Patient “vs” Client

Policy Statement

Number 4

May 1994

Over the years methadone providers and patients have begun using client in place of patient. While this maybe well intended NAMA is concerned that the results could become damaging to methadone treatment, and most especially to patients. The use of client is deprogating to methadone patients, inferring that their addiction to narcotics is their fault – a result of their weak character and compulsive behavior and not their brain chemistry. Many medical conditions arise because of destructive behavior, (i.e. tobacco and lung cancer, diet and heart conditions) yet addicts are consistently made to feel inferior and weak because of their drug dependency.

There are several reasons why client should not be used when referring to methadone patients:

1. Methadone maintenance is a medical treatment for narcotic addiction, prescribed by a doctor and administered by a nurse, therefore the recipients must be patients. (Diabetics are not called insulin clients.)
2. Methadone patients are protected by the Patient’s Bill of Rights while clients on the other hand may not.
3. Health and medical costs continue to rise and public and private health insurers are continuing to look for ways to reduce their costs. If client is used in place of patient then the private and public health insurers could refuse to pay for methadone treatment. They could say, “Methadone treatment is not a medical treatment, after all you call them clients.” While this may not be an imminent threat it could be ten years from now if health care costs continue to increase.
4. Methadone maintenance treatment supports the theory that narcotic addiction is caused by a brain dysfunction–an abnormal endogenous opioid receptor-ligand system that is expressed through a deranged physiology. Methadone maintenance corrects this deficit by stabilizing the system. Therefore, methadone maintenance treatment is not curative, but a replacement chemotherapy as insulin is for the diabetic, dilantin for the epileptic, estrogen for menopausal women, and many more medical conditions. In contrast, drug free programs call treatment recipients clients and believe that narcotic addiction is primarily a behavioral problem that can be corrected with therapy. It is well documented that heroin addiction when treated with an abstinence oriented modality is not very successful with only about 30-40% remaining drug free after two years. Blendings of the two treatment modalities have also not proven successful. It therefore depreciates methadone patients to call them clients, because it infers that their addiction is a result a character disorder and is a behavior problem.
5. Presently, methadone treatment has a difficult time in attracting medical talent and one reason is that narcotic addiction is still perceived as a behavioral problem. If a clear distinction is not made then programs will never be able to attract the skilled physicians or other medical staff to work in methadone maintenance treatment. Nor will physicians consider undertaking addiction medicine as their specialty, or medical researchers continue to choose their field. This point is important if we want skilled physicians trained in addiction to treat us, otherwise methadone treatment will be relegated to profit oriented doctors with little concern for their patients–and we will become clients. It must be noted that this is beginning to change, a recently formed American Society of Addiction Medicine (ASAM) has several committees, including a Committee on Methadone Treatment, chaired by Dr. J. Thomas Payte. A very large and expensive textbook, Substance Abuse – A Comprehensive Textbook, edited by Drs. Lowenson, Ruiz, Millman and Langrod has been prepared for and is being used in medical schools. The continued use of client could impact negatively on these advances in addiction medicine.

Recently, Beth Israel Medical Center, the largest methadone program in the United States providing treatment to 8,000 methadone patients has issued an executive order to their staff instructing them not to use client. And, at one of the final plenaries of the 1992 National Methadone Conference held in Orlando, Florida the room was strongly urged to use patients, and drop the term client. Using client goes against policy set by The National Institute on Drug Abuse (NIDA), The Center for Substance Abuse Treatment (CSAT), The American Methadone Treatment Association (AMTA), and The Amercian Society of Addiction Medicine (ASAM) and is therefore, anti methadone.

Of course we understand that the use of client is usually well intended. After all patients are sick and the use of patient can infer this and methadone patients have enough stigma to content with. But it is not the word patient that is negative and causes the prejudice–it’s methadone and the misunderstanding of addiction as a disease. Only when the public understands addiction as a disease, as they do with alcohol will methadone be perceived as a medical treatment for addiction, rather than as a substitute.

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