Ask an Expert: Should My Daughter Be on Methadone?

By Edward M Paul 02/16/16

Our expert advises a concerned mother on whether her daughter's decision to start on methadone is the right one... or if she's really on methadone at all.


Dear Expert,

My daughter is a year out of rehab, is trying to get her children back from CPS and she is now going to a methadone clinic. She just started it maybe two weeks ago. She is always nodding and very sleepy, she says it's because of the methadone until they get her up to the right dose. She was not on this or anything this past summer. However, after her boyfriend passed out in a public bathroom while taking care of their son, she says she became scared that she could relapse like that and is doing the methadone so she will not. I am trying to understand this, but it seems like if she was fine, why would she have to start this stuff now? I have heard and read that so many people can be on this for a lifetime.

Any thoughts?

I'm still very new at trying to understand what's going on with my daughter and why she does the things she does. She is 32, and never did this stuff until this boyfriend came along eight years ago.

Thank you.

Edward Paul, MD: First, it sounds like you aren't sure that your daughter should be on methadone at all, or maybe you are questioning whether she actually is on it. That's a valid question, because if someone is either ​using ​prescribed or illicitly obtained Xanax, Klonopin, Valium or ​other benzodiazepines, those medications can also cause the "nodding" that you're referring to.​

​If she is in fact on methadone, then it's safe to assume that she has been using opioids, because it would be inappropriate for a methadone program ​to​ accept her if she were not using opioids​ like heroin or an opioid-based painkiller. Methadone is often a good way of preventing death and infectious disease​, ​but ​when somebody is new to it, ​it can take a while ​for them ​to get used to it​ and for the program to find the correct dose​.

In my experience, I've found that people do ​very ​well in well​-​run programs​,​ and poorly in program​s​ with high staff turnover​ or where clients aren't receiving the full array of services that they need. So you might want to explore these issues with your daughter. The other issue you're raising—whether going on methadone inevitably results in the treatment becoming a lifelong process—is also important. Methadone, by definition, tends to not be a short-term intervention, but people can successfully come off it as their overall life functioning improves and stabilizes. Assuming that she does have an opioid problem, being in a methadone program and abstinent from other substances should also help her regain custody of her child.

Finally, it's important to note that she is far more likely to achieve a successful recovery if she is engaged in meaningful psychotherapy with a clinician that she has a solid treatment alliance with. ​Good psychotherapy will help people understand the motives behind ​their ​self-destructive behavior​​. Pleasing boyfriends can be high on the list.​ ​

Edward Paul, MD, has been working in addiction psychiatry for almost three decades (unless you count his eighth grade talking a friend out of trying heroin). He is trained in several forms of psychotherapy as well as the pharmacology of addiction and co-occurring psychiatric disorders. Full bio.

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