Start with the premise that opiate addicts don’t get well. (Unless they’re doctors.)
Perform a study offering only two variations of your preferred treatment. (Cheap and crime reducing.) One is high dose or long duration and the other low dose or short duration. Do not offer a recovery oriented option at all, or offer a recovery oriented option of inadequate duration and intensity.
Find that, when offering 2 lousy options, the lousy option with the longer duration or higher intensity reduces symptoms better at follow-up.
Run a headline of, “Methadone Detoxification Remains No Match for Methadone Maintenance, Even with Minimal Counseling.” In the comments, declare, “Methadone maintenance is the preferred treatment approach for heroin dependence.”
Bonus: “No difference between groups was found for cocaine use or depressive symptoms.”
Bonus bonus: “Results for MM with standard counseling (2 hours a month) did not differ from those for MM with minimal counseling (15 minutes a month).”
Question: Do you think this will be used to justify offering even less counseling to methadone recipients?
- First, a question. If methadone is a superior treatment option, why don’t they use it for opiate addicted health professionals? Health professionals have high rates of opiate addiction and typically receive long term treatment with monitoring that lasts several years. Treatment is stepped up or down as needed. Guess what? They have great treatment outcomes. You might be inclined to chalk it up to a population with lots of recovery capital. To be sure, that plays a role, but surely a real chronic disease management approach plays a role too.
- Second, is it coincidence that this study was done on poor black men? Why aren’t studies like this done on young adults from affluent communities?
- Third, methadone used to be one component of some comprehensive bio-psycho-social treatment programs. I understand that there are still some programs that fit this description, but every program in my area is a dosing clinic and little more.
- Fourth, regarding misery, notice that there was no difference in depressive symptoms.
- Fifth, heroin addicts in our long term programs do just as well as everyone else. It’s all about hope and expectations. Beware of the subtle bigotry of low expectations.