Methadone Maintenance and Patient Self-Advocacy by Arlene S. Ford

Education Series

Number 1

March 1991


Arlene Ford helped to start one of the first methadone advocacy groups at Nassau County Medical Center. This article was written for the COMPA Newsletter for distribution at the National Methadone Conference.


Methadone has allowed me to salvage my life. In May of 1988, following a

fourth relapse, my twenty year marriage, my relationships with my sons, and

indeed my very existence was under attack by addiction. Methadone maintenance

treatment has granted me the chance to heal myself while repairing shattered

relationships. My husband and I are now able to renew our love. My children can

again rely upon me, and I have returned to work. Hippocrates said, “Healing

is a matter of time, but it is also a matter of opportunity.” The

program has given me that opportunity. The siege is over and the healing has

begun.

I have been asked to share some thoughts and concerns to many successful

methadone maintenance patients, specifically as they relate to that all

important decision of whether it’s time to advocate for oneself…determining

when it is no longer sufficient nor appropriate for Program Administrators and

staff members to speak for you…determining when, as a patient, one is capable

of coming to terms with the fact that a significant part of recovery is both

disclosing who you are and what your require to continue, even when that

recovery is methadone maintenance.

Partially because substance abuse professionals within the methadone

maintenance field are so very aware of the bigotry confronting the methadone

patient, they tend to shield the patient form public scrutiny. Counselors,

nurses and other staff members often feel that if they speak on behalf of the

methadone patient, indeed if they alleviate the need for the patient to advocate

for himself, they then can protect the recovering addict from the invasiveness

of outside prejudice. Although selfless in nature, this approach often can

extend longer than is healthy for many of us who are well along into our

recoveries; or conversely for those who are still struggling with recovery but

require a sense of self worth to continue in the day to day work of abstinence.

By understanding or sensing that it’s “okay to be on methadone,” we as

recovering addicts, regardless of our stage in sobriety, can in turn send a

message through our actions that we are healthy individuals ready to become

functioning, contributing citizens.

On a purely selfish level, there are clearly some methadone patients who, if

they “come out of the closet” would only serve to further perpetuate

harm to an already negative public myth that surrounds methadone clinics and

their patients. It is however, the other segment of the patient population that

should be addressed and encouraged to take an active role in the consumerism of

recovery, particularly as it relates to self-advocacy within their own clinics

and with local and state officials. For clearly, when patients are invested in

their own treatment, opting responsibility for their own recovery, the results

are all the more positive.

Occasionally, in the development of a working self-advocacy program, staff

members may feel the impulse to “put the lid on” some seemingly chancy

activity because of inherent risk, threat or embarrassment to the Program. This

instinct hopefully will be diminished by the knowledge that an essential part of

any growth process is the opportunity to make mistakes, benefit from those

errors in judgement and go forward. Because methadone patients have relatively

low levels of self-confidence and esteem, it may be necessary for program staff

members to signal their confidence in and acceptance of the stabilized methadone

patient as an individual capable of coming to terms with the issues and stresses

of self disclosure and advocacy. Initially, even successful patients may be

reluctant to come forward and spread the word of their success on methadone, but

with repeated clinic encouragement and preparation, a core group will soon form

and attract other stable, sober patients.

As a patient at the Substance Alternative Clinic (SAC) in Nassau County, I

have been fortunate to witness and be involved in the growth of our own patient

advocacy activities, Within the last year, this group has undertaken numerous

endeavors to involve methadone patients at SAC more actively in treatment

policy, programming and planning, in public education and in healthy alternative

activities in their clinics and communities that not only benefit the individual

patients, but their familiar, communities and all methadone patients. Within the

clinic, for example, a Patient Advisory Committee was established to work with

the SAC Program Director on matters of concern to the patient, community and

staff. Suggestion boxes prominently displayed in the units serve as conduits for

patient comments and suggestions that are in turn discussed by

patient-representatives and the Director. As a result, a myriad of changes have

been effected ranging from those of patient’s basic dignity to matters of

patient convenience. Additionally, selected patients serve with staff to revise

clinic policy. The involvement of their peers in administrative policy changes

is utilized to allay patient concerns that clinic procedures not be mandated

unilaterally without the aid of their fellow patients’ collaboration. The

anticipated result is an increase in patient acceptance and compliance with

clinic regulations. And, a clinic newsletter, now published monthly by patients,

reports on clinic activities and serves as an important forum for problems and

issues. The newsletter has significantly enhanced communication and

understanding by patients of all aspects of the clinic’s programs.

Beyond the clinic sphere, public advocacy and education has been a priority.

Following the highly slanted “investigative” piece appearing in

Newsday this summer, patients wrote letters of protest to editorial staff, and

various SAC patient groups wrote letters of concern and protest to public

officials regarding ongoing GAO audits of methadone clinics. An important item

of note is that several active members have begun, in their strong belief in the

positive powers of methadone maintenance, to utilize both their first and last

names when identifying themselves as methadone patients – indicative that

anonymity is secondary in importance to crucial matters of advocacy.

In August 1989, Nassau County’s newly appointed Director of Drug

Enforcement/Information Council attended the Friday Night Peer Support Group at

SAC as an honored guest and speaker. The Group was able to alert the Director to

the critical need for the education of the county’s judicial and penal system

officials in order to debunk the myths and legends that have continually

surrounded mthadone maintenance treatment programs. By meeting’s end, an empathy

and deeper understanding by the Drug Enforcement Director was perceived which

further reinforced the self-advocacy theorem as well as advanced the patients’

self esteem and confidence, providing the impetus to go further.

Additional SAC activities have been initiated and while not specifically

advocacy oriented, have directly linked many patients to healthy,

“straight” activities and relationships – in many cases for the first

time in years. In May, the SAC Mother’s Group sponsored the first in a series of

clinic bake sales to benefit clinic children’s activities. Initiated and run

entirely by volunteer patients, the success of the sale sent a clear message

that many patients were no longer solely content to just report to their clinic

for medication, and that involvement in clinic events and advocacy was

involvement in one’s own recovery. October marked the opening of a patient-run

and patient-donated SAC Clothing Swap shop to Supply any patient or family

member in need with used presentable warm garments.

There is little question that it may initially require a “leap of

faith” for clinic administrators and staffers to promote and encourage

patient self advocacy. Staff may be discomforted at first, unsure that the

patients may say something out of line, that some power has been transferred or

lost, and roles and identities blurred. Coupled with the need to “let

go” staff must also be alert to patient disappointments and

discouragements. Patients may tend, in their new found zeal, to take on

everything and everybody, in an attempt to prove that their recovery is here to

stay as well as powerful. But clearly the risks bring rewards. Patients will

unite, networking together to both protect their program as well as expand their

horizons into the community with the message that methadone maintenance is an

important, positive recovery tool.

Notably, with entrance into public activism, comes the patient’s greater

awareness of himself as an enfranchised individual; someone with the rights and

power of the voting booth. With the realization comes power…power to effect

change as a member of a constituency that verbalizes how they wish the

localities’ scarce funds expended in the arena of drug addiction…power to

remove officials from office if they are not responsive to the requirements of

the patient activist.

Methadone maintenance treatment, always controversial, has recently attracted

another spate of unwarranted, negative attention. Federal and State

audit-investigations abound…seemingly convinced from their inception that

methadone treatment is equivalent to the continuation of an addict’s active

addiction, not necessarily supportive of abstinence nor a “true”

recovery program. Given the less than enthusiastic reception of methadone as a

treatment modality by elected officials and the misperceptions of the general

populace, continuing existence and growth of patient self-advocacy groups is

essential. Inherent in the validation of methadone treatment as a recovery tool

is communication and cohesiveness between clinic staff and stabilized patients

who are prepared to be advocates. It’s time to take the burden off the shoulders

of clinic personnel and share it with those who are the only ones in a position

to speak personally of the struggle as well as the joys of methadone maintenance

treatment and recovery.

Notes

Reprinted from the COMPA Newsletter Fall 1989/Winter 1990 (2): 6-8. Committee of Methadone Program Administrators COMPA, 250 Fifth Avenue, Suite 210, New York, NY 10001. 

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