Recovery-oriented Methadone Maintenance

Bill White has a new monograph out on recovery oriented methadone maintenance (MM). There's something in it please everyone and something in it to anger everyone. He takes the position that MM is an essential part of the treatment continuum but is hard on MM in its current form.

I'm very busy with a couple of projects but I plan to try and post some highlights every day for the next several days. Here's the first.

Here Bill descibes the disappointment of methadone pioneers at what they see as a devolution of MM:

Dr. Dole later spoke of the “stagnation of treatment” that occurred throughout the 1970s and 1980s.87 He was particularly incensed at the depersonalization of MM and the loss of partnership with patients in MM: “the contempt with which many regulators and program administrators have treated their patients seems to me scandalous.”

The strength of the early programs as designed by Marie Nyswander was in their sensitivity to individual human problems. The stupidity of thinking that just giving methadone will solve a complicated problem seems to me beyond comprehension.

Dole was not the only early MM pioneer who criticized the evolution of MM in the 1970s. In 1976, Dr. Robert Newman, who led the expansion of MM in New York City, declared:

Methadone maintenance treatment, with its unique, proven record of both effectiveness and safety, no longer exists. One can only hope that it is not too late to reassess that which has been cast aside, and to resurrect a form of treatment which has helped so many, and which could help many more.90

Other critics, including Dr. Stephen Kandall, concurred with Newman and further argued that:

Political forces reduced methadone to an inexpensive, stripped down way to “control” a generation of addicts without having to provide essential rehabilitative services… 91