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Methadone maintenance: The addict's family recreated


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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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).

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