Tuesday, July 14, 2009

“RECENTLY, I DID SOME CLINICAL WORK AT A METHADONE CLINIC”

This comment was a response to a posted blog in the Addictions Recovery Professionals group at Linked In (http://www.linkedin.com/). The original blogger is an addictions counselor discussing working at Methadone clinics. Please review the many comments at: http://www.linkedin.com/groupAnswers?viewQuestionAndAnswers=&gid=862107&discussionID=4887361&goback=%2Eanh_862107


Mr. Jenkins, others,

Thank you for concisely and clearly stating the facts regarding the unique physiology of opiate addiction. Pure science dictates the intractability of opiate addiction in the malfunction of opiate receptors. It has nothing to do with “will power”, but rather with changes that occur in the brain and neurological synapses.

For many years I advocated for medicated recovery, specifically Methadone, and was deeply involved and invested in the passage and implementation of the Drug Abuse and Treatment Act of 2001 (DATA). In addition to changing methadone rules, this Act allowed for the private physician use of Suboxone for opiate withdrawal and maintenance. In my research and advocacy since then, I have come to believe that Suboxone/ Buprenorphine/Naltrexone may be a better choice in many circumstances. Methadone is very effective for long term treatment of heroin addiction. Still, it has many drawbacks, specifically, the difficulty in withdrawal; however, the stigma of Methadone also cannot be underestimated in its effects on the clients social wellness. As such, Methadone should be used as a last resort, only after other avenues have failed, including abstinence programs.

True stabilization and reorientation into a non-drug seeking lifestyle can take many years, and even then, it is not unusual for heroin addicts to relapse, often after many years of abstinence. True, intractable heroin addiction may best be treated with life-long Methadone, in terms of the client’s well being and social harm reduction. Too many times, though, clients are accepted into Methadone clinics before other treatments have been attempted. Often, these patients may be opiate naïve in comparison to long-term heroin addicts seeking methadone maintenance. The methadone may get them off of their “drug of choice”, but only addicted to one that is even more difficult to overcome. In these cases, if abstinence is not an option, then Suboxone should be used. Using methadone in anything but the most severe cases, i.e., the patient is at risk of IV related disease and social degradation, is like swatting a fly with a sledgehammer.

I also agree that your “Counselors-in-relapse” is a valid paradigm, and one seen much too often in recovery. While some addicts in treatment may prefer to have a counselor that is also a recovering addict, the value of learning the pathology and physiology underlying opiate addiction an educated cannot be understated, nor can the value of certification. The best of both worlds, of course, would be ideal, and fortunately many recovering addicts have gone on to receive certification and/or college graduation. When I hear of recovering counselors who have been clean for less than two years working in methadone clinics, I worry that they are not only ineffective, still fighting their own battles, but they are also putting their own recovery at risk by being in a drug-centered environment before they have had a chance to put that environment behind them, and think themselves “well”.
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