Methadone Mythbusters: Do People on Methadone Lack Willpower?

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In our recent blog post Methadone: Changing Attitudes, Saving Lives we discussed the benefits of methadone treatment for people struggling with an opioid use disorder. The purpose of that post was to highlight the advantages of methadone treatment – and Medication-Assisted Treatment (MAT) in general – and begin the work of removing the stigma surrounding both methadone and MAT programs.

After publishing that post, we decided to continue discussing the topic – in the form of our Methadone Mythbusters series – for three reasons:

  1. MAT, including methadone, is recognized as the gold-standard treatment for people with an opioid use disorder.
  2. Stigma, misinformation, and common misconceptions keep millions of people from getting this life-saving treatment.
  3. If we can save lives by eliminating that stigma and getting people the treatment they need, then we’re all in.

Click here to read our first Methadone Mythbusters post, “The Addiction Bait and Switch.”

Click here to read our second Methadone Mythbusters post, “Do People Use Methadone to Get High?”

This is the third post in the series. We’ll use it to address the following misconception about methadone treatment:

People on methadone lack willpower.

Unpacking this misconception means going back in time to the latter half of the 20th century, when evidence-based treatment for substance use disorders began in earnest. This was before research scientists had a lot of data on addiction and addiction treatment, before we understood the connections and relationships between genetics, neurobiology (brain science), environment, lifestyle, and substance use disorders, and before people understood addiction as a disease. This was when a majority of people, both medical professionals and laypeople alike, considered addiction to be a moral failing, or, as the misconception at the center of this blog post, simply something that happened to people who lacked willpower.

The New Science of Addiction

Unfortunately, the idea that people with alcohol and/or substance use disorders lack the willpower to just quit drinking and doing drugs is still prevalent in our society. This is not just something in our heads or a case of people struggling with addiction being over-sensitive to criticism. It’s based on data. Research shows that people in methadone programs experience stigma, negative stereotyping, and discrimination from family members, coworkers, employers, potential employers, and in some cases, from healthcare workers when seeking treatment for unrelated medical issues.

What makes this situation even worse is that the medical community officially moved past these negative stereotypes over twenty years ago. In 1997, the National Institutes of Health (NIH) issued a report summarizing the conclusions reached by a consensus panel on effective medical treatment for opioid use disorders. In their summary report, “Medication-Assisted Treatment (MAT) For Opioid Addiction in Opioid Treatment Programs,” the panel concluded:

“…opioid addiction is a chronic medical disorder that can be treated effectively by a combination of medication and psychosocial services.”

In addition, the panel:

“…explicitly rejected the notion that [addiction] is self-induced or a failure or willpower…”

The best way to understand the effectiveness of MAT for substance use disorders and reduce negative stigma around methadone and MAT is to follow the informed conclusions of the experts. As a society, we must accept and embrace the fact that substance use disorders are chronic, relapsing diseases. And once we accept and embrace that idea, we need to start treating people with substance use disorders the same way we treat people diagnosed with those diseases: with respect, support, and one thing in mind – healing them with the latest, most effective treatments available.

The National Institutes of Health (NIH): A Firm Position on Substance Use Disorders

The National Institute on Drug Abuse (NIDA), a department of the NIH, maintains a web page with the heading “Drug Abuse and Addiction: One of America’s Most Challenging Public Health Problems.” The page presents the case for treating addiction as a chronic, relapsing disease by comparing it to other chronic, relapsing diseases, such as type II diabetes, cancer, or cardiovascular disease.

The scientists at the NIH identify similarities between chronic disease of addiction and those other chronic diseases in four key areas:

  1. Like cancer, cardiovascular disease, and type II diabetes, researchers have pinpointed gene-related proteins present in people with substance use disorders.
  2. Environmental Factors. Like cardiovascular disease, the development of substance use disorders is related to risk factors present in the environment of the individual. Whereas the development of cardiovascular disease is affected by obesity, a sedentary lifestyle, and stress – all environmental factors – the development of substance use disorders is related to adverse childhood experiences (physical or sexual abuse), witnessing violence, and stress – all of which are also environmental factors.
  3. People with substance use disorders relapse at similar rates to those with other chronic diseases:
    1. Type II diabetes: 30-50% relapse rate.
    2. Hypertension: 50-70% relapse rate.
    3. Asthma: 50-70% relapse rate
    4. Substance Use Disorders: 40-60% relapse rate.
  4. The treatments for substance use disorders and the major chronic, relapsing diseases are strikingly similar. For instance, the treatment of addiction, cardiovascular disease, and type II diabetes include:
    1. Medication
    2. Lifestyle changes
    3. Knowledge of family history
    4. Stress management
    5. Evidence-based treatment and adherence to the treatment protocol.

The parallels between substance use disorders and other chronic, relapsing diseases are plain to see. All have genetic and environmental factors. All have similar approaches to treatment, and all have similar rates of relapse.

Why Do We Treat People With Substance Use Disorders Differently?

We do. And we shouldn’t.

When we look at the facts, there is no good reason to treat people struggling with a substance use disorder any differently than we treat people with type II diabetes, cardiovascular disease, or cancer. We don’t stigmatize people with these chronic diseases – and when they relapse, we most certainly don’t tell them the reason they relapsed is because they lack willpower.

That would be cruel on its face, and insensitive at best.

No one would ever do it. Not doctors, not nurses, not anyone. Blame someone with breast cancer when it returns?

Nor would we tell someone who has their condition under control with medication that their condition isn’t really under control at all, then treat them like their medication is a crutch that keeps them from real healing. All the while implying they’re weak because they can’t beat the disease without taking medication.

No one would do that, either.

Yet it still happens every single day of the year to people in methadone treatment programs.

It’s an attitude that leads to so many negative outcomes we’ll skip straight to the one that matters most: it’s keeps people from getting treatment that can save their lives. Rather than stigmatize people on methadone programs, we should treat them exactly as we do people in treatment for other chronic relapsing conditions. We support them, help them stay on track with their medication and lifestyle changes, and let them know we’re here for them if they need us. Many people look at the opioid problem from the outside – people with little or no stake in the crisis – and wonder what they can do. This is one thing they can do: help reduce stigma by spreading awareness about the value of substance use disorder treatment, MAT, and methadone programs.