International Journal of Family Therapy

, Volume 1, Issue 4, pp 338–355 | Cite as

Methadone maintenance: The addict's family recreated

  • John Schwartzman
  • Peter Bokos
Article

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”.

Keywords

Social System Health Psychology Formal Structure Heroin Adaptive Response 

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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.Google Scholar
  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.Google Scholar
  3. DiMascio, A., Rinkel, M., & Leiberman, J. Personality and psychotomimetic drugs. Proceedings of the Third World Congress of Psychiatry, Montreal, 1961.Google Scholar
  4. Dole, V.P., & Nyswander, M. Heroin addiction: A metabolic disease.Archives of Internal Medicine, 1967,120, 19–24.Google Scholar
  5. Freudenberger, H.J.The Staff Burn-out Syndrome, Washington, D.C.: Drug Abuse Council, 1975.Google Scholar
  6. Ganger, R., & Shugart, G. Complementary pathology in families of male heroin addicts.Social Casework, 1969,49(6), 356–362.Google Scholar
  7. Glasscote, R., Sussex, J., Jaffe, J., Ball, J., & Brill, L.The Treatment of Drug Abuse. Washington, D.C.: American Psychiatric Association, 1972.Google Scholar
  8. Goldstein, A.: Heroin addiction and the role of methadone in its treatment.Archves of General Psychiatry, 1972,26, 291–297.Google Scholar
  9. Haley, J.,Strategies of Psychotherapy, New York: Grune & Stratton, 1963.Google Scholar
  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.Google Scholar
  11. Haley, J.Uncommon Therapy: The Psychiatric Techniques of Milton H. Erickson. New York: W.W. Norton and Company, 1973.Google Scholar
  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.Google Scholar
  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.Google Scholar
  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.Google Scholar
  15. Maruyama, M. The second cybernetics: Deviation-amplifying mutual causal processes.American Scientist, 1963,51, 164–579.Google Scholar
  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.Google Scholar
  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.Google Scholar
  18. Ramer, B.S. Methadone maintenance for narcotic addiction.Journal of Psychedelic Drugs, 1971,4(2), 162–164.Google Scholar
  19. Rappaport, R.A.. Ritual, sanctity, and cybernetics.American Anthropologist, 197143, 59–76.Google Scholar
  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.Google Scholar
  21. Rosenberg, C.M. Young drug addicts: Background and personality.Journal of Nervous and Mental Disease, 196948 (1), 65–73.Google Scholar
  22. Rosenberg, C.M. The young addict and his family.British Journal of Psychiatry, 1971,118, 469–470.Google Scholar
  23. Schwartzman, J. The addict, abstinence and the family.American Journal of Psychiatry, 1975,132 (2), 154–157.Google Scholar
  24. Schwartzman, J. Systemic aspects of methadone maintenance.British Journal of Medical Psychology 1977,50, 181–186.Google Scholar
  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.Google Scholar
  26. Sluzki, C., & Veron, E. The double-bind as a universal pathogenic situation.Family Process, 197110 (4), 397–410.Google Scholar
  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.Google Scholar
  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.Google Scholar
  29. Vaillant, G.E. Sociopathy as a human process.Archives of General Psychiatry, 1975,32, 178–183.Google Scholar
  30. Wikler, A. Dynamics of drug dependence.Archives of General Psychiatry, 1973,28, 611–616.Google Scholar
  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.Google Scholar

Copyright information

© Human Sciences Press 1979

Authors and Affiliations

  • John Schwartzman
    • 1
  • Peter Bokos
    • 2
  1. 1.Center for Family Studies, The Family Institute of Chicago, Institute of Psychiatry, Northwestern Memorial HospitalNorthwestern University Medical SchoolChicago
  2. 2.Illinois Dangerous Drugs Rehabilitative SystemsChicago

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