Recovery-oriented Methadone Maintenance, part 3

Consistent with Newman’s and Dole’s views are definitions of recovery that focus on health and functionality without reference to cessation of medical use of methadone. The examples below illustrate such definitions:
Recovery is the process of pursuing a fulfilling and contributing life regardless of the difficulties one has faced. It involves not only the restoration but continued enhancement of a positive identity and personally meaningful connections and roles in one’s community. Recovery is facilitated by relationships and environments that provide hope, empowerment, choices and opportunities that promote people reaching their full potential as individuals and community members.194
Recovery is a deeply personal, unique process of changing one’s attitudes, values, feelings, goals, skills and/or roles.195
The process of recovery from problematic substance use is characterised by voluntary sustained control over substance use which maximises health and wellbeing and participation in the rights, roles and responsibilities of society.196
Stabilized MM patients would meet these criteria for recovery if they were demonstrating progress toward increased health and functionality. The “sustained control over substance use” in the UK recovery definition is broad enough to include multiple pathways of alcohol and other drug (AOD) problem resolution—traditionally defined abstinence, decelerated patterns of AOD use that no longer meet criteria for a substance use disorder, and medication-assisted recovery—as long as the other criteria of health and positive community participation are met. Similar in spirit to the UK definition were suggestions to the authors from some methadone patients that a broadened definition of recovery is needed.
The only way we will ever be able to move addiction treatment to a chronic disease model is if we take the “abstains from alcohol and other intoxicating drugs” out of the recovery definition, or at least stop making it the deciding factor for the status of being “in recovery”… I think we need to make it one of many goals rather than the focus. This would help us achieve the focus of every other chronic disease treatment: QUALITY OF LIFE and the reduction of symptoms…We have got to stop thinking of recovery as ALL or NOTHING.”
Personally, something about the patient’s statement is more compelling than any of the others. I think a lot of people in drug-free recovery would be open to thinking about abstinence as a goal when defining recovery. “One of many” may be a problem because it makes it sounds like it would reduce abstinence to an item on a checklist when, for many of us, without abstinence there is NO recovery–an insufficient, but necessary condition for recovery.

With abstinence being so central to our recovery, it certainly feels like defining recovery as something for which abstinence is not necessary leaves it feeling like an incomplete definition. One of the factors that binds us together is the shared experience of searching for chemical solutions to our addiction problem and having to face the reality there is no chemical solution to our problem. If someone can find one, our hats are off to them, but their experience and our experience are qualitatively different. Not better or worse, but different. The journey may be similar, but it’s not the same. Does that make any sense?

This isn’t to dismiss recovery-oriented MM, but is it realistic to expect people in drug-free recovery and medication-assisted recovery to identify as one community? We might get there, but we’ve got a long way to go and a lot of mental barriers to navigate. Many of those barriers were created to protect our recovery and our identity as recovering people. I associate stigma with “otherness”. Addicts have long faced being defined as “the other” and recovering people have constructed our own positive sense of otherness. We talk about “normal people” and that we different from people who manage to moderate or find recovery through faith communities. Would embracing MM patients erode this protective differential identity? It also begs the question, why have MM patients been unable to create their own communities of recovery?

One thought on “Recovery-oriented Methadone Maintenance, part 3

  1. This neatly sums up the dilemma those of us in abstinence based recovery face. Abstinence is the platform that we started to build our recoveries on. To say that it is equivalent to medication assisted recovery is foreign to our experience. Many of us fought hard to move off of licit and illicit substances and each step was hard won. But it leaves me with a dilemma, for I don't want to apply stigma to those who define themselves as in recovery in a different way from me and I don't want to diminish real gains others have made. However if I don't think of abstinence as an ultimate goal, how do I continue to aspire to the highest level, to hold the bar high for clients so that opportunities exist for them to move on?I think the lack of a maintained recovery community is interesting. In my part of the UK it is notoriously difficult to get service users on MM to engage with service user groups or therapeutic groups. Those in abstinent recovery are queueing up.

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