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How I Learned to Stop Worrying and Love Methadone - Page 2

By Maia Szalavitz 08/19/12

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

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But the 180-degree turn in my thinking wasn’t just due to data. As I researched my book, I met people on long-term maintenance who I came to admire and respect. Indeed, one of the smartest people I’ve ever known, and one of the UK’s leading thinkers on addiction, has been on maintenance for multiple decades. But what really leveled me and made me deeply ashamed of my prior ignorance was when another methadone patient—who also ultimately became a leading recovery activist—told me a story about methadone myths that nearly destroyed her. 

Lisa Mojer-Torres was a kind, brilliant woman who tried repeatedly to recover without methadone. She wanted to attend law school, but believed that methadone caused cognitive impairment that would preclude being able to do it effectively—so she didn’t enroll. Ashamed and self-hating after multiple rehab attempts (and believing that methadone prevented emotional growth as well), she eventually came in contact with methadone advocates who debunked—with data!—these self-defeating beliefs and encouraged her to try. Rather than suffering through another failed detox, she stayed on methadone and, before long, she had graduated law school and passed the bar in two states. Over time, she became a powerful advocate and attorney, as well as a loving wife and mother. Sadly, she died last year from ovarian cancer.

While it’s certainly possible for people with opioid addictions to thrive without maintenance, there’s no need to stigmatize the treatment for those for whom it works.

Russell Brand believes only abstinence offers hope. I’d like to hear what he would have said to Lisa—or to the millions of others now quietly working and living productive and full lives on maintenance. I’d also like to know what he thinks about the UK’s prior painful experience with putting time limits on methadone, which occurred just before AIDS hit the country in the late 1980s. Researchers found then that the limits produced both increased abstinence rates and increased death rates: perhaps an acceptable trade-off for those who believe addicts deserve a death sentence, but not so for those who believe that where there is life, there is hope.

Moreover, with HIV spreading rapidly via IV drug use, experts feared that continued restrictions would push the death rate even higher. Wisely choosing to reverse course, under Margaret Thatcher the country expanded methadone prescribing and began a needle-exchange program, policies that actually prevented an AIDS epidemic in British drug users. While HIV rates reached nearly 50% in American addicts in some cities, they never climbed above 1% in the UK. In contrast, Russia—which bans methadone—has experienced one of the worst epidemics in the world, with at least one million people infected with HIV. More than three-quarters of these cases are directly linked to IV drug use, while many of the rest are the result of sexual contact with people who were initially infected via dirty needles.

And yet here we are again, several decades later, engaging in the same misinformed debate, which often seems more about a puritanical vision of what’s “right” rather than what works. While it’s certainly possible for people with opioid addictions to thrive without maintenance—and while most of us prefer to be dependent on the fewest possible medications—there’s no need to stigmatize the treatment for those for whom it works.

Type 2 diabetics who have conquered their disease through diet and exercise don’t go around calling those whose disease is more resistant “defective,” nor do they demand that insulin be pulled from the market or used only for limited periods of time in order to force those weaklings to recover more naturally. If they did, no one would listen. We know that personal experience doesn’t trump medical expertise and that medicine should be based on research, not anecdote.

It’s time we recognized that the same is true of addiction. If we want to call it a disease, we’ve got to have the humility to recognize that, as AA’s own “Big Book” puts it, we are not doctors. Different approaches offer hope to different people. One size does not fit all, and different strategies may even be needed for the same person at different times of his or her life. Perhaps Brand will come to understand this when he reaches his seventh step.

Maia Szalavitz is a columnist at The Fix. She is also a health reporter at Time magazine online, and co-author, with Bruce Perry, of Born for Love: Why Empathy Is Essential—and Endangered (Morrow, 2010), and author of Help at Any Cost: How the Troubled-Teen Industry Cons Parents and Hurts Kids (Riverhead, 2006).

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Maia Szalavitz.jpg

Maia Szalavitz is an author and journalist working at the intersection of brain, culture and behavior.  She has reported for Time magazine online, and is the co-author, with Bruce Perry, of Born for Love: Why Empathy Is Essential—and Endangered, and author of Help at Any Cost: How the Troubled-Teen Industry Cons Parents and Hurts Kids. You can find her on Linkedin and  Twitter.

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