The hospital where I trained had one of the original methadone pilot programs. They rounded up a bunch of addicts, provided counseling, educational assistance, housing assistance, employment assistance, health care, peer suppport and peer counselors, and oh yeah, methadone. Guess what, some of the “incurable sociopaths” got better, got jobs, rejoined their families, etc., so the methadone program seemed to be working. So they took away the counseling, educational assistance, housing assistance, employment assistance, health care, peer suppport and peer counselors, and left the clients with – methadone. Funny thing, it didn’t seem to work as well any more.
This, of course, beg the queston of what is the effective ingredient. I’m guessing that this was also not a maintenance program. Of course the next part of the story is that, when these clients started doing poorly, rather than re-implement all the other services, they decided that all of them needed to be on methadone longer–maybe forever. Then, when they still did poorly, they decided that they needed to be on higher doses, and then ultra high doses. (The slide above is from this presentation.)