Harm Reduction and Methadone Maintenance Treatment
One Perspective About Opiate Addiction & Long Term Treatment
By: Lara Windett, MFT
In thinking about opiate dependence, many people wonder how individuals end up dependent on a substance like heroin, vicodin, oxycontin, morphine or fentanyl. Whether clients use illicit or legal ways to manage pain, these drugs come with a constellation of withdrawal symptoms that often create more havoc than they support. Of course no one ever starts using drugs with the thought “please let me be homeless, with no family relationships because I have stolen or abused those who once loved me, let me have no job or place to go but the streets, let my veins collapse from so much needle use, and give me a number of life-threatening diseases like Hepatitis C and/or HIV,” and yet a percentage of opiate addicts — and almost all of those now clean on Methadone — struggle with some or all of the mentioned hazards of opiate dependence.
Methadone has been around for over 30 years and continues to be one of the county’s options for opiate addiction and harm reduction. Methadone Maintenance clients are dependent on a synthetic opiate and achieve dependence under a number of circumstances and for one universal reason — they are medicating some type of pain. As a class of drugs, opiates are pain killers and whether my clients are recovering for numerous back surgeries or were gang raped and can now hardly stand life, they some how started Methadone after a number of years abusing opiates and other substances.
Part of what psychotherapy or counseling does is treat psychic pain. Ideally, therapists help people better manage and tolerate feelings and it is an interesting proposition to work with clients who have already self-identified as having a difficult time tolerating all kinds of pain. Clinic staff is often treating clients who are suffering with unimaginable pain; where the pain is outside language and where there are no words to bind loss or damage.
When I started treating opiate and other substance abusers about five years ago, I was much more hopeful about clients staying clean and managing life without alcohol or other drugs. I saw substance abusing and dependent clients as reaching out for something rather than retreating inward where they cannot accept help or support. People coming to treatment want to get better and they are brave enough to walk through the door and try something new and something that is often very difficult to tolerate
As time has moved forward and a number of women came back into treatment with more advanced substance dependence and losses of children and periods of incarceration, I began to lose hope in the fantasy that my clients could contain their destructive impulses to use alcohol and other drugs. While I was happy that these clients were coming back to get help, I was also saddened to see the greater level of illness
One client who has helped restore my hope in treating very ill clients has been on Methadone for over 16 years. Andrea is a prime example of how both Perinatal and Methadone Maintenance services have provided a client with the chance to get clean, be a mother and a productive member of society who is not using jail or prison as a way to contain herself or her behavior.
Andrea requested individual sessions as she was working and getting back into school and wanted some extra support for “stress in my sobriety.” She was attending daily meetings and had over 16 years off heroin.
She began her recovery over 16 years ago in the Perinatal Substance Abuse program as one of the first clients. She stated that she had first wanted to quit heroin to avoid prison. Around session 10, the client seemed unusually sad and quiet in session. She said “you know it is my daughter’s birthday next week.” I must have looked perplexed as I knew she was raising her 16-year-old son and she said, “Oh didn’t I tell you? I lost my first child, my daughter, to heroin. She is with family, but I don’t see her. I kept my son because of treatment here. I know that I was difficult to deal with in the early years and yet somehow I kept him and now he will go to college in another year.”
I asked my supervisor about this client, as she had worked in the clinic, and her experience was of a much different client. Andrea initially presented as many clients first do: demanding, entitled and behaving as if they do not want or need treatment. Through the strength of her motivation, as well as the Perinatal and Methadone team, Andrea was able to tolerate treatment and gain the desire and ability to attempt living without heroin. She stated that coming to a program with other women in her same situation was a big part of her beginning to feel better about herself and her desire to parent her child. Andrea said that her parents never really seemed to care for her and that caring for herself and her son was something new that she learned while in treatment.
This was a client who came into treatment to raise her second child. She accomplished that, and with the years of treatment she is working, paying clinic fees and supporting herself and her son. Here is a woman who now has an amazing ability for self-reflection and empathy. She is one of the reasons that the people working in Perinatal and Methadone Maintenance Services know that treatment is necessary for the benefit of the clients and for the county at large.
I now work to bring the memory of this client forward when I feel hopeless or that treating my chosen client population or pregnant and parenting substance users is pointless. With more impending Santa Clara County budget cuts, I pray that our society puts prevention above incarceration. If we cannot as a society treat those who are the most in need, as this woman once was, the legacy we leave for our children will not be one where they have the chance to grow to their potential. This client acknowledges that without Methadone she would have lost another child and that cost to society is far greater than the prevention services that the county offers.