Relationships are never easy. When it comes to our relationship with methadone, let’s just say it’s complicated.
Debby, the Mom at the blog How’s My Son?, recently wrote a post updating her readers on her son’s recovery from addiction to OxyContin and other opiates. Debby is a good Mom and a good person, and I’ve been a fan of her blog for the better part of a year now.
Debby writes:
I was just saying prayers of thanks this morning for my son’s six months of sobriety. That’s definitely debatable, because some people believe that if you are using methadone you are not sober. As far as I am concerned, my son is not buying heroin. He’s using methadone at a clinic that has a good reputation for dispensing this, in liquid form, and adhering to the state of California’s very strict guidelines.
The medication is working and Debby is grateful. Yet she feels the need to qualify her description of her son as sober. She recognizes that some people in the recovery community would not agree that her son is sober since he is taking prescribed methadone.
Methadone-assisted recovery is real recovery, but some people in the recovery community have trouble accepting that fact. When it comes to methadone and the recovery community, the relationship is complicated.
Methadone is strictly regulated in California, which is not necessarily a bad thing –as long as the regulations are based on science and treatment effectiveness. The problem is, some regulations are based on stigma and politics and nothing more. In California and everywhere else, our social and political relationship with methadone is complicated.
Debby’s son’s relationship with methadone is complicated too.
He’s been sober for six months. He was allowed to move home six weeks ago, and Debby says he’s been great. He’s working two jobs and saving money.
Recently, Debby’s son ran out of gas and missed his appointment at the methadone clinic. Without his methadone dose, he began to experience withdrawal sickness. “I hate that poison that’s in his body,” Debby wrote.
Debby’s son bought some methadone from a friend. He said he had to do it or he would be tempted to use.
Frickin’ poison. How I pray that my son will finally be able to purge that crap out of his body. Synthetic opiate or not, how I long for my son to be free of drugs of any kind. I can only watch, and feel sorrow for what he’s going through.
Debby’s feelings are understandable. But they reminded me that the complexity of our feelings about methadone is not without consequence.
Ambivalence about methadone can be a barrier to successful treatment. Methadone treatment requires a strong commitment to recovery. Mixed feelings about methadone can make it more difficult for a methadone patient to sustain the effort it takes to be successful in treatment.
Most methadone patients do have mixed feelings about methadone treatment. They are grateful for the often dramatic improvement methadone treatment has brought to their lives. Yet, they wish they didn’t need it.
They wish they didn’t have to rely on a medication. They struggle with “clinic fatigue” from having to go to the methadone clinic frequently and over extended periods of time. Some may experience side effects from the medication. Yet they keep at it because the treatment is working and in the end it is worth it to them.
Those who are part of a methadone patient’s circle of support often have mixed feelings about methadone too.
They are grateful for the benefits of methadone treatment. Yet they can’t help but wish that their loved one didn’t have an addiction in the first place.
They wish other treatments would have worked. They wish they didn’t have to worry about whether this treatment is really working or still working. They wish that their was a cure for addiction and the whole nightmare of addiction could just be over. They worry about their loved one taking a long term medication (even though research shows that long term methadone use is generally safe).
The problem is that mixed feelings often lead to mixed messages. If you want someone you care about to succeed in methadone treatment, then you want to make sure that you don’t allow emotionally-driven, negative feelings about methadone treatment to turn into negative messages about methadone treatment.
You can bet that your loved one in methadone treatment is highly tuned to these messages, and they matter.
Sometimes the negative messages are subtle and inadvertent. Other times the messages are overt and intentional. Either way, the effect can be disastrous.
The good news is that positive messages have power too.
Messages like:
I support you in your treatment and your recovery. I admire you for the effort you are putting into your recovery. I understand how hard it is to do what you are doing. I support your right to make your own treatment choices. I support whatever path to recovery works for you. I want you to stay in methadone treatment as long as you need to.
Methadone patients, and those who care about them should recognize that their feelings of ambivalence are normal. But they should also monitor their feelings carefully. Unless managed properly, these feelings can and do effect treatment outcomes.
I appreciate Debby for sharing her feelings openly on her blog. She is a great example of a Mom who is both honestly expressing her feelings and doing a great job in supporting her son through difficult terrain. People like Debby and her son are making heroic efforts that I think we can all admire.
{ 7 comments… read them below or add one }
Hi Tom
Though I understand Debby’s desire to see her son well and whole again, referring to methadone as a “frickin’ poison” to be “purged” from his body shows that she is still unclear on the concept of MMT.
For example–if a diabetic, whose life had been saved by the administration of daily insulin injections, unexpectedly found themselves without their insulin one day–let’s say they went camping at a remote locale and forgot to bring it–they would quite naturally become ill. They have a chronic illness and their body depends on the insulin to keep them stable. They would experience severe symptoms and would have to cut their trip short to get back to the drug that sustains them. In that case, would the family members of the patient likely say “I hate that fricken’ poison” in reference to the insulin? No. They know that the medication is not the culprit–it is treating the disease that is the culprit and keeping it in control.
Certainly it would be nice if no one needed any kind of medication and no one were ever ill. However, for most chronic illnesses that require long term medication, people do not view that medication as a “poison”, but as a lifesaver, allowing them to have their loved one around and stable.
i AM a mother of a loved one on mmt for almost 4 years now. My question is this? Are there not any successfully recovering heroin addicts who do not use mmt in their recovery? I am interested to know how successful others are at living clean of opiates without methadone. Surely their are some who ohave experience recovery without methadone. How many choose to use it only as a “tool” toward sobriety and then wean off of it and are successful at staying drug free. I am not sure I believe the old “insulin/diabetic line of defense that everyone uses. First of all, alot of diabetics can control their sugar levels buy changing their diet and exercise and are not “insulin dependent” . Is this not also true of heroin addiction? Can a detoxified body learn other ways to ward off cravings and use other tools of rehabilitation to stay drug free? The medical comparison seems to indicate that mmt is completely necessary to treat heroin addiction and absolutely nothing else will work or can take it’s place in recovery. Are you saying that the brain is forever damaged and therefore this is a disease that will always require this opiate forevermore? How often do people choose to go ff the methadone, detox and live drug free lives? Does anyone know? Also, no one ever seems to want to talk about the side affects of methadone. The totally slowed down heart rate and other systems; heavy, labored, breathing, the risk of heart attack. I believe that these are very serious risks one takes, am I wrong? I know the traditional line of defense is that it is so much better than the stats of those heorin addicts that are still using, breaking the laws, risking their health, etc. But this talk all sounds like mmt is the only successful treatment for heorin addiction. Any answers or comments from anyone?
Hi Kimmy,
Your comment raised some red flags for me, so I hope you will allow me to challenge you a little, gently I hope!
Yes, there are many people in recovery for addiction to heroin or other opiates who did not use methadone in their recovery. That’s great for them. But there is a temptation for family members and even treatment professionals to use this fact to shame people who really do need long term methadone treatment. Reading between the lines of your comment, I suspect you are not happy with your loved one’s path to recovery. I hope you have read 10 Things You Should Know About Methadone. And I hope you will be very careful that you don’t allow your discomfort with MMT to become a barrier to your loved one’s recovery –especially since MMT appears to be working.
Your loved one should not need to prove that MMT is “completely necessary to treat heroin addiction,” that their “brain is forever damaged” and therefore will always require MMT, or give you any other “line of defense.” Your loved one is an adult and their path to recovery is their own. Chances are your loved one tried many options (home detox, counseling, rehab) before even considering MMT. MMT is a lot of work and often a long term commitment. It’s not something most people want but rather what they eventually conclude they need. If MMT is working for your loved one, please offer them your enthusiastic support.
I have worked with hundreds of people who are opiate dependent for over 10 years. Recovery is a process of finding what works for each person. Some people can quit on their own. Others need counseling. Others need short term residential treatment. Others need long term residential treatment. Others need methadone treatment for 2 years. Others need methadone treatment for decades.
Treatment for decades is okay too. MMT is well studied, and many people participate in MMT for decades with no significant side effects.
For many people, methadone is the only realistic path to recovery. It is the only thing that works. And since it works, those who require a further “defense” (why are we having to defend an effective treatment?) might be wise to reflect on why they feel that this path isn’t good enough. The goal of the reflection would be to figure out if the feeling is based on what works best, or is instead based in social stigma relating to “addicts” and judgments about the moral superiority of recovery via 12 Step Meetings versus recovery via medication-assisted treatment. This matters because your negative feelings about MMT may influence your son or daughter to give up an effective and possibly life-saving treatment.
Thank you for your comment. It’s clear you care enough to think, read and wrestle with this. I care enough to give you my best response even if it challenges you a little. If you still need to continue this dialogue, please comment back to me. This is important. Best of luck to you, and your loved one.
Thank you for your response. I don’t believe that other methods were tried first, it was straight to methadone; however, when on it the first time, and then came off of it due to pregnancy, she went back to using. I believe she was extremely vulnerable because the heroin was brought back into her home by her husband. I believe that I do not trust the stated stats promoted by the methadone clinics. I have a very hard time trusting the information they give. They have no desire to see patients come off of methadone, it is their business. They make tons of money off of these patients and have no desire to see them as anything but methadone addicts. That is how they stay in business, and become very wealthy, I might add, by pushing methadone. How can I trust that they have my loved ones best interest at heart? You did not address the side affects I mentioned, ones that are real and proclaimed to be real by my loved one. My other concern is that a lot of these patients don’t seem to really deal with their addiction issues, they rely only on the methadone, in other words, are not concerned with receiving real therapy, a changed mindset, way of life, real rehabilitation. They are just staying off the streets. And sure, this is better than shooting up, but does nothing to change the person. Often these patients are addicts in every other sense of the word,, ie. smoking, drinking and other addictions, they have just ceased heroin. Is that real recovery? It doesn’t seem so to me. I believe that real recovery engages the mind and behavior, not just blocking the need for other opiates. I am very glad that my daughter has made as much progress as she has, and that she is alive. I do wish that the opiate world would embrace a more true recovery (i.e. therapy, other addictions and their reasons for being addicts in the first place), not just cessation of heroin or the other illegal opiates. It appears to me that these methadone clinics do very little other than dispense methadone. I did read all of the info you suggested, a long, long time ago,aas well as last week, I am just not sure that I believe it all to be fact as so stated. My concern is not “social stigma”, that has never been an issue with me, my concern is true addiction treatment that involves more than blocking the need for the opiate. I believe that real therapy is needed to help these addicts change their way of life and their thinking. The things that caused them to use in the first place. Methadone seems to make them think that they are rehabilitated and nothing else is needed. What if they cannot get the methadone? What if they miss a dose? I believe that there is more to rehabilitation than just cessation of the illegal drug. I think that children of these addicts are very vulnerable to their addictive behaviors if they don’t learn to change them from the inside out and become new people. Are you beginning to better understand where I am coming from: Not just “social stigma” or misinformation, but real concern for the MMT system.
Hi Kimmy – The methadone clinics in my state are all non-profit clinics and nobody is getting wealthy. They provide ongoing individual drug counseling and sometimes groups too as a requirement for participation in the program. I realize that there are for profit clinics in many other states. Some are great and some are not so great. Methadone programs are intended to address opiate dependence, and they are often very successful in that regard. I’m not sure that it’s fair to criticize them because they don’t also treat addiction to things like tobacco, or because they don’t “change the whole person” in some global way. On the issue of side effects, methadone has no serious side effects for most people. Tom
Hi Kimmy,
I have read the posts and wanted to comment on things. I think an addict should try to recover without medication before jumping right into methadone or suboxone therapy. It is when they have tried traditional forms of therapy and they don’t work that I would recommend ORT (opiate replacement therapy)
I also agree that there needs to be more to MMT than just “medicating” someone. There needs to be some type of counseling or 12 step type program so that the addict can work on the “core” issues which led to their addiction in the first place. Some ppl disagree, but I wholeheartedly think this is a major factor in recovery. The clinics that I have attended have all been “for profit” or private clinics, there are no “free” clinics or gov’t funded clinics anywhere around where I live. At one clinic I did feel that they were only interested in the money. The “counseling” sessions were done once a month which was required by the state and all it consisted of was signing a paper saying I had talked with the counselor. Half the time I never saws the same one anyway (the turn over was crazy) and I had already tried utilizing the counseling offered at this clinic and after going through all my “story” with one, I got tired of having to repeat it to a different one next time and there was no sort of rapport allowed to form in this type situation. However, the other for profit clinic I attended has the same staff that they had since they opened 8 yrs ago and you are able to form a counselor/pt relationship there that you can count on. The staff all live in the area the clinic is located in, so they have a stake in the patients that come through that clinic. While I have never attended a clinic that does this, I have heard that some clinics require weekly or biweekly sessions w/a counselor in addition to several group sessions as well. So I think it all depends on the clinic and what is behind the motivation of the clinic. I say all that to say this, there are good clinics out there and there are bad clinics out there. I agree that counseling and deep soul searching needs to be done in addition to the medication for a pt to get all the tools they will need for a real chance at recovery. However, there are problems with every type of program like this and while there are those out there who are just abusing the program, diverting the medication and still in active addiction, there are those of us who actually are trying to do the program right, keep our addiction in remission (because with or without methadone or other meds like suboxone) an addict will never be cured 100% from their addiction, It is always there, waiting for the first chance it can to poke it’s little head back out and gain a threshold in the addicts life again. I don’t care if you have been totally off any meds and drugs for 40 yrs, you are still only in remission.
I would much rather be able to keep my addiction in remission without any type of medication, but that isn’t possible for me. So in the end, I would much rather be on MMT and be able to keep a handle on things, work through my issues without having to deal with the cravings and withdrawals, and live a more stable life with my husband and our two boys, even if it means staying on methadone for the rest of my life. The alternative to that is so much worse.
Thank you for your comments. I hope you continue to do well and succeed at life for yourself and your family.