Introduction
For me, I agree with the viewpoint that there is a fundamental difference in the way in which the methadone maintenance approach and the therapeutic community approach view the nature of addiction, as such this paper will attempt to express my views as to why they are different and justify why such views are accurate. First and foremost it must be noted that the main difference between the methadone maintenance approach and the therapeutic community approach is that the former believes in illegal substance abstinence through the use of substitute methadone prescriptions while the latter utilizes an approach that proscribes complete abstinence from any and all drugs, this drug-free ideology utilized by the therapeutic community approach is the main point of contention between it and methadone maintenance and as such which will be further explored in this paper in order to understand why this is so.
What is Methadone?
Before proceeding with the rest of the paper, it is deemed necessary to elaborate on the effects of methadone so as to enable a greater understanding of how and why it works in substance abuse rehabilitative treatment. Methadone is basically a synthetic opiate in that while it is chemically dissimilar to substances such as heroin, it does act on the same neural receptors for these drugs and, as such, have similar effects. On the other hand, methadone has a far longer durational effect period lasting 24 to 48 hours as well as having the capacity to “block” the pleasurable (euphoric – defined as getting “high”) effects of similar types of opiates.
This enables a greater degree of stability during the process of drug withdrawal and actually prevents patients from using various illegal substances since the effect no longer works. In essence, the methadone maintenance approach helps to relieve the “craving” patients feel when off drugs and due to the nature of its consumption which is oral this creates a far safer method of relieving drug addiction since it prevents the spread of HIV, hepatitis and other forms of diseases transmissible through sharing needles as heroin and drug addicts are often seen doing.
Two Categories of Intervention
Basically, the two approaches to be discussed in this paper can be divided into two categories of drug addiction intervention, namely pharmacotherapy and psychosocial treatment. Pharmacotherapy, as its name implies, administers drugs to patients as a means of treating a disease or substance abuse addiction. In essence, this particular category of treatment firmly believes in the use of drugs as the most effective, immediate and most of all convenient form of therapy due to results often manifesting themselves after only a few treatment sessions (Degenhardt et al., 2009: 9 – 14). Psychosocial treatment, on the other hand, believes in the ability of a group or community-led interventions, without the use of drugs, as an effective means of enabling an individual to overcome substance abuse addiction (Worley et al., 2008: 209).
This method of approach often uses group sharing exercises, experience sharing, group/ buddy support systems, normalization of daily behavior through the creation of routines as well as other forms of group/community-based intervention that utilizes multiple support systems in the form of other individuals within the same program as a means of constraining behaviors and predilection related to addiction (Worley et al., 2008: 209).
What is Addiction?
Before proceeding with the sections presenting arguments detailing the different perspectives regarding the nature of addiction to the methadone maintenance approach and the therapeutic community approach, it is necessary to give a brief elaboration on the concept of addiction and how it functions.
The concept of addiction is defined by studies such as Pescor (1952) as consisting of a physical or psychological dependence on a particular type of psychoactive substance ranging from illegal narcotics to alcohol, and cigarettes or it can be classified as a form of psychological dependency on a particular action such as masturbation, shopping, gambling, etc. (Pescor, 1952, 471 – 475). In essence, addiction can be viewed as an adverse action that has distinctly negative consequences on a person’s life. Furthermore, it is noted that over a certain degree of time an addiction continues to increasingly manifest itself as not just an additional activity but rather an action that a person “needs to do” in order to feel normal (Round table, 2007: 6 – 8).
Raymond (1975) explains that addictions can actually be separated into two distinct types consisting of either a physical or psychological dependency, while there are certain overlapping instances it is noted that certain types of addiction such as shopping or gambling are considered to be categorized under psychological forms of dependency while smoking and drinking are at times considered physical forms of dependency (Raymond, 1975: 11). Overlapping occurs when psychologists consider the psychological element of dependency, meaning why a person has a particular form of addiction (such as why does a person smoke) beyond merely looking at the body’s dependency on that particular type of substance/action (Kolesova, 2003: 39).
Methadone Maintenance
Based on the article Conversation with David Deitch (1999), which interviewed David Deitch, an expert in the field of substance abuse treatment who examined the individual effectiveness of either methadone maintenance or the therapeutic community approach, explained that both methods have a different concept of what they think of as “the nature of addiction” in that the methadone maintenance approach categorizes addiction as a physical compulsion brought about by the long term introduction of narcotics into the body (Conversation with David Deitch, 1999: 791 – 795).
This, over time, creates a chemical imbalance wherein the body’s chemical system has grown used to the presence of particular narcotic substances resulting in the “craving” sensation often felt by addicts which is not only caused by addiction to the pleasurable sensations created by these drugs but is also caused by the body attempting to normalize itself by triggering the need to have a chemical it is used to having reintroduced into its system.
This particular form of “craving” is similar to individuals who smoke wherein the body gets used to the daily consumption of nicotine resulting in the chemical being considered a normal aspect of the body’s daily biological functions. In fact, the use of methadone maintenance is actually quite similar to the use of nicotine patches and gum wherein the body receives a supplementary source of the chemicals it graves until it is “taught” to no longer feel the need to have such a chemical in its system. This is done by gradually lowering the needed dosage over a period of time until the craving disappears.
Therapeutic Community Approach
Going back to the interview of Davind Deitch (1999), the concept of addiction for the therapeutic community approach is based on the idea that an individual’s addiction to drugs is a direct result of psychological maladjustment and as such can be changed through the use of rehabilitation whereby individuals suffering from substance abuse addiction can be taught to relearn or reestablish functioning skills, physical and emotional health as well as being able to reestablish for themselves a functional lifestyle (Conversation with David Deitch, 1999: 791 – 795). Studies such as Day and Doyle (2010) that have examined the therapeutic community approach have stated that the psychological compulsion to take drugs is based on a “cycle of destruction” wherein the more drugs a person takes, the more likely they are of distancing themselves from social and emotional support resulting in a dysfunctional lifestyle which further necessitates the need to take drugs (Day & Doyle, 2010: 380 -384).
As such, in order to facilitate what is described as a “rehabilitative lifestyle,” all drugs (even methadone) are banned from the program, and patients are kept within a group/community-style housing unit where they are slowly accustomed to being able to live normally. Other forms of psychological compulsions, such as those described by Smiley –McDonald, and Leukefeld (2005), can range from depression, desperation, hopelessness, anti-social tendencies, living environment, etc. (Smiley-McDonald & Leukefeld, 2005: 574 – 583). Geraghty (2011) described these factors as facilitators of drug use and, as such, need to be tackled during the rehabilitation process in order for them to actually be able to resist the temptation to take drugs after the program is completed (Geraghty, 2011: 878 – 884).
Supporting Arguments
Based on the facts presented so far in this paper, it can be seen that the methadone maintenance approach ascribes to the physical nature of addiction and attempts to resolve this by utilizing pharmacotherapy. The therapeutic community approach, on the other hand, ascribes to the psychological nature of addiction and utilizes the psychosocial method of intervention as a means of treating patients. What must be understood is that from the viewpoint of the therapeutic community approach addiction can be controlled by “normalizing” patients by exposing them to routines, a support group and a means of dealing with the source of the addiction however in order to do so it prescribes a method where the patients are placed in a communal home where they are able to establish the initial normalizing practices that would lead towards behavioral readjustment.
For the therapeutic community approach, addiction is a result of psychological maladjustment, whether in the form of anti-social tendencies, the lack of effective social bonds, and an otherwise abnormal method of emotional and behavioral development. As such, it presents the notion that a patient will regress back into addiction so long as these particular facets of their personality are not addressed
Application of Social Control Theory
It must also be noted that the therapeutic community approach has similar elements to the social control theory developed by Travis Hirschi which especially states that all individuals actually have the potential to engage in socially unacceptable behavior however it is the “bond” they share with society whether in the form of friendships, recognition of societal rules and norms of conduct, parental influences, etc. that prevent them from actually committing such actions (Higgins et al., 2009: 949 – 951).
In the case of the therapeutic community approach researchers such as Higgins et al. (2009) believe that the reason why people take drugs is because they lack the necessary social bonds and routines that prevent them from engaging in such actions and it is only by establishing these “bonds” with individuals and society that makes a person less likely to take drugs and as a result enables them to live normal lives (Higgins et al., 2009: 949 – 951).
While the methadone maintenance approach does take into account the psychological aspects of addiction, it places a greater emphasis on the physical nature of addiction wherein it is the chemically endued cravings caused by years of substance abuse that causes addiction to manifest itself. Thus in order to resolve it from the perspective of this particular approach is to tackle the problem from a physical perspective and remove the physical dependence on narcotics.
Which method is the most effective?
While this paper has so far established the different concepts of the nature of addiction as utilized by the two approaches elaborated on, a certain question comes to mind regarding the two approaches examined, namely “which approach is the most effective?” Rather surprisingly when examining the case of either approach, it was discovered that in studies such as those by Korte et al. (2011) which examined which approach was the most effective it was determined that when categorizing patients into three distinct categories such as “low, medium and high” with each level ascribing to the level of drug addiction and psychological imbalance it was discovered that both approaches actually have distinctly similar results in the number of people successfully rehabilitated and even in the number of people that went back to normal drug use (Korte et al., 2011: 358 – 366).
It was only in the “high” levels of the experiment that there was a slight change with methadone maintenance showing slightly better results. (Korte et al., 2011: 358 – 366) The results of this are rather startling in that is appears that neither method actually outpaces the other and calls into question whether a more appropriate approach would be to just combine both methods in order to maximize their individual effectiveness.
Conclusion
Based on the findings of this paper it can be seen that the view that the methadone maintenance approach to addiction is based on different conceptions of the nature of addiction as compared to the therapeutic community approach is in fact accurate due to the form basing itself on the physical nature of addiction while the latter focuses on the psychological basis of addiction.
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