Interview with a Methadone Counselor

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.

Treatment professionals can also make the mistake of dismissing non-medication treatment of opioid addiction as ineffective, when clearly this is not true. Though treatment with methadone and buprenorphine can provide enormous benefit, so can the other medication-free forms of treatment. And as we have seen, methadone can cause great harm when used inappropriately, and some opioid addicts don’t do well on methadone.
There’s no one best treatment path for every addict. Every evidence-based treatment helps some addicts.

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6 responses to this post.

  1. Posted by trusandrataylor, md on August 29, 2010 at 5:23 pm

    I appreciate the comments from RJ. I am a medical director in a methadone treatment program and have worked treating addiction for many years. I support her point of view and share her perspective.
    Thank you for this contribution.

    Reply

  2. Posted by Konrad M. on August 12, 2012 at 9:51 pm

    I also share Rj’s perspective, as a methadone patient. I agree methadone is not for everyone and it has a bad reputation from the rocovery society, but keep in mind, most of those bad opinions are people who haven’t been on a methadone program. When your on a maintainence plan you cease to feel that “high” feeling as opposed to someone who takes it recreationaly. I didn’t get sober right when I got on methadone, but it gave me the opportunity to get off the street and stop scamming, which in turn also by getting rid of all opioid cravings, gave me a chance to think a little bit more clearly to want to get sober. Now I am working on detoxing off of methadone and I inspire to also become a drug and alcohol counselor specializing in methadone to give back what has been given to me. I believe methadone maintenance also works in the right cases, but is not for everybody.

    Reply

  3. Posted by Bowza on August 8, 2017 at 12:54 am

    I don’t agree that just because someone is on methadone for 20 years means they will be for life , studies have shown that the longer your in treatment betters your chances of getting off and staying off and the slower you detox when ready is key . But if methadone is working and you feel like you need it then there shouldn’t be any reason to stop, unfortunately the people that have done everything right for 20 years are at best forced to get in line every 2 weeks to pick up take homes and stand in line with addicts fresh off the street and that’s dangerous you hear them talking about how great the dope is and they sell benzos in line that’s why after you have proven yourself and 5 years or ten you should be able to go to a regular doctor for your methadone and do they really need counseling for 20 years ? I think forcing someone that has shown all they need is a there medication to still do all the same things as a person off the street only indangers the person and puts them close to temptation that they wouldn’t be near if treated Better basically a methadone pt is on parole for life even murders and rapist get off parole at some point !!

    Reply

  4. Posted by Bowza on August 8, 2017 at 12:57 am

    I’d like to know how she got clean ? Jail time ?

    Reply

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