week during the third 90 days in treatment.

In the remaining months of the first year of treatment, patients may be given up to a 6-day supply of take-home medication.

After one year of continuous treatment, a patient may be given up to a two-week supply of take-home medication.  And after two years of continuous treatment, a patient may be given up to a one-month supply of take-home medication (but must make monthly visits to the clinic).

Commitment to recovery

People who are participating in methadone treatment have made a strong commitment to recovery.  They are making a real effort every day to live with and seek to overcome their opiate dependence -just like everybody else who is in recovery.

Please support people in methadone treatment in their right to choose their own path to recovery.

Think about how insulting and demoralizing it would be to have your efforts and successes disparaged by family, friends, or people who have chosen other paths to recovery.

Methadone-assisted recovery is real recovery!