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Jason Schwarz from Dawn Farm in the States has posted a blog on his experience of methadone treatment in Michigan. I’ve posted it below. What’s our experience in the UK and on Wired In on the subject? Is our experience of medically assisted recovery different?
Here’s Jason’s blog:
“Bill White on Methadone and Recovery
I love Bill and have enormous respect for him. This is not the first time I’ve heard him express these opinions and I respect where he’s coming from, but it’s just not been my 18 years experience in Southeastern and central Michigan.
Just last week I admitted another 19 year old who had been going to a dosing clinic, getting no real counseling, no real recovery and little help when he asked to be detoxed so that he could pursue drug-free recovery. These are the kinds of stories I hear without exception.
I recognize that my contact might be limited to a non-representative sample, but I’ve never even heard someone say something like, “Other people were doing well on it, but it wasn’t for me.” or “The people there really cared and treated me well, but I decided I needed something else.”
I’ve yet to meet a person on methadone at a professional conference as a success story. I’ve interviewed countless professionals seeking to leave methadone clinics – including people who don’t have any connection to 12 step recovery.
Methadone seems to be the dominant approach in the U.K. and it appears to be wrought with the same kinds of problems I see locally and the same pessimism about the capacity of opiate addicts to recover.
It’s a crime if there are all sorts of great methadone recovery stories and stigma is preventing them from being heard, but I’m skeptical.
Bill has a history of doing a great job of delivering difficult messages to drug-free treatment providers. If drug-assisted treatment is ever to have a place in a recovery-oriented system of care, it seems to me that the providers in my area need a dramatic culture change.”
I’m interested to hear the experiences of our own community on this one.
Im afraid my experience is very similar to Jasons, i really hope we will get a good response to this blog.
I think its the same story all over the country all over the word,after starting off smoking cannabis when i was 15 to cure the dreaded disease of bordem i then turned to heroin with my ex partner when i was 17 a month after giving birth to my daughter in 2001 as i was suffering post natal depression and it felt like the answer to all my prayers and cure for me until i started withdrawing and that was me sentenced to 6 hard and terrifying years as an addict,in late 07 i had had enough and decided to seek help for the 2nd time in 3 years(i had been on 10 single dihydracodienes a day and had managed to stay clean on them for a few months as my habit wasnt that big then),unfortunatly i still lived in the same house with 3 smack dealers only doors away all willing to give anyone who was interested tic until payday so that was that accidted again,but in nov 07 i was determined to get clean as i had been drining in those last few months to try to wean myself off the heroin which didnt work as whenever i had money for both ,i did both,well i was still heavily addicted to heroin with no methadne or anything,i started methadone on nov 4th 07 and since that day i have never touched another bit of heroin,i had moved away and was nearer fmily and had already had 2 previous warnings from social work regarding my 2 kids aged 6 and 2 then and about the company i was keeping(known drug users with violent pasts) having been on methadone and stable for 2 months i thought i could handle a drink with a few vallies and my usual trusted 70mls of methadone,my ex partner decided he wasnt keeping the kids overnight that night and dragged them round to another drug users house to drop them off well by then i didnt know my own name never mind how to navigate the way to the bus stop and get the bus home so eventually after god knows how longs trying to get the kids to the bus stop the police turnd up and took me and the kids home returnng in the mrning cos id slept in and my ittle girl wasnt at school anyway to cut matters short social work came removed the kids to my mums and to this day i still dont have them back,anyway to the point i worked with s/w and stopped drinking and went on antabuse and gradually started cuting my methadone down,now im at 4 mls my dr just wants to stop it saying i cant possibly need it,in the head or not I KNOW I NEED IT.I still withdraw from it. Has anyone ever been put on subutex on such a low amount of methadone? i feel if i was offered counselling id maybe have felt different about it but there isnt an counsellors who specialise any kind of drugs in my area(20 miles from edinbrgh).It pisses me right off when my dr and s/w keep saying oh yeah this woman is the miracle story that you long to hea but so very rarely do and im not downing myself im pround of how far ive came but why can i let go of this last wee bit of methadone then if im such a miracle,does anyone else feel like this,OH an by the way now ive got my own place im gonna get the kids back gradually but i wanna be CLEAN not 4mls of methadone clean i mean CLEAN CLEAN.If i went cold turkey on 4mls how long would it take to come out my system? please give me any advice you can,im unsure about subutex too,dont wanna subsitute one addiction for another like the meathadone
Well, of course you don’t see methadone success stories: they aren’t going to come to a drug-free treatment program and say help me!
And they are going to be very shy in introducing themselves to people who advocate abstinence because of horrific past experiences. I know because I used to oppose methadone and until I became more open-minded, many people wouldn’t tell me about their experiences.
To make matters worse, the people hanging out at the clinic almost never notice the people who are doing well for the same reason college students tend to over-estimate the number of drunks on campus. The drunks stand out, the sober people dont’. The people who aren’t doing well hang out at the clinic and look bad and nod out— the people who are doing well rush in and out and get on with their life.
And they won’t talk to the media giving their real names because of the enormous stigma associated with being on methadone.
What you get is adverse selection— the opposite of what you get with drug-free. With drug free, the 20-30% of people who are doing well at any given time are visible: they are at meetings, they speak out, they advocate, they are praised if they come forward.
With methadone, the 70% percent who aren’t doing well are visible and speak out and trash methadone. The ones who are doing well are afraid to speak out because they get told they “aren’t really clean” and they feel compelled to say things like, “I really should come off” and like the person above, blame the methadone for problems when in fact, if she’s doing well on 4mg, what is the problem? Her relapse wasn’t due to methadone— it was using on top. She stopped that while still on methadone. The stigma hurts methadone patients by telling them they’re not good enough if they’re still on maintenance more than anything else.
Btw, methadone (or buprenorphine) isn’t substituting one addiction for another. Addiction is compulsive use despite negative consequences— dependence is needing a drug to function. Some people need antidepressants, insulin and blood pressure meds— all of which can cause withdrawal— to function. There’s no difference with methadone. Dependence is not a problem. Addiction is.
METHADONE SAVED MY LIFE
I was on Methadone from 1989 till 2001 and it allowed me to take control of my life and complete my recovery.
When I first started on methadone my main need was to be maintained until I was in a position to get drug free, which I eventually managed because I had a say in my treatment.
I reduced when I was ready to and stopped the reduction when I needed to level out again.( There were times I thought Methadone will do me for the rest of my life and other times that I was desperate to get off of it)
I eventually went right down to 3mg which I took for 2 months I then took 3mg on alternative days for a further month then stopped completely.
Since getting drug free I have worked for a community rehab where I started volunteering which then led to full time employment after this I went to work for Sign Post FV and helped to set up a Harm Reduction service and I am now working with Criminal Justice drug Treatment Service.
If it had not been for Methadone I know I would not be here today or I would be in prison.
Calum
Sarah, well done on your recovery; it sounds like a massive achievement to get as far as you have. It doesn’t sound as if you have too far to go either.
For me, recovery was not just about detoxing, though I did find that hard. It was about changing thinking and behaviours. It was about getting support. It was about allowing professionals to guide me in things I didn’t know much about (like detoxing) and then it was about learning how to live life comfortably drug free. Mutal aid groups like Narcotics Anonymous have helped me greatly with this. Are there any near you?
Listening to your story, I wonder if you are worrying too much about those last four mls. If you are anything like me, maybe your energy would be better help in getting the support you need. There are specific services in Lothian and Forth Valley that might be close to where you are which are abstinence focussed.
Methadone withdrawals start about 24 hours or so after the last dose and will peak at four or five days. From a small dose like you are on, they are likely to be manageable. You could reduce by one ml a week. I can understand your fears around coming off. Get plenty of support.
Remember too that we lose tolerance quickly once detoxed. This puts us at risk of overdose if we use again. The message we give to our clients is don’t use! If you do then don’t inject. Don’t use alone. Use less than normal. Don’t mix with other drugs, particularly alcohol and valium.
I know you’re not planning on using. Keep in touch with the communithy here and tell us how you are doing
THANK YOU Sarah, Maias, and Calum
we really do need to see some positivity about methadone. I get frustrated when the recovery focus becomes basically an anti methadone agenda…I was looking forward to hearing how the anti methadone lobby (who are well represented on this site) would repsond to Bill White and his acceptance that methadone is part of recovery in the same way we accept that medications are part of mental health recovery.. Yes we do need to ensure that methadone and other subsitutes are delivered better and that alternatives such as detox are available…but we should not rubbish a valuable and effective treatment.
BEING ANTI METHADONE IS BEING ANTI RECOVERY as many people are benefitting greatly from it but feel they are failures because of the propoganda that being on methadone is not being CLEAN….Maias you are spot on with your comments….
I suspect this blog will attract some diametrically opposed views, what we do know is that according to the Cochrane review methadone is better at retaining people in treatment than other opiate substitute which raises the question of whether or not one is willing to accept that ‘treatment’ equals recovery.
The next question is whether the majority of those on MMT continue to use other addictive substances and if so to what extent, if any, is the use of them preventing entering into recovery?
My personal opinion for what it is worth is that recovery needs to be measured not only in terms of abstinence, but also in terms of quality of life (QOL), therefore whilst I’m not a fan of MMT I feel that if those engaged in the programmes have abandoned what is referred to as illicit drug use and any co-occurring disorders are being addressed with a view to enable them to function ‘normally’ in the sense of work play rest and exercise, it should be a carefully assessed medical/psychiatric assessment as to whether they should continue on MMT or not. Regrettably there does not appear to be any empirical evidence which suggests that those on MMT do enjoy a QOL meeting those fundamental criteria. In fact what research I have been able to find suggests the opposite.
An extended version of a study some 1,200 people on MMT in Ireland was published in Nursing Times last year http://www.nursingtimes.net/printPage.html?pageid=1811733 and focused on the health concerns of people on methadone, the overall conclusions appears to be that clients on MMT have numerous health related concerns, particularly related to mood and the presence of HCV. The study recommended that the mood of those on methadone should be assessed routinely and that appropriate interventions be implemented. The need for specialist intervention for those identified with HCV although self evident is also emphasised.
In the light of the foregoing it would indeed be interesting to learn to what extent such interventions are regularly applied in current MMT programmes.
Hi Peapod and all :)
For me being on MMT was really productive. I achieved a great deal over the years I was on it. As soon as I started on it I made the choice to stop using and get off drugs, and thats what I did.
Methadone supported me to go back into education, which I’d left at the age of 14. Through mixing with other people I gained confidence and learnt social skills. I made new friends and felt hopeful about the future.
Methadone also provided me with the stability to parent my children better. It brought security to our home life.
When I decided to get off it I was encouraged to do my own detox plan and go at my own rate. By that time I had built a new life for us all and felt much stronger. My coping skills were developed and my life was happy.
I agree with other posts, its easy to notice the people who haven’t done well on methadone. I know people still on it who have a good quality of life. They have a family, mortgage, work and pay tax. Are they happy? Well they say so. Who am I to say they’re not.
The people who have come off methadone are integrated in society. We won’t hear their success stories.
I know that for some people methadone doesn’t work as with every other form of treatment, sometimes it does and sometimes it doesn’t. I agree that Drug Services need to collaborate more with other forms of treatment, be it medical or non medical. We all need to be open to the possibilities of treatment that support people to get off drugs and self actualise.
As the comments above show, many negative issues still need to be sorted out in drug services but many positives about medication-assisted recovery need much more recognition.I found Bill White’s paper on medication-assisted recovery very helpful. For me, it also points to the conclusion that appropriate candidates who have taken the path of medication-assisted recovery should be employed in drug and other treatment services including those supporting abstinence from all forms of drugs. Otherwise, it is another example of stigma towards medication-assisted treatment and recovery and prevents staff, individuals wanting recovery and the wider public seeing the full possibilities for people to get a better life. Is this a correct conclusion from Bill’s paper? Are such employment opportunities available?
It is self evident that pharmacotherapy has an important and in many cases an essential role in the process of recovery, there is nothing new or unique in that point of view as witnessed by the views of 12 step fellowships in their advice to members dating back over many years.
Regrettably many of the established and emerging ‘substitute’ drugs available which are designed to assist recovery, are in themselves addictive, therefore given the obvious vulnerability of those who are already addicted to forming an ongoing dependency on substitute medication, the need for vigilance on the part of the recipients and those responsible for the administration, whilst seemingly apparent, appears in many cases to be overlooked, thus we find long term use to be common when in fact the clinical guidelines suggest that the drug(s) in question are designed for short term use.
That particular practice is not only uncommon in addiction treatment, but also common in the treatment of depression and sleeping disorders, thus it is not unusual to encounter clients with those co-occurring disorders, who have been on medication long after any therapeutic value has expired and, that a dependency has formed.
Sadly I have also encountered cases where those in recovery are still being prescribed anti psychotic drugs by their GP, which were initially prescribed for a short term treatment by psychiatrists. Somewhere along the line a serious breakdown in communication has occurred and the patient is subjected to an ongoing regime which not only has no residual value, but has resulted in avoidable and detrimental changes to both the patient’s mental and physical well being.
An enlightening and informative book on medication is ‘Power and Dependence’ by Charles Medawar, published by Social Audit. Although published in 1991, many of the dubious and unnecessary prescribing practices described are still prevalent today. Another well worth studying is ‘Prescription for Injury’ by Colin Downes-Grainger published by the author in 2007 is also worthy of study.
Whilst those who are in recovery have an invaluable, if not essential role to play in addiction treatment, we need to bear in mind that recommendations for the use or otherwise, of pharmacotherapy, is rightly a decision for those who are not only medically qualified, but also have an understanding of addiction, rather than the opinion of a lay person such as myself.
For me the issue is not one of methadone or no methadone with respect to recovery. It is much more essentially about achieving all that is possible, about moving on, about having aspirations and hope.
Having been involved with treatment services for longer than I care to remember, I’m not sure that we are helping all or even most maintained clients achieve that. In fact we don’t know how many maintained clients would fit the various definintions of recovery.
Unfortunately the same lack of knowledge holds for those who are in drug free recovery. We don’t know really what they achieve. This lack of research is concerning, but is being addressed elsewhere. (See David Best’s blog on the subject).
We have no UK research to tell us how many are in education or training or the workplace. We don’t know how many have achieved their goals (and for some those goals will be to become illicit drug AND prescription drug-free). Essentially that’s why we need the methadone stories to stand alongside the abstinence stories.
I’ve worked in maintenance clinics, I’ve worked in abstinence focussed treatment and my impression is that far more people could move on to achieve thier goals (not mine, nor anyone else’s) if the knowledge, skills, treatment and structures were there to catalyse the process.
There is a challenge here though. How do we encourage people to move on without stigmatising or belittling what they are moving on from?
Look at what’s happening in pockets in the UK. Because of vision, the enthusiasm of recovering people, access to recovery-focussed treatment and developing communities of recovery, recovering addicts and alcoholics are becoming visible and voluble.
I believe that this needs to be an inclusive process, but that part of that process needs to be ensuring momentum is present to help move people on to be all they can be.
Hi all I would like to share my story briefly.
I was first introduced to the 12 steps when i was 18 and i spent 20 years chasing and failing to achieve continual abstinence.
With each defeat i would return to the 12 step felowships feeling all the usuall shame and guilt (mostly my own but certainly the clean time pecking order did not help)
I could not understand why i kept failing I tried as hard as humanly possible.
I could not understand why even though i kept asking god why he was not curing me, after all it is the foundation of the twelve steps that i cant he can and would if i asked him. It felt to me that the suceses were gods victories and despite ,no human power being able to remove my addictions, when i failed i was consistently told it was my fault.
Due to very low self esteem i kept going back even through the being sent to coventry , the constant lectures from people with more ,“clean time”.
Eventually i got ill with hep c and went through the toxic and difficult therapy, i was so ill i could not leave the house so after being told that i never asked for help i did . I phone the numbers the kind people gave me and of the fifty i phoned not one would help(and i dont blame them they were scared of my illness and due to my constant failed attempts peoplehad lost patientswith me).
But the the result of that i finnaly stopped looking for others including god to help me i took responsibility for my self and have never looked back.
For the first time in twenty years i went somewhare else for advice and was extremely lucky to find a treatment agency that believed in client choice.For the fisrt time instead of being told to shut up(cotton wool out of ears and into mouth) I was asked how can we help you?
This simply blew me away and i spent some time really thinking about what i wanted and it was just to live a normal life thats all.
As i had become dependant on pain killers during my treat ment for kidney stones i needed to decide what to do about it. The agency laid out all of the choices from 12 steps to maintenance and helped me decide what next.
As i had given up on the 12 step approach i choose maintenance to give me a breathing space.
since then i have had a quality of life i did not dare to dream about taking only the medication prescribed by my doctor in the manner it was prescribed(one of the definitions of being clean when having to take mood altering chemicals).
Very shortly my life improoved financially, the bills got paid the flayt got cleaned and i met my obligations.
Much more than that i was able to work on very difficult child hood issues(with out having to find what part i played in my own abuse as so many step 4 had done)No child has any responsibilty for what and adult chooses to do full stop.
As my self esteem improoved i for the first time in my life built good relationships honest relationships (not dependant on how well i was percieved to be or if iwas attending meetings)
I was able to deal with my hcv treatment failing , developing diabetes , glucoma and more recently my mother being terminally ill.
I found that i was well liked by people in general and that the self image i had built during my time with the 12 steppers was wrong and destorted. I was capable of managing my own life infact the more responsibility i took the stronger i became. I was no longer a constant disapointment to my only friends which were 12 steppers too.
So i finnaly found what i wanted a good quality sustainable way of life and just as i take insulin i take methadone daily.
As for swapping one addiction for another well that may be chemically true but the effect these different drugs was worlds appart one leading down hill fast and the other helping walk uphill. I have to add it takes me less than five minitues to drink my medicine which beats 3hours every night attending meetings.(another dependance defended on the ground that it helping people.
I hear a lot of attacks from the 12 step brigades on methadone which is surprising as if they read their own book and followed there own doctrine they should have no opinion on out side issues and they should appluad choice live and let live remember.
As for limiting my potential i am afraid that is almost entirley due to stigma even the wonderfull agency i went to has a policy not to employ people on methadone so what chance do you think uneducated employers would give.
They also tell me people on methadone dot feel anything this is just an out right lie , i love my family and am heart broken at the prospect of loosing my mother i feel sad mad happy angry content the full range of human emotions.
Unfortunatley people who get well like this are not part of a larger group that makes a business of getting its beliefs (and they are just that befliefs not facts) to the ears of the descision makers.
And as long as the felowship and its members feel free to attack MMT I would like to say it has more than enough problems of its own to clean up before it starts blowing its own trumpet.
In my time with them i saw sexual predation of newcommers as standard so common they even have a term for it 13 stepping. i have seen people bullied and bellitled in the name of tough love. I have lost friends who were told to stop all their meds immediately and ended up dead.I my self ended up in hospital when i was told by a member not to go to the doctor but to sit it ut and feel every thing so i would never forget,and i never forget waking up in hospital after a fit.
And lastly and most scarily are the poeple who have died trying it this way. By far the highest death rates from opiate addiction are caused though periods of abstinence , like leaving prison or relapsing from abstinence due to tolerance. I have had friends die due to this tollerance problem after a period of abstinence, due to the confidential nature of the felowships no one is held accountable and no advice is given in their literatue because they rarely see a person fail(according to them that is). a simple warning about this should be prominantly displayed and it should be talked about.
And most of all according to its own reaserch there result do not differ from anything else on offer approx 10% making a year ( but really this whole field lacks genuine quantative study. Too often decisions are made on anecdotal evidence. In my area a very active c.a man has tried to have all maintenance stopped in favour of excercise and good food on the basis of 12 people who reached three months clean(12 people with no folow up) and they call this science.
There is also this to consider the law was changed conscerning faith healing , as we are in the year 2009 the law finnaly decided faith healing has to be advrtised as for entertainment purposes only because there is absolutly no evidence it works yet what are the firt steps of the minasota model all about ,faith healing.
If you were to tell diabetics or any other non stigmatic condition that they had to believe in god to get better there would be such an out cry , it would be front page news. Yet as an addict i am meant to put up with this nonsence.
And all of you that will trot out the party line about it not really being about gog have not read there own literature. In the big book of aa (treated like a bible by some) it states very clearly that the entire purpose of the book was to enable you to find a higher power.
There is also a very good comment in the book about closed minds to the effect that contempt prior to investigation was a bar against all learning and i sence a great deal of contempt from the more enthusiastic converts.
I know i will be savagely attacked for my views by the unwitting buchanites (whare bill w learned his trade and a man dedicated to converting the world to religion). I hope it will not be as much as the writer of the orange papers who has recieved deaththreats from members of the 12 step community the same treatment a woman in america got for complaining about the sexual predation.
The twenty years i believed in the twelve steps brought me missery and dispare contrary to their belief i did not die because i left and have met so many others that have blossomed since leaving but as they genuinly are just getting on with their life they dont go back to tell their stories, they only hear the stories of those that fail.
The truth about this field is that no one has all the answers and any that claims to is a snake oil salesman. the 12 step claims that they rarely see a person fail(who thouroughly folows our path) is quite frankly a lie.
I dont like attacking the 12 steps just as i do not like being judged by them i would much prefer that we learn what works and what doesnt from each other and champion choice, educated choice.
So i wish the stepper well if it works for you the go for it , but do not attack what works for others if you cant take critasism your self.
Now your turn i got my armour on i expect i will need it. Oh and i have been stable for 8 years now.
ps the spelling is bad because i was never any good at it it did not happen as a result of methadone.
Thanks for your courageous story, Sturitch. Regarding all the issues you outed I think you have summed up the essential way forward to address them , including the stigma towards medication-assisted recovery in employment, with your words, “we learn what works and what doesn’t from each other and champion choice, educated choice”.
Sturitch,
I congratulate you on the changes you are bringing about in your life. If methadone has played a significant part in bringing about those changes, i cannot think why any reasonable person would want to criticise or in anyway demean the progress you are making.
As an ardent drug free recovery fan my principle concerns about long term MMT the first of which are the documented detrimental side effects that it induces,including the potential for addiction; equally I accept that not everyone experiences them.
My second concern is the reported widespread misuse of other addictive substances by those on MMT which I consider to be obstacles to achieving the full potential of staple and sustained recovery. However neither of those concerns give me, or anyone else the right to attach a ‘stigma’ to those on MMT, and I have not seen any substantial evidence in this blog that such exists, therefore I’m puzzled why Mike McCarron feels it does, but i have no doubt he will enlighten me.
Once again congratulations together with my best wishes for your ongoing recovery.
Peter, which part of the word stigma do you not understand? Sturitch’s story shows repeated examples of 12-steppers insisting that their way was the only way. He was told that people on methadone “don’t feel” anything— how is that not stigmatizing?
He found that people on methadone aren’t employed in the field— while people in abstinent recovery are and are held up as role models. How is that not stigma?
Finally, people in abstinence-based recovery misuse other drugs just as often as people on methadone do— it’s just that when they do it, they are declared “no longer in recovery” so you don’t see it.
If you look at the statistics, roughly the same proportion of people who start in abstinence-based recovery and on methadone are totally abstinent from non-prescribed drugs at any given time (actually, methadone folks are slightly more likely to be so, especially with higher doses). But you don’t count that for definitional reasons.
Nonetheless, the fact remains. If you are going to worry about people “using on top” with methadone as an issue unique to methadone that makes it inferior, you have to prove first that people are less likely to do that in abstinence based recovery. But since those people are considered “drop outs” from abstinence, you are basically just fudging the data by defining those people out.
With methadone, those people are retained in treatment and there’s access to them to try to help with any additional problematic use. With abstinence, you can’t even reach those people since they have dropped out.
None of this means, of course, that people shouldn’t choose their own paths to recovery or that methadone is better for everyone. But you have to examine your own definitions and preconceptions if you are going to understand things like stigma and the ways you may not be aware of that you see something as inferior.
Maias,
First, if you want to comment on anything I say I would appreciate it if you were to do so without the sarcasm or rudeness expressed in your opening comments.
According to the Oxford Concise Dictionary, stigma has a number of meanings none of which featured in Sturitch’s blog. What I did note was what considered to be from those he was unfortunate enough to encounter. I suggest that my comments re no ‘reasonable person’ reflects my view.
I fail to understand the relevance of your comments regarding ‘people who start in ‘abstinence based recovery’. People who start in abstinence based recovery either stay there or not.
Equally I find the rest of your comments irrelevant to the personal views in my reply to Sturitch, nor do I wish to enter any discussion with anyone who is unable or unwilling to do so without resorting to what I consider to be unecessary rudeness and sarcasm.
I find it rather strange that you are calling me rude when your post was so condescending towards Sturich. And, if you don’t wish to enter a discussion, why did you post?
What I said about abstinence is what I meant. To explain, there’s a form of analysis now widely recognized as state of the art in evaluating any kind of medical treatment.
It’s called “intention to treat” analysis and what that means is that whoever starts in the study must be considered in its outcomes.
That is, dropouts are considered treatment failures, rather than having their data excluded. here’s why. if a drug helps 80% of people who can continue taking it, but 90% of those who start taking it stop because of side effects, you really don’t have a very good drug.
This is exactly what happens in abstinence based treatment research— they count only the successes and the drop-outs are simply excluded, even though in many instances, more drop out than stay in.
Anyway, if you are going to look at people “using on top” with methadone, you have to compare them not just to people who stay abstinent but to everyone who starts trying. Methadone retains the people who would be “drop outs” in abstinence. If you don’t include them in your considerations, you are not getting an accurate picture and are comparing apples to oranges.
I just wanted to say thank you for the support you have shown and for the restraint that has been used.
I fully expected to come back and be villified as i have been the once or twice i have shared my experience.
The fact that poeple have responded to the facts rather than attack me personally is very refreshing.
To adress peters concerns if the treatment agencies facilitate MMT properly cleints should be screened regularly for other drug use and actions taken to address that behaviour.
While you mention conserns over addiction I have allready agreed whole heartedly that this is happens but the point was that as a controlled addiction supervised correctly it has improoved the quality of life for me , methadone does not rob all my cash from me or cause e to commit crime infact it has been a bit of a wonder drug for me enabling me to tackle things that for twenty years i kept failing at.
Thank you maias you already have a great understanding of what has taken so long to grasp. when someone attacks you personally it is almost always because they cannot attack your ideas it is a smoke screen.
I was intending to dump my story and run and duck and hide under the covers thank you for prooving me wrong.
Your comment regarding the responsibility of MMT treatment agencies in addressing ongoing misuse of other addictive substances is absolutely right; unfortunately to what extent they feel they have a responsibility in that area, or the extent to which they seek to fulfill it appears to be rather vague.
I also endorse your comment regarding those who make personal attacks on others, not only because of their weakness in being unable to attack one’s ideas or comments, but also because it shows a unwillingness to pay attention or respect to other points of view than their own. In addition a very wise person once pointed out that those who indulge in such ill mannered behavior almost always do so because of their low self esteem and in attacking others it gives them a false sense of superiority.
With renewed good wishes for your ongoing recovery and I for one am glad that you did not ‘dump your story and run for cover’
Hey Sturich, thanks! I am hoping that people can work to overcome stigmatization and can begin to understand that it’s something that people may be doing to others without realizing it.
People in the majority often are unaware of how their unconscious attitudes or words affect others. For example, saying that people on methadone are still addicted. They are not necessarily. If they are using methadone compulsively despite negative consequences, then, they are. If they are simply physically dependent on a medication to function, they are no more addicted than everyone else is to food, air and water.
The DSM V committee will hopefully finally change the diagnosis that means addiction—substance dependence— to simple addiction. They previously thought that using substance dependence would be destigmatizing, but instead, it added more stigma for people who are pain patients or methadone patients. Dependence is not the problem— addiction is. Since Nora Volkow, head of NIDA is in favor of changing it to addiction, it probably will change and that’s one thing that people can do to help stop the confusion over terms.
Maias,
this may come as a shock to you, but I am in total agreement with you. I’ve been attempting to make the same point for some considerable time.
Attempts to remove or minimise the stigma attached to both alcohol and drug addicts by semantics has not only failed it has caused confusion and distress, especially to those who are on prescribed medication in order to stabilise their condition.
You’re probably aware that when the DSM team agreed to use ‘dependency’ rather than addiction, it was with a majority of one. In a subsequent article published in the American Journal of Psychiatry in 2006 both O’Brien and Volkov pointed out the fundamental differences between the two and called for the change to be reversed. A view that was later endorsed by a number of Canadian psychiatrists in a follow up article in the same publication in November of that year.
I share your hope that in the next edition of DSM that they agree to reverse the early decision, but somehow even if they do, i doubt whether WHO will.
I also find it totally unhelpful that euphemistic phrases such as ‘problematic substance misuse’ and ‘entrenched patterns of drug use, neither of which have any definition or meaning, have also crept into use causing even more confusion.
I find it difficult to understand how people can talk about recovery, if they are unable, or in the latter case unwilling, to identify the nature of that from which recovery is being sought.
What an interesting run of comments!! Right, where to start?!
Is MMT or abstinence the better course of action overall? Absolutely impossible to answer!!
Why? The correct course of action suitable for aiding those with substance misuse issues into recovery (increased quality and stability of life) can only ever be investigated on a case by case basis, taking into consideration the big picture of their needs, wants and circumstances.
Keep all the options available and thoroughly investigate what’s right for the individual, before making the decision of what the correct course of action is.
Hey Peter, glad we agree on that ;-) I did know about that meeting and would like to know who provided that fatal last vote.
I also think “substance abuse” needs to be changed to substance misuse, because it’s a stigmatizing term that makes no sense. I mean, if you abuse a child, you are hurting that child, so are you hurting the drug you abuse? It’s absurd. And it’s creating associations in people’s heads with either child abuse or masturbation (“self abuse”) which are not helpful, either.
Misuse is clear— and there certainly needs to be a diagnosis for problematic use that does not meet the criteria for addiction but is still causing problems.
Hi Maias,
The names of those who voted one way or another for the change are not revealed.
Regarding ‘problem use’ we already have what I feel is an adequate definition and criteria under the heading of ‘Substance Misuse Disorder’ (WHO) and Substance ‘Abuse Disorder’. (DSM-1V.) I feel it’s more a question of why those who use euphemisms are unwilling to state which condition they are referring to.
I’m not inclined to agree with either the terms ‘abuse’ or ‘misuse’, instead I prefer ‘use’ and that where use is having adverse affects on the user and use continues, it is the user who is ‘abusing’ self, rather than the substance, (much in the same way that ‘cutters’ self harm) even though users may be unable or unwilling, to recognise it as that, or never looked at their use from that perspective; Therefore I feel that the term ‘use’ is adequate.
Now before I get ‘slated’, just let me say that over the years, when I have judged the time to be right, which in each individual case obviously differs, but as a generalisation, is when my clients are well into the ‘preparation’ stage of the ‘process of change’ or entering into the ‘action’ stage, I have suggested to them that they may want to consider their use from that point of view, with some notable exceptions, it has not only increased their awareness of their condition, but also how their use has been causing them considerable conflict and other forms of discomfort. In the majority of cases, it has accelerated the process of change.
I need to emphasise that such a strategy is not without risk, nor is it one I use where there is evidence of sustained childhood abuse, without that being dealt with first.
Insofar as stigma is concerned, I believe that much of it arises from fear, ignorance and prejudice, which in turn is fuelled and reinforced by the behaviour of those who are addicted. Since the former is, and has been, characteristic of the human condition throughout history, I suggest it is unlikely that cosmetic or ‘education’ attempts, to change it are likely to succeed. On the other hand many people I encounter socially know someone who does have a ‘problem’ and are not unsympathetic towards them. It is also interesting to note the esteem they have for those who have accepted their problem and made, or are making, an effort to come to terms with it, together with the respect and admiration they express for those who have, and whose behaviour has changed as a result.
It therefore seems to me that if individually and collectively we are concerned about stigma, we have a responsibility to diminish it by action rather than words, through our gradually changing and improved behaviour, and our even more gradual willingness to overcome our reluctance to begin making a contribution to the communities we live in. Whether or not during the process of that action we choose to declare ourselves as recovering from our ‘problem’ is a personal decision; however what I can say, based on what I’ve observed, is that where this has occurred, any misconceived or preconceived opinions, if not entirely eradicated, diminish considerably and replaced by declared admiration and respect.
We are unlikely to succeed in eliminating stigma, but we can by action and example, reduce it, therefore it is in our interest and the interests of those who are still struggling with overcoming their addiction. It is my personal believe we have an individual and collective responsibility to do so; that we have a responsibility and obligation to change, and thus to bring about change, rather than the right to demand change from those who hold us in contempt.
I stress that these are personal views and I’m not aware of any evidence, other than my own observations and personal experience, together with the experiences of clients past and present, to support them, I’m perfectly willing to be criticised for holding such views, but since I can’t change others, but can change the way I react to them, I may choose not to respond to such criticism.
I think that simply changing language will not help stigma. But I don’t think it’s necessary— though it certainly is desirable for many reasons— for everyone to “do service” in order to reduce stigma.
Sometimes, mere contact is enough. This is why having diverse classrooms and other public places where people have contact with all kinds of people is helpful in reducing other kinds of stigma— when you know one of “those people” the blind hatred that people have of “the other” is reduced. That’s because it often comes simply from fear of the unknown, and now it’s not unknown.
You might only reduce prejudice to the extent of “they’re all awful, but [the one I know] is an exception,” but usually, it generalizes more than that and opens minds.
This is why it is important for people in all types of recovery to “come out” because simply letting people know helps reduce the fear of the unknown that often drives stigma.
Another problem that is probably not resolvable is the straightforward fact that people who are actually sociopathic— who have diagnosable antisocial personality disorder— are overrepresented amongst addicts. That’s why you get the “we’re all liars, manipulators, con artists” stuff— even though it is by no means the case that all addicts exhibit this behavior.
Blaming that stuff that actually precedes addiction in the lives of people who are affected on drugs causes a great deal of problems for people with addictive disorders.
just wanted to say how impressed i am at such informed and reasonable debate I think theres alot to learn here.
