Sarz Maxwell, Psychiatrist and Addiction Specialist – Galena Clinic
Patients maintained on methadone are no more addicted to methadone than diabetics are addicted to insulin. Both cases are medical dependence, where a drug is necessary to remain healthy. This differentiation is not mere semantics, it is a crucial medical concept, which I shall explain.
Most people use psychoactive drugs. You may be using caffeine as you read this; the caffeine may be helping you recover from another common recreational substance, alcohol. Drug use does not cause addiction. Most people use drugs, but only about ten to fifteen percent of people who use drugs – even ‘hard’ drugs like heroin and alcohol – develop addiction disease. Those 10-15% become addicted because of a pre-existing, genetically-determined glitch in the brain that affects what happens when that individual uses drugs.
In these unfortunate few, drug use results in a specific cluster of symptoms: loss of control over the drug, neglect of important functions (educational, vocational, social) in order to use the drug, continuing to use the drug despite negative consequences (health problems, arrests), and a general deterioration in medical, educational, vocational, and/or social function, all leading to distress and disability.
Diabetes has specific signs and symptoms: thirst, weight loss, fatigue, numbness, poor wound healing, irritability, vision problems. The symptoms cause disability (missing work, hospitalization), and distress. Insulin therapy relieves the symptoms, and the patient returns to his or her normal level of function, and is no longer distressed. But if the insulin is discontinued, the diabetes will relapse and the symptoms will recur, causing more distress and disability: blindness, amputations, even death.
Opiate addiction has specific signs and symptoms. These symptoms cause disability (marital problems; criminal acts) and distress. Methadone therapy relieves the symptoms, and the patient returns to his normal level of function, and is no longer distressed. But if methadone is discontinued the addiction will relapse and the symptoms will recur, causing more distress and disability: arrest, unemployment, even death.
Addiction occurs when drug use causes distress and disability. Medical dependence is when drug use relieves distress and disability. It really is that simple!
Claims that patients can discontinue methadone if they want to badly enough are short sighted. No one stops overweight patients from taking blood pressure medicine. Nobody suggests withholding treatment for cardiac patients who don’t exercise. Certainly their doctors recommend lifestyle changes, but nobody advises stopping their lifelong treatments (many far more expensive than methadone).
Research shows that addiction disease will recur within a year in at least eighty percent of patients who leave methadone maintenance. Worse, patients who leave methadone treatment have a death rate eight times higher than those who continue.
Since 1964, thousands of studies with hundreds of thousands of patients have consistently shown that methadone treatment WORKS. Decreased drug use, improved physical and mental health, less crime, increased education and employment, better parenting and partnering skills, lower risk of HIV and Hepatitis C infection … every outcome measure improves with methadone treatment. But no matter how long the patient has been stable, or how motivated he or she is, or how slowly the methadone is withdrawn, or what psychosocial treatments continue, at least eighty percent of patients will relapse if methadone is stopped, and eight times more of them will die.
Everyone wants to get off methadone. For that matter, everyone wants to get off insulin! Nobody likes taking medication, especially medication that’s a hassle. But the diabetic’s family and friends don’t bug him to “get off that stuff”. Diabetics aren’t threatened with losing their children if they continue insulin. And diabetics don’t have to drive to the clinic frequently to have their insulin dispensed.
Some people say they believe addiction is an illness. However, some are only paying lip service to addiction being an illness – it’s the politically-correct thing to say – but their attitudes reveal their true, deep-down conviction that addiction is shameful, a moral deficit for which the only true remedy is for people to buckle down, straighten up, and fly right … even if it kills them.