Insights of a Methadone Clinic Counselor and Recovering Addict

I met a skilled drug addiction counselor, previously addicted to heroin, who became abstinent from all drugs, by going to meetings of Narcotics Anonymous. She had been a patient of methadone clinics off and on for many years prior to getting clean. I met her after she had more than ten years of completely abstinent recovery, yet she happily works at a methadone clinic, helping opioid addicts. I interviewed her because of her personal experience and her striking open-mindedness to different approaches to the treatment of addiction. Here is what she had to say about her experiences with methadone, and her perspective:

JB: Can you please tell me your personal experience of opioid addiction?

RJ: Well, my personal experience began at the age of…probably eighteen….and I was introduced by some people I was hanging out with. I was basically very ignorant about those kinds of things. I wasn’t aware of that kind of stuff going on, ‘cause I was raised in this real small town and just didn’t know this kind of stuff happened.

My first experience was with a Dilaudid. Somebody said we had to go somewhere else to do it, and I really didn’t understand that, because I certainly didn’t know that it would be injected. That was my first experience with a narcotic, with opiates, and….I fell in love!

I loved it. I injected it, and the feeling was…..like none I had ever felt. And even though I did get sick, I thought it was what I was looking for. It was the best feeling in the world.

Obviously, they didn’t tell me about getting sick, [meaning opioid withdrawal] and that after doing it for some days consecutively, when you didn’t have any, you’d get sick. I never will forget the first time I was sick from not having any.

And that lead to a habit that lasted twenty-some years. My experience and my path led me down many roads… with addiction, going back and forth to prison, because I obviously didn’t make enough money to purchase these drugs that I needed to have in my body, to keep from being sick. This lasted for twenty four years.  I ended up doing heroin and I liked it, because it tended to be stronger. Morphine I liked a lot, but it wasn’t easily accessible, so I switched over to heroin at some point. Which I liked a lot.

JB: What role did methadone play in your recovery?

RJ: I’ve been in numerous methadone clinics. I typically would get on methadone when I got a charge [meaning legal problems] and I wanted to call myself being in treatment.  I never ever got on methadone with any expectations, hopes, or thoughts of changing my life. I got on because it kept me from being sick. And it kept me off the street for a period of time. If I had a charge, I was in treatment and I always thought that would help me in my journeys with the legal systems. That was the part methadone played in my life, it was just to help me get through it.

JB: Did it help you?

RJ: At the time, it did. My problem with methadone was, when I would get on methadone, I would tend to do cocaine, because I could feel the cocaine, and I wasn’t about changing anything. I just wanted temporary fixes in my life. I’d switch to cocaine while I was on methadone. And it [methadone] worked for a time. I never got any take homes, because I continued to test positive for other substances while I was on methadone, but I thought I was doing better, ‘cause I was not doing narcotics. In that aspect it did help.

JB: And you’ve been in recovery from addiction now for how long?

RJ: It will be fifteen years in June.

JB: Wonderful!

KS: Yes, it is wonderful.

JB: And tell me where you work now.

RJ: I work at a methadone treatment facility.

JB: How long have you been working there?

RJ: I’ve been there for almost fourteen years and in this [satellite] clinic for a little over two years, and I’ve been in methadone [as a counselor] for five years.

JB: How do you feel about methadone and what role it should play in the treatment of opioid addiction?

RJ: I believe in methadone. Our [her clinic’s] philosophy certainly is not harm reduction but I believe that’s what it’s about.   And I do believe that those people on methadone, and are doing well, have a home, have a life, I think that’s all they aspire to. For them that’s enough, you know, they’re not out ripping and running the roads, they’re not looking for drugs on a daily basis. They come and get their methadone, they go to work, they have a life, they have a family, they have a home, and for them that’s good enough.

JB: Do you think it keeps them from getting completely clean [I purposely chose to use her language to differentiate being in recovery on methadone from being in recovery and completely off all opioids]?

RJ: No. I think they know they have a choice.

JB: OK

RJ: I really believe that a lot of them don’t think that they can ever do anything differently, and I know from personal experience that can be very true. I think that you just get so bogged down in your disease that you don’t see any way out. I think if you can find a place where you can get something legally and you’re not using the street drugs, and you’re not out copping [buying drugs] and you’re working and basically having a life, then that becomes OK, and that becomes good enough.

And addicts by nature are scared of change, and they get in that role and they get comfortable and that’s good enough for them. So I don’t believe they think that they can do any better.

JB: What percentages of your patients have already used street methadone by the time they get to the clinic?

RJ: I’d say seventy-five percent. Very rarely do I do an assessment [on a new patient] that somebody hasn’t already used methadone on the street. Very rarely.

JB: What are your biggest challenges where you work?

RJ: Actually my biggest challenges where I work are internal challenges. Fighting that uphill battle of no consequences for clients. There’s no consequences. We allow them to do basically what they want to do. [She is speaking of her methadone clinic’s style of interaction with patients].

JB: Do you think patients did better when there were a few consequences?

RJ: Oh yeah. Yeah. I mean, when certain clients can continue to have the same behaviors, like use benzos [meaning benzodiazepines like Valium and Xanax] and there are no consequences, certainly they are going to continue doing those behaviors. And those are the things that are challenges now, for us, for me.

I can’t enforce any consequences because we’re not allowed to, because it’s called punishment. The powers that be, they see it as punishment, where I work. Being that I come from living a life of doing the wrong thing always, I’m a big believer in consequences. And I believe that if you don’t have any, you continue to do those things. That’s the kind of stuff, the inadequacies where I work at.

JB: What do you like most about your job?

RJ: (pause) The light…. in somebody’s eyes every now and again. It might not happen much, but now and again the light comes on, and you have that “ah ha” moment. They have it, and you’re like, yes! Or when somebody comes and tells you they have that little spark of hope. Yep. That’s what I like most about my job.

JB: If you could make changes in how opioid addiction is treated, what would you do? If you could tell the people who make the drug laws, what would you recommend? How would you change the system, or would you?

RJ: I don’t know that I would change the system. I think the system works. I think it’s individual facilities that don’t work sometimes. Yeah. I think – methadone’s been around a long time – I mean, obviously it’s worked for a lot of years or it wouldn’t still be in existence. I think methadone maintenance programs work, but each individual facility maybe needs to make changes. You know, that’s just my opinion.

JB: If you were the boss of a methadone treatment center, how would you handle benzodiazepine use by patients?

RJ: They wouldn’t be tolerated. At all.

JB: Why is that?

RJ: Because I think they kill people. I know they kill people.

JB: How about alcohol?

RJ: Alcohol wouldn’t be tolerated either. I mean, obviously you would be given a chance to straighten it and rectify it and clean it up, with help, if you need it. But that would be it. You would get that opportunity and then [if the patient couldn’t stop using alcohol] you would be detoxed from that program. I believe that’s the route to go. We’ve had too many deaths. And there’s nothing to say that it’s not going to continue to happen…so, yeah, if I had a facility it would not be tolerated. There would be zero tolerance, period. There just wouldn’t be any.

JB: What do you say to people that say that’s keeping people out of treatment?

RJ: There are other types of treatment; maybe you need a different level of care. Maybe methadone’s not the answer.

JB: So you don’t think methadone’s the answer for every opioid addict?

RJ: No. No I don’t.

JB: What do you think about people on methadone coming to Narcotics Anonymous?

RJ: I think they have a right to come to Narcotics Anonymous.

JB: Do you think they should share?

RJ: I wish they could share, but I know, there again from personal experience, how methadone is viewed by people in Narcotics Anonymous. And I think that if that person does share [that they are on methadone], they are treated differently.

JB: Do you tell your patients to go to NA?

RJ: I do.

JB: What do you tell them about picking up chips?

RJ: That’s their personal call, because I feel like it is. But then I don’t view methadone as using. See, I look at it as treatment, and somebody taking medication because they’re sick, and trying to get better. So I don’t view that as getting up and doing dope.  Therefore if I were on methadone and going to meetings, I’d pick up chips.

JB: Can you think of anything else [you’d like to say]?

RJ: I believe in methadone. I really do. I just believe that it works. I know people who have been on our program for twenty years, and granted, those people will never get off methadone, but they have a life today. And twenty years ago they didn’t have one. They’re not perfect but I’m not either, you know, just ‘cause I don’t use dope any more. But they’re still suffering addicts, just like I am. So I just believe that methadone works, and if you want to make changes in your life, that there are people at every facility who are willing to help you make those changes.

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14 responses to this post.

  1. Posted by Benjamin K. Phelps on October 4, 2012 at 10:44 pm

    Wow! I had a couple of reactions to this article: First and foremost, it was very nice to hear of a person that didn’t necessarily fare well on methadone & is now in abstinence-based recovery that still supports methadone treatment – that’s practically unheard of, as we all know. But second, I was a little thrown at the zero-tolerance part. I fully understand & support the idea & usage of accountability policies. That said, addiction is a CHRONIC, RELAPSING DISEASE. Which means that it is not uncommon for those who do recover to eventually have a relapse, if only once & isolated (doesn’t lead to dependence as a result.) I also am FULLY aware, as a methadone patient myself, of the dangers of mixing methadone w/benzos &/or alcohol (though alcohol to a lesser extent.) And I’m not claiming that I have a better answer as to how it should be handled – I think maybe I was just a little stung by how quickly & adamantly the “zero-tolerance” phrase was used, instead of making clear first & foremost that relapse is something that is understood by staff, compassion will be shown, BUT there will be consequences if the patient does not discontinue the behavior after some time. Perhaps that’s because my last clinic (a private-owned) was very big on the “suspicion/zero-tolerance/don’t believe in harm-reduction at all/methadone is 5% of your treatment & counseling is 95%” approach. Because of this, their handbook & notices/memos on the wall @ the clinic read like they were for inmates sometimes. EVERYTHING was followed by a huge “Failure to blah blah blah will result in 10-day administrative detox!!” statement, which we all felt was totally unnecessary – we were all VERY clear that they had that power at any given moment from the very start, & didn’t need reminding every time we came in the door! Their policy around admin-detox was also that once 1 was started, it was NOT stopped for ANY reason. This included inability to pay, & then coming up w/the money after the 10-day detox started. And finally, once that detox started & you got to zero in 10 days, you couldn’t get another intake until 3 days had elapsed (for God only knows what reason.) What all this translated into was a group of patients that felt like we were walking on eggshells about everything – grievances were retaliated against (takehomes taken away for them & then not returned, even within the time that a new patient would earn them!) Nobody trusted the staff there, & we DEFINITELY didn’t self-report ANYTHING for fear of total annihilation! I finally had to transfer because I’d lost ALL faith in this treatment team & the company that ran it & a few others in NC & VA (Sellatico). With such an experience as this, I now have extreme disdain when the owner or management of a clinic puts TOO MUCH focus on consequences, consequences, consequences, & not enough on patient care, compassion, understanding, concern, & treatment retention. NOT saying AT ALL that patients should not be held accountable or that staff should look the other way 1 or 2 times on dirty urines, etc… I’m saying that when a + drug screen happens, it should be an opportunity for counselors to have an open & honest discussion w/the patient; one where the patient isn’t made to feel like s/he’s done something morally irresponsible & wrong, but has rather succumbed to the symptoms of his or her disease, & to discuss what steps can possibly be taken to maybe help alleviate this issue in the future. Is a higher dose needed? Is there a dual-diagnosis issue that’s not been addressed (particularly w/benzo use)? Would other medications possibly help (Campral or Antabuse w/alcohol misuse/abuse)? Etc. When you immediately jump to “zero-tolerance” & no use for harm reduction, you do away w/some very important aspects of MMT – the potential to keep someone alive via induced tolerance by methadone in what would have been an overdose situation w/heroin or other opioids; HIV-transmission reduction; crime reduction; higher likelihood of stability in employment & home-life; & the list goes on & on. Throwing someone out of treatment TOO quickly is a grave mistake, in my opinion… one that many clinics seem to be all too willing to make! And having a propensity to misuse another substance does NOT negate the good that methadone might be doing for that patient – I know that if I had a Valium problem, I would still ABSOLUTELY need methadone for my opioid problem, as I spent almost 10 years trying to get clean via 6 inpatient treatment centers ranging from 3 weeks to 2 years, all abstinence-based, & all of which failed for me w/in 3-4 weeks of getting out, if that long. I also did 2.5 years in prison for passing fake prescriptions, where I couldn’t get opioids. I relapsed w/in the same amount of time (1 month) & thought about opioids almost all the time the entire time in prison. It was a horrific experience not to have MMT available to me at all during that time. Had I found a clinic to dose me correctly beforehand, I likely would’ve never been in prison to begin with. When I got to my stable dose of 155mg in 2004, it was like someone flipped a light switch & all talk, thought, etc of drugs went completely away! I’ve remained in treatment since, & done very well, with zero relapses to illicit opioid use, & only 3-4 negligible scripts for them during that time for dental issues (under 16 tabs of hydrocodone on ANY occasion, some of which I didn’t finish, & didn’t enjoy taking, in all reality… they made me very dizzy & nauseous, I assume from incomplete cross-tolerance & perhaps issues w/activation or inhibition of receptors other than the mu.) Discontinuing MMT for me would be absolutely DEVASTATING for ANY reason! Thank God I don’t have a benzo misuse issue (nor alcohol,) so this is not a problem for me. But I worry for those that DO have one or both of these issues! I see patients that suffer everyday from them, whether at the clinic or on the methadone boards online. I don’t think it’s legitimate to make the presumption that NO MMT patient needs to also have a prescription for a benzo for ANY reason. If we can say that, we should be able to also say, by default, that NO person needs to have a benzo script for any reason! It only stands to reason.

    Reply

    • You make some excellent points. This counselor did use some strong language with “zero-tolerance” but she works at a clinic that’s been sued 4 times for methadone overdose deaths. At the time she was interviewed, benzos were permitted or at least tolerated, and I think she was worried for patient safety.
      My complaint with benzos is that they’re often prescribed for months and months, yet we have no data to justify their use for more than three months, except for when the patient is terminally ill. There’s some good evidence (a good topic for a future blog) that long-term use of benzos actually interferes with recovery from axiety disorders, due to the tolerance that builds fairly quickly with daily use. Benzos are certainly not first-line treatment for anxiety disorder.

      I’m please to hear you’re doing so well on MAT!

      Reply

    • OMG Benjamin….I can not thank you enough for sparing me for having to write the long response myself…YOU DID NOT SKIP A BEAT….I am also in NC clinics.

      When I read the Interview I was trying so hard to be appreciative of it. I wanted it to work out better though. I hate that HARM REDUCTION just seems to be fading out as time goes by and it is what made MMT so successful really. I have skipped all the other replies to include Dr. Burson’s because I did not want to get distracted or unfocussed at all from telling you that this is one of the best replies that could have ever been written IMO and I know everyone has them. I have used your reply in defense of harm reduction on a forum I am a moderator of…

      I like you…do find some appreciated parts in the interview but I am also disappointed in the zero tolerance or zero appreciation for benzo needs and harm reduction modality and NA/12 step supporter…..from one of our own….. So I am trying real hard not to find the article damaging I hope it is seen ineffective before harmful if there has to be a black or white no gray area approach.

      We all have our opinions and I so appreciate Dr. Burson taking her own time to promote MMT/MAT and by no means want to seem disrespectful. These sites will always have differences of opinions, attitudes and insight and without all this being taken into consideration blogs that are open for discussion would be useless. I would love to have your email address and invite you to some other MMT/MAT forums where your ideas and insight could be very well appreciated.

      Thank you again…..and now I will go back and read all the other replies. I am almost afraid to look.

      Reply

  2. Posted by Cb on October 5, 2012 at 12:36 am

    Great insight! I would suggest those that feel uncomfortable at na should try Aa! The singleness of purpose gives methadone users an out! The only requirement is a disire to not drink! Lots of alcoholics are cross addicted now & certainly understand. I have a brain diseaese & take medicine for that. Same as if I had diabetes or cancer.

    Reply

  3. Posted by Benjamin K. Phelps on October 5, 2012 at 4:19 am

    I do understand the dilemma a clinic owner &/or doc must be in w/this problem of liability when running an OTP. As you may be able to tell, I have some medical background, & I’ve been very aware of the boom in methadone deaths over the previous 12 or so years (not that EVERY MMT patient hasn’t heard something about them… I think it’s affected all of us in some way, big or small.) As I said before, I don’t claim to know the best answer to the issue of how to handle it. But the idea of simply tossing a person out of medication-assisted treatment REALLY bothers me, based on how well I’ve done on it & the fact that I truly believe that the majority of patients can do just as well w/their opioid addictions if they’re listened to by the prescribing doctor & counseling staff as to what is happening w/their cravings & illicit use, etc. It has made all the difference in the world for me to find a doctor that did so versus one that didn’t. I also am very aware of the difference a proper dose makes versus a lower one. I know that many patients come in w/preset ideas of “I don’t wanna go any higher than Xmg, so I can come off quicker,” & it really works against them. Deciding you will not go above 40 or 50mg (or whatever # you arbitrarily pick out of the air) is doing yourself a real disservice in most cases, though a few people get by on such doses, b/c doses that small are not even at the lower edge of the beginning blockade dose. Not to mention that there’s little point of being in MMT if you’re going to crave/use day in, day out. Additionally, you can drop MUCH quicker from the higher part of a dose w/out any problems (like I did from 155mg to 55mg going down 10mg twice weekly) than you can from the lower end (from around 40mg down to zero, at which point you generally need much more time between drops & much smaller drops.) As I’m sure you know, Dr. Burson, many patients have no idea what the term “blockade dose” means, or where it usually begins – which is around 60mg, MINIMUM (according to most literature/studies. And please, by all means, correct me if I state anything that is off here, Dr.) However, best practices indicate that 80mg is preferred, w/some needing up toward 120mg (& then of course we all know many people need more than this, w/some needing much more.) For me, it was initially 155mg that did the trick – I wasn’t interested at that point in going any higher or doing other opioid drugs. In fact, I came back down from 160 b/c I felt too lethargic & sleepy. But 155 was the magic number, & it changed my life. I no longer need quite that much to avoid using & thinking of using – I’ve remained clean at 120mg for around 3 yrs now. However, I fight quite a bit more w/urges to use my takehome dose a little early – like the night before instead of waiting until morning (I resist, as it would only make the next day miserable,) I also feel hot/cold cycles at night & in the mornings, & generally feel like I can’t do much of anything until I dose, though I’m not “sick”. I didn’t experience these things at my higher stable dose for 6 years. But my current clinic will not raise us above 120mg w/out a trough test (no peak), as they believe in a “therapeutic range” set of numbers – though that’s not been found to really exist for maintenance patients (Google the article “When ‘Enough’ Is Not Enough”.) I’d actually be more interested in doing the peak AND trough than just one of them, b/c knowing the gap in the two (the window) is what helps show why a patient is craving or having difficulty. The smaller or more narrow the window, between peak & trough, the less fluctuation (obviously.) Rather than looking at this, though, my clinic only wants to know if your lowest number is within a particular area, & I wish that weren’t so. We deal w/a less than perfect system, though, & my concern w/doing the test is that my clinic will actually potentially drop your dose if they feel your trough is too high. I don’t imagine that would happen in my case – I’m nowhere near over-medicated – I’ve been there before & would recognize that, I’m sure. Anyway, my clinic will taper you to 40mg when you have a dirty drug screen for benzos (though there’s no science I know of to support this other than concerns over liability, as you pointed out,) & if you continue to use them, you’re put on a 10-day admin-taper from MMT eventually. I know anxiety studies have yielded the results you mentioned, Dr. Burson, but are there any studies that have had any different results supporting long-term use of long-acting ones, such as Klonipin for epilepsy control or as a sedative? My father was put on it for about 15 years for chronic fatigue syndrome in which he could hardly sleep at all & there was virtually nothing else that worked at all for him any longer than 2-3 weeks or so, except things like Elavil, which gave him such a hangover the next day that he couldn’t function. Incidentally, he’s never had any addiction issues. I do know that benzo withdrawal is considered to be likely the worst type of all (though I also know that benzos, alcohol, & barbiturates are all capable of relieving withdrawal of each other, from my understanding, & are all dangerous due to possible seizure & death.) Hence, I would not ever WANT to take benzos for any sustained length of time. If they’d be ANYTHING like the Lunesta withdrawal was, I’d be scared to death of them!! It was absolutely terrible. But I’ve read SO many accounts of people who claim there is absolutely, positively nothing else in the world that has ever worked for treatment of their anxiety issues or agoraphobia, etc & they just go nuts when they try to use other meds in place of them – makes me wonder how much of that is what you spoke of: worse anxiety issues due to extended use of them to begin with!

    Reply

    • Once again brilliant thought, perspective, knowledge and insight let alone the eloquence in your writing….Funny I would love to know your thoughts on racemix vs. non racemix methadone and qtc intervals if you have any thoughts….Sorry off topic

      Nit back on your reply…I am so confused by the the Peak and trough procedures and how they cary from clinic to clinic …doctor to doctor. The doctor at my clinic prefers the results of the peak….I am sure to see if there is a toxicity value and then possible decreasing. I was fortunate enough to be one of his first patients where he followed the norm of the doctor before him and did bot which my results were 881/226.

      He did not like my peak level but thought my trough was low and the numbers in between the two of course showed a great need for split dose which thank god is what he did…after about a 30 milligram increase he decided a year down the road to pull me in and ask me to do a peak level which I was never told the results but they must have not been offensive because I never heard anything back from him about it…

      I was told by my counselor that my chart had been pulled for a random peak and trough then I was only administered the peak…???…. Which can be scary since it is hard to have any confidence in the manner of testing because of the inability to get trusted figures as the isomers might be the inactive or either the active isomers showing up in the type of methadone we use in the States.

      I am considered high dose which leaves me vulnerable to call backs…qtc/ekg testing….peak and troughs etc…which keeps me quite anxious as I have at times seen people/patients/clients endangered in their recovery due to these results not being considered optimal. It seems like I never have any peace at first it was qtc issues but when I went to a cardiologist on my own recognizance….it was determined I did not have any qtc issues but for over a year…I had to beg for increasing (to stop withdrawals and cravings) suffer 7 attempts on peak and troughs because I am a almost impossible person to stick when finally a new nurse that came from a plasma center who actually let me determine the best place to stick me was my wrist she finally got it and that was when it was 881/226.

      So for 18 months I considered myself in the induction phase and even though I did not use (which they used against me because they determined I must be on a proper dose or I would have been relapsing) In all actuality I was scared to relapse due to the qtc issues as I was being threatened with having to detox of methadone and be placed on suboxone which I failed at twice before. That was the only reason I did not relapse…I craved all the time.

      Sorry Yall I got all yappy there…Just excited and super refreshed that someone else out there has some of the same ideas, feelings and circumstances as I. Thanks again Benjamin……

      Reply

  4. Posted by Jennifer on October 7, 2012 at 12:54 am

    Hi my name is Jennifer I just came across your blog actually looking for something else having to do with methadone. I am currently in a methadone clinic and have been now for over 4 years. I am a recovering addict and have been off of heroin now for 2 years. I struggled for a while when I had first started n the program. Then finally I had that “Ah Ha” moment and to me it was the most wonderful feeling in the world. I live in Ohio and at our facility our doctor is very strict which I love he doesn’t let us use benzos or any types of narcotics or alcohol him and the counselors do work with those struggling but, recently so many people have been detoxed off due to not stopping the drinking and using the “benzos” or due to not ever having clean urines. We also have to do mandatory group meetings inside our facility as well as outside The number of meetings is determined with your counselor when you go over your treatment plan. Going to meetings to me is a huge part of what keeps me clean today. We have an Methadone Anonymous meeting at our clinic for those who go to the clinic who would like to attend it is not mandatory but lots of people do attend. I usually do atleast a meeting everyday at my clinic I attend. Also I attend outside ones. I love them have met so many great people in meetings everywhere and I will keep attending for the rest of my life. I am currently detoxing a little bit because I feel my dose is just to high now. I am doing this very slowly I am not ready completely to be off I just want to go down on my dose. I am enrolling in college to one day become a counselor. I want to help people just as I have been helped. I have the most wonderful counselor who has helped me so much in my addiction and she has been there for me and never let me down. Been tough with me when needed I’ve cryed to her many times and she was there to listen. I have signed up to follow you and I look forward to reading more from you. Thank you for your story and I am so happy for you. Keep up all the wonderful things you are doing.

    Reply

    • Thank you for writing!

      Reply

    • Posted by Benjamin K. Phelps on October 7, 2012 at 9:43 am

      Jennifer, your story is interesting to me – I know you were aiming it to Dr. Burson, but I was intrigued to hear your road to recovery. See, for me, it may sound foreign to you or in some way negative, but the medication was more of a factor in my recovery than meetings ever were or could be – I think my problem is purely that of an unbalanced endogenous opioid system (endorphins, enkephalins, dynorphins, etc., if you’re familiar with that whole deal…) In other words, I truly believe I screwed up my internal chemical balance – or it was already messed up – and I discovered what “fixed” it, & have felt as though it was necessary to feel “normal” ever since. I don’t mean what was needed for me to feel “good” – I mean what was necessary for me to feel “normal”. There’s a difference. Given, prior to ever having an opioid, I wouldn’t have known what “normal” felt like, but when something is off, our bodies do make efforts to compensate until a balance is struck – like the desire to crunch ice when we’re short on iron (don’t know if you’re familiar with that tendency, but it’s real…) Anyway, going to meetings has never helped me unless I really needed to get something off my chest or talked out at that moment. In fact, going to them prior to being on methadone only led to me meeting drug contacts, for the most part. If I wasn’t already craving that day (which was rare, given,) by the end of the hour, I was like “hey, let’s go get us one!” That’s a sad thing to say, but that was how I experienced meetings. Once I got into MMT & begun doing well (within a half year of starting – around mid-2004,) I attended group weekly & counseling almost as often. I enjoyed some of them, but preferred private counseling more (as I still do.) Basically, once I got to monthly takehome doses, I didn’t have to attend group any longer (4 years from my date of compliance, so about mid-2008, which was 4.5 years after I started.) I only attended group at that point when I needed to talk or hear others for a specific issue I was having. I currently have gone back to attending group again at my present clinic b/c when I transferred, I didn’t get to bring my takehomes. However, I find no help in them – they’re like a burden that uses up valuable time, as opposed to personal counseling, which I MUCH prefer still. I enjoy that, but we no longer get more than 1 time a month, due to limited local funding (even though I’m self-pay.) If I want more than 1/mo, I have to pay extra, which I cannot afford. Those things said, I’m not intending to speak badly of meetings – please don’t misunderstand me here – I’m just intrigued at how differently treatment works for various people, & how individual we all are in our needs & recovery paths. It just goes to enforce what I’ve always felt – that courts & judges & people in general that endorse a one-size-fits-all approach to recovery – thinking that forcing every addict that passes through to attend 90 meetings in 90 days is the answer, or not allowing medication-assisted treatment, or whatever the case may be – is NOT the answer. Listening to what the individual patient needs & is experiencing, however, IS. I’m not advocating for allowing people like myself to not have to attend meetings at all, or saying that b/c I needed medication more than meetings (perhaps,) that I should have not had any requirements of that nature – I think we ALL need some level of intensive counseling & group therapy, particularly at the start of treatment (when coming from active addiction.) Those in that phase of treatment have to learn to live all the way from the beginning again!! Hence, they must learn to cope with practically new feelings once again that they may not even remember having before, or how they dealt with them before. That’s one of the things groups can really help with. So please don’t misunderstand why I say what I’m saying here. But anyway, thanks for your story. I’m glad to hear that you’re wanting to help others accomplish what you have, & I hope your taper goes well, if that’s how you would like your path to continue – as for me, I doubt I’ll ever taper all the way from methadone – but that’s b/c it’s corrective, not curative for an chemical imbalance. For those who need a transition from dependency to abstinence, it is a wonderful tool. But for those who have permanently destroyed their chemical balance, I think it can be necessary for the long haul. Unfortunately, I seem to fit in the latter category… though I’d love to find out I’m wrong about that. I have, however, tapered down to a low dose (47.5mg/day from 155mg,) & found that old behaviors came flooding back in. I found myself scouring the web for pictures of pills to drool over, which I’d not done in YEARS. I stayed at that dose for about 2 months to give myself time to adjust, but it didn’t happen. I didn’t relapse, but I knew I eventually would, so I went back up to a stable dose. I have been at 120mg for about 3 years now, so I’m lower than the 1st 7 years, but still at a rather high dose, at least to most people. I’m okay with being on MMT for life, as far as my own thoughts go – though it doesn’t suit my parents & others fine, evidently. But I’ll occasionally try to lower my dose, & if I can ever get to abstinence, it’ll be a great day! Thanks again.

      Reply

      • If we had methadone anonymous….I would attend because I do like the idea of the spiritual connection to a power greater than myself and also.the camaraderie. I work in abstinent recovery for 5 years and also for years that was all I could rely on for help with my thirty years of opiate abuse. But with that in mind I too agree that I suffer from EDS (Endorphin Deficiency Syndrome). Being on opiates on the most part made me feel normal I think that is why I was able to be a pretty high functioning addict. Working and avoiding jail etc….Once again though…I enjoy meetings and I have missed them due to my choice to partake in MMT. (which really looks to be my choice but in all actuality it was my only option.)

        NA is not very supportive of MMT and AA either. I feel AA is less supportive for the methadone patient. I don’t like the idea of MMT patients being forced to go to a place where they have to suppress or even lie about their recovery method and in all my years of NA Meetings (20 or so)…I found one meeting in Daytona Beach Florida…it was on a hospital floor…that was welcoming to the mMT community. No Offense Dr. Burson but do you really encourage your clients to go to NA Meetings? (Here in NC???) I would drive a couple of hours if you indeed can tell me of a NA meeting where the clients are appreciated for their recovery in MMT. I am not being sarcastic as it may sound I am truly interested….

        I too, Benjamin have no intentions of coming off MMT unless something magical happens and I am convinced I will never fall back to opiate abuse….My fear is some of these rumors coming to life about limited time in MMT like Tennessee and a few other States is advocating for. What a nightmare that could be for me and so many others….

  5. It was I worked in abstinent recovery not work…This was 10 years ago.

    Reply

    • Posted by Benjamin K. Phelps on October 8, 2012 at 3:25 am

      Oh Tonya, I fear those types of laws, too – but keep in mind those are aimed at people receiving MMT through state benefits like Medicaid (or whatever they call it in their state.) It pains me to imagine being forced off if I were on Medicaid, but thankfully, I’m self-pay, so at least at this point in time, they haven’t made laws in ANY state that I’m aware of that state a self-pay person can’t stay in MMT as long as s/he feels necessary. But there again, there’s always those few bureaucrats that LOVE the sound of “drug-free” and feel it’s the ONLY way for you to be a real person again. I don’t know or understand why it’s SO important to them for you to be able to say those 2 words – it makes absolutely zero difference in their lives, only yours. But not in the way THEY think – instead of it making your life so much more wonderful, it’s likely to turn it upside down once again, unfortunately. This has been found COUNTLESS times – so why they continue to jump on this bandwagon every 5-6 years in various states is totally foreign to me. For God’s sake, Google the methadone studies and related issues and read them for yourselves if you’re not well-versed in the subject before you go running into a board room to try to ruin thousands of peoples’ lives that are thriving before you came along! Can you tell it’s easy for me to get on the soap box? :0) Don’t mess with my recovery treatment – it’s been the ONLY thing that worked for me after 6 in-patient treatments ranging from 3 weeks to 2 years, Bible-based, work-based, NA/AA-based, you name it, I’ve done it. This was my last hope before habitual felon for forged prescriptions, which would’ve been 10 years in prison just for the habitual part… then the crime itself carries more time on top of that. No thank you.

      Reply

  6. Oh yeah good point great see I let my fears over ride my common sense sometimes….I would love to invite you to http://atwatchdog.lefora.com/2012/10/07/where-is-harm-reduction-disappearing-to-do-intervi/#post5 where I used one of your post in a thread….Join us. It won’t take you but a moment to figure out who I am by screename….

    Reply

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