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How I Learned to Stop Worrying and Love Methadone

Just like ex-junkie Russell Brand, I used to believe that “maintenance” was as bad—if not worse—than active addiction. Here’s how I came to understand how fatally wrong I was.

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Contrary to popular opinion, maintenance and abstinence can co-exist. Photo via

By Maia Szalavitz

08/19/12

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British comedian Russell Brand has a bit of 12-step recovery under his belt—and so, like a lot of people who fit that description, he fancies himself an expert on addiction. In fact, he’s so sure he knows his stuff that he’s taken it upon himself to tell the British government what treatment method is best: abstinence-only—and no maintenance, please! Conveniently, this is right in line with a recent push by the UK’s Conservative government for an abstinence-focused recovery agenda.

Brand elaborated on his position while discussing a documentary about his addiction that’s set to air this month on the BBC, telling The Guardian, “Without abstinence-based recovery, I’m a highly defective individual, prone to self-centeredness, self-pity and self-destructive, grandiose behavior. But if I seek the company and fellowship of other addicts and alcoholics … then, one day at a time, I have a chance of living free from this disease.” As for maintenance, he sniffs, “We might as well let people carry on taking drugs if they’re going to be on methadone. Obviously it’s painful to abstain, but at least it’s hope-based.”

It turns out that study after study shows that when methadone prescribing increases, addict deaths drop. It is superior to abstinence-only treatment in terms of fighting HIV and overdoses, and many studies find it superior in cutting crime.

I understand Brand’s position well. When I first quit heroin and cocaine, I shared it. In 1992, I even wrote an op-ed for Newsday, declaring that people on methadone were as far from recovery as active heroin users. It was like replacing vodka with gin, I wrote elsewhere at the time.

But I soon learned that not only is this perspective wrong, it can be deadly. And why shouldn't it be? After all, simply having an addiction and recovering from it no more makes Brand—or me—an expert on the topic than being treated for a brain tumor makes him a neurosurgeon.

Here’s how I learned a tiny bit of humility and began to develop some actual expertise. In the early 1990s, I began conducting research for a book on the addict’s perspective on drug policy. As part of that work, I interviewed dozens of recovering and active addicts, trying to include the widest possible range of experiences. I also read lots of addiction-research literature and joined a supposedly “academic and scholarly” listserv about topics related to addiction—which, as it turned out, included some of the country’s leading addiction experts, plus a number of 12-steppers. What happened, as anyone who’s ever commented on a Fix article can surely relate to, was that the list rapidly turned into a battle royal over whether the “truths” taught in recovery programs were supported by data.

At first, I argued fiercely against methadone, claiming that when I’d tried it, it had simply extended my addiction by six months and left me with a more protracted withdrawal to battle through when ultimately I chose abstinence. Adding insult to injury, my methadone counselor had done nothing but recommend Narcotics Anonymous—where, of course, methadone isn’t considered recovery and where I would not have been allowed to share.

The experts on the listserv demolished my arguments with data. It turns out that study after study shows that when methadone prescribing increases, addict deaths drop. It is superior to abstinence-only treatment in terms of fighting HIV and overdoses, and many studies find it superior in cutting crime. The conclusion is clear-cut: Add a methadone program to your community and crime and addiction-related deaths fall; eliminate one and they rise. 

The World Health Organization and the Institute of Medicine both agree that methadone maintenance (as opposed to detox, which is what I did) is the most effective treatment for opioid addiction. More recently, buprenorphine has been found to be a close second in terms of effectiveness, at least for those who don’t require high-dose maintenance. So it wasn’t that methadone had failed me—I’d just been placed in a lousy program that didn’t use it effectively. I was also wrong about my “replacing vodka with gin” analogy, because an opioid-dependent person can be tolerant and not impaired on a steady dose, which is not true for alcohol.

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