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Methadone maintenance: The addict's family recreated

Abstract

A study of four methadone clinics, the addicts treated at these clinics, and their families, reveals basic dissonances in treatment ideology and professional-paraprofessional relationships which, combined with the addict's particular mode of functioning, make significant change in his behavior improbable.

Addiction, as used here, is a class of behaviors in which the addict acts purposefully to acquire heroin but concurrently defines this behavior as the result of an “out-of-control” craving. This is an adaptive response to contingencies in his natal family.

Both the natal family of the addict and the methadone clinics will be described as aspects of a social system characterized by the paradoxical injunction “be out-of-control,” communicated to the addict by those in the system and his response. Dissonandes in the functioning of both the addict's family and the methadone clinics are transformed into the “flaw” in the addict that results in the behavior defined as his addiction.

This transformation is maintained by the “treatment” provided by the clinics, described as a ritual whose covert function is the maintenance of dissonances in the system within tolerable limits, through fomalized procedures. This implicitly validates both the formal structure of the clinic and the “flaw” in the addict. At the same time, addictive behavior creates and maintains an increasingly inclusive social system characterized by similar “core dissonances”.

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References

  1. Batsson, G., Jackson, D.D., Haley, J., & Weakland, J.H. Toward a theory of schizophrenia.Behavioral Science 1956,1(4), 251–264.

  2. Bourne, P.G., Hunt, L.G., & Vogt, T.A Study of Heroin Use in the State of Wyoming. Washington, D.C.: Foundation for International Resources, 1975.

  3. DiMascio, A., Rinkel, M., & Leiberman, J. Personality and psychotomimetic drugs. Proceedings of the Third World Congress of Psychiatry, Montreal, 1961.

  4. Dole, V.P., & Nyswander, M. Heroin addiction: A metabolic disease.Archives of Internal Medicine, 1967,120, 19–24.

  5. Freudenberger, H.J.The Staff Burn-out Syndrome, Washington, D.C.: Drug Abuse Council, 1975.

  6. Ganger, R., & Shugart, G. Complementary pathology in families of male heroin addicts.Social Casework, 1969,49(6), 356–362.

  7. Glasscote, R., Sussex, J., Jaffe, J., Ball, J., & Brill, L.The Treatment of Drug Abuse. Washington, D.C.: American Psychiatric Association, 1972.

  8. Goldstein, A.: Heroin addiction and the role of methadone in its treatment.Archves of General Psychiatry, 1972,26, 291–297.

  9. Haley, J.,Strategies of Psychotherapy, New York: Grune & Stratton, 1963.

  10. Haley, J. Toward a theory of pathological systems. In G.H. Zuk and I. Boszormenyi-Nagy (Eds.),Family Therapy and Disturbed Families. Palo Alto: Science and Behavior Books, 1967.

  11. Haley, J.Uncommon Therapy: The Psychiatric Techniques of Milton H. Erickson. New York: W.W. Norton and Company, 1973.

  12. Hunt, L.G., and Chambers, C.D.The Heroin Epidemics: A Study of Heroin Use in the United States, 1965–1975. New York: Spectrum Publications, 1976.

  13. Jaffe, J.H., Drug addiction and drug abuse. In L.S. Goodman and A. Gilman (Eds.),The Pharmacological Basis of Therapeutics. New York: Macmillan, 1965.

  14. Klerman, G.L., DiMascio, A., Greenblatt M., & Rinkel, M. The influence of specific personality patterns on the reactions to phrenotropic agents. In J. Masserman (Ed.),Biological Psychiatry, New York: Grune and Stratton, 1959.

  15. Maruyama, M. The second cybernetics: Deviation-amplifying mutual causal processes.American Scientist, 1963,51, 164–579.

  16. Mello, N.K. A semantic aspect of alcoholism. In H.D. Cappel and A.E. LeBlau (Eds.),Biological and behavioral approaches to drug dependence. Toronto: Alcoholism and Drug Addiction Research Foundation, 1975.

  17. Preble, E., & Casey, J.. Taking care of business: The heroin user's life in the streets.International Journal of the Addictions, 1969,4, 1–24.

  18. Ramer, B.S. Methadone maintenance for narcotic addiction.Journal of Psychedelic Drugs, 1971,4(2), 162–164.

  19. Rappaport, R.A.. Ritual, sanctity, and cybernetics.American Anthropologist, 197143, 59–76.

  20. Rhodes, C., White, C., & Kohler, M.F. The role of the so-called paraprofessional in the six years of IDAP In E. Senay and V. Shorty (Eds.),Developments in the Field of Drug Abuse. Cambridge: Schenkman Publishing Company, 1974.

  21. Rosenberg, C.M. Young drug addicts: Background and personality.Journal of Nervous and Mental Disease, 196948 (1), 65–73.

  22. Rosenberg, C.M. The young addict and his family.British Journal of Psychiatry, 1971,118, 469–470.

  23. Schwartzman, J. The addict, abstinence and the family.American Journal of Psychiatry, 1975,132 (2), 154–157.

  24. Schwartzman, J. Systemic aspects of methadone maintenance.British Journal of Medical Psychology 1977,50, 181–186.

  25. Senay, E.C., Jaffe, J.H., Chappel, J.N., & Renault, P.,et al., IDAP—Five-year results Fifth National Conference on Methadone Treatment. March 17, 19, 1973.

  26. Sluzki, C., & Veron, E. The double-bind as a universal pathogenic situation.Family Process, 197110 (4), 397–410.

  27. Stanton, M.D. Some outcome results and aspects of structural family therapy with drug addicts. In D. Smith, S. Anderson, M. Buxton, & Chunget al. (Eds.),A Multicultural View of Drug Abuse: The Selected Proceedings of the National Drug Abuse Conference, 1977: San Francisco, 1978.

  28. Stanton, M.D., Todd, T.C., Heard, D.B., & Kirschner, S. et al. Heroin addiction as a family phenomenon: A new conceptual model.American Journal of Drug and Alcohol Abuse, 1978,5 (2) 125–150.

  29. Vaillant, G.E. Sociopathy as a human process.Archives of General Psychiatry, 1975,32, 178–183.

  30. Wikler, A. Dynamics of drug dependence.Archives of General Psychiatry, 1973,28, 611–616.

  31. Wilden, A. Structuralism as epistemology of closed system. In I. Rossi (Ed.),The Unconscious in Culture. New York: E.P. Dutton and Company, 1974.

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Correspondence to Dr. John Schwartzman.

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Schwartzman, J., Bokos, P. Methadone maintenance: The addict's family recreated. International Journal of Family Therapy 1, 338–355 (1979). https://doi.org/10.1007/BF00924454

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Keywords

  • Social System
  • Health Psychology
  • Formal Structure
  • Heroin
  • Adaptive Response