Herman Joseph, Ph.D. is a member of NAMA’s Advisory Board and
has been involved in methadone treatment and research since it’s beginning.
This article is excerpted from Herman Joseph’s dissertation on stigma.
Methadone maintenance treatment has been subjected to professional trivialization
and misunderstandings, has consistently received sensationalized negative
media coverage and been the target of widespread community opposition.
Methadone patients are perceived as addicts: weak-willed, unemployed,
untrustworthy and dysfunctional. Employed stable patients whose lives have
been saved by enrollment in methadone treatment have been forced to conceal
their status as methadone patients from members of their families, friends
and employers for fear of losing their jobs, social ostracism and stigmatization.
They are hiding a “dirty secret.”
Addiction is perceived as being self induced, rather than the result
of injury or an inborn problem beyond the individual’s control. This impacts
methadone patients — in terms of feelings of self worth and esteem and
the social perception of addicted per sons. Stigmas that are perceived
as the direct result of a person’s behavior are the target of social hostility
and rejection.
Irrespective of the intentions of the critics, the ultimate effect of
the criticisms stigmatizes patients: the “deviant rehabilitative therapy”
has become a “rehabilitation without honor.”
The stigma of heroin addiction has been transferred to methadone. The
addict has traded the heroin monkey (drug hunger) for the methadone gorilla
(social control).
The labelling of methadone patients as methadonians and methadone addicts,
vitiates the attempts at normalcy. The accomplishments of methadone patients
belie the labelling.
In no other field of social service or medical treatment has a procedure
shown such potential efficacy only to be nullified by the effects of stigma.
The Patients Speak
“I go to meetings in the community and would like to participate more politically.
I was asked to consider running for political office, but I am concerned
about reporters finding out about my past. I do not want to embarrass my
children.”
“It’s the media. Every time I read something or see a TV show about
methadone and see these professionals – psychologist and sociologist types
– they call it substituting one addiction for another. This is not true
– they don’t know what they are talking about. When the public hears substituting
they don’t understand the difference between heroin and methadone. Here
I am a very successful businessman with a wife, son and a beautiful home
– methadone for me is medicine.
“We told our teenage son he doesn’t like it. He feels it is our fault.
The only people who know we are on methadone are in my family – some work
for me but the other employees don’t know. I don’t know about detoxing.
This is a medical condition. My wife d etoxed and had to go back on.”
“I do not tell local doctors in my community that I am on methadone.”
“I have my own business. My husband is in sales. I am happily married
with two beautiful daughters. The babies were born within the last seven
years. I was maintained on methadone during my pregnancies. I took off
time from work after the births of my dau ghters. The girls are doing well,
there were no problems with withdrawal or other effects.”
“No I don’t see myself as being weak willed or having a character disorder.
Methadone: A Technological Fix (Nelkin, 1973), “Methadone – It Takes
Your Heart” (Hunt, Lipton, Goldsmith, Strug and Spunt, 1985-1986). Who
writes this stuff? Some Ph.D.s wrote this doesn’t impress me! It is not
true. Of course it is stigmatizing. This gets me very angry. I am currently
on 20 mg/day. I feel comfortable at that dose, no withdrawal or sleeping
problems. I have no intention of getting off methadone. I have l ived a
wonderful life and I see no reason to get off.”
“I have my own home, but nobody in the town where I live knows I am
a patient. My family knows but they do not accept it even though I am very
successful more successful than my brothers who have technician jobs. They
only want to know when I am getting o ff. They have never told me that
I am doing great. I am on 90 mg, feel fine, don’t get high and am able
to do all types of work without any effect from the methadone.”
“Who knows that I am on methadone? My wife is the only one. I am the
most successful person in my family and belong to social clubs in my community.
All of this can be destroyed if they knew I was on methadone. I have two
teenage children they do not kno w.”
“Everybody in my family knows I am on methadone. My family has only
seen the good that methadone has done. They remember the stealing when
I was addicted to heroin. They can’t understand the negative publicity.”
“On methadone I was able to complete college and take professional courses.
I now have a wonderful job which demands a lot of responsibility, education
and skill. My boyfriend is also a patient and an engineer. I have friends
who are on the program. Many of them went through therapeutic communities
and 12 step programs only to relapse.”
“Methadone has allowed me to live without compromising my ethics or
values, which may not have been possible if I continued to use heroin.
This is very important to me.”
“Unfortunately, there is a lot of stigma against patients and ignorance
about methadone in the health professions. I am considered very competent
and skilled. Physicians trust me since in my specialized field. This has
given me a great deal of satisfactio n. I work with highly skilled professionals.
If they knew I was a methadone patient I would either lose my job or be
restricted in my duties.”
“I have an excellent safety and attendance record. I also have received
good evaluations. For the past 20 years I have had to take urine tests
about every two months (120 tests). They’re all clean. I’ve never used
drugs since I’ve been in the methadone pr ogram. I never got a promotion
and I think it was because of the methadone. They have no complaints about
my work. My children do not know.”
“Practically everybody I know knows I am a diabetic, but not too many
people know I am a methadone patient. I am a little ashamed of this dependency.
I tell people I am taking insulin what’s wrong with me taking methadone
to stop killing myself.”
“I work in management and put in very long hours. I am also registered
in graduate school for my masters. Recently I told two close friends that
I was on methadone. I tried to explain it but they now insist that I try
to get off. Before they knew I was a patient, they accepted that I was
tired after a day at the office and school. If I yawned or went to sleep
early this was normal. Now if they see me yawning or going to sleep early
it is not accepted as normal but that the methadone is causing me to yawn
and be tired. Before I was napping, now I am nodding.”
