Fostering Patient Autonomy in a Methadone Maintenance Program

  • John A. RennerJr.
  • Howard Shaffer


This point is clear: the goal of psychotherapy is demonstrable personal change. For the addicted client, therapeutic change must focus on replacing dependence, self-doubt, and denial with self-sufficiency, independence and autonomy. Can one justify the use of an addicting drug such as methadone in a treatment program where the goal is to release clients from their dependency and restore their autonomy? Are the goals of methadone maintenance in opposition to the goals of other forms of addiction treatment? Is there not a logical contradiction in a treatment approach that espouses the goal of autonomy, yet continues to provide its clients with an addicting drug? This paper will explore these questions and concerns. The authors contend that the use of methadone is consistent with the therapeutic goal of autonomy, and will illustrate how a program can maximize a client’s opportunities to achieve autonomy in a methadone maintenance treatment setting.


Contingency Management Methadone Maintenance Treatment Methadone Maintenance Therapeutic Community Opiate Addiction 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Angle, H.V. and Parwatikar, S. 1973. Methadone self prescription by heroin addicts in an inpatient detoxification program. Psychological Record. 23: 209–214.Google Scholar
  2. Dole, V.P. and Nyswander, M.E. 1965. A medical treatment for diacetylmorphine (heroin) addiction. JAMA. 193: 646–650.CrossRefGoogle Scholar
  3. Dole, V.P., Nyswander, M.E., and Kreek, M.J. 1966. Narcotic blockade. Arch Internal Medicine. 118: 304–309.CrossRefGoogle Scholar
  4. Dole, V.P. and Nyswander, M.E. 1967. Rehabilitation of the street addict. Arch Environmental Health. 14: 477–480.Google Scholar
  5. Dole, V.P., Nyswander, M.E., and Warner, A. 1968. Successful treatment of 750 criminal addicts. JAMA. 206: 2708–2711.CrossRefGoogle Scholar
  6. Erikson, E.H. 1963. Childhood and Society. New York: W.W. Norton, 2nd ed.Google Scholar
  7. Garbutt, G.D. and Goldstein, A. 1972. Blind comparison of three methadone maintenance dosages in 80 patients in Proc. 4th National Conference on Methadone Treatment.Google Scholar
  8. Gilbert, R.M. 1976. Drug abuse as excessive behavior. Canadian Psychological Review. 17: 231–240.Google Scholar
  9. Kanfer, F.H. and Phillips, J.S. 1970. Learning Foundations of Behavior Therapy. New York: Wiley.Google Scholar
  10. Khantzian, E.J. 1977. The ego, the self, and opiate addiction: theoretical and treatment considerations in Psychodynamic Aspects of Opiate Dependence: Research Monograph #12. Rockville: NIDA.Google Scholar
  11. Kiresuk, T.J. and Sherman, R.E. 1968. Goal attainment scaling: A general method for evaluating comprehensive community mental health programs. Community Mental Health Journal, 4: 443–453.CrossRefGoogle Scholar
  12. Langrod, J. Brill, L. Lowinson, J. and Joseph, H. 1972. Methadone maintenance: from research to treatment. In Brill, L. and Lieberman, L. (Eds.), Major Modalities in the Treatment of Drug Abuse. New York: Behavioral Publications.Google Scholar
  13. Nyswander, M.E. 1967. The methadone treatment of heroin addiction. Hospital Practice. 2: 27–33.Google Scholar
  14. Pakes, E.H. 1975. Dependency and psychotherapy: developmental considerations. Am. J. of Psychotherapy. 29: 128–133.Google Scholar
  15. Renault, P.F. 1973. Methadone maintenance: the effect of knowledge of dosage. Int. J. Addictions. 8: 41–48.Google Scholar
  16. Rogers, C.R. 1961. On Becoming A Person. Boston: Houghton Mifflin.Google Scholar
  17. Stern, R., Edwards, N.B. and Lerro, F.A. 1974. Methadone demand as a heroin detoxification procedure. Int. J. Addictions. 9: 863–872.Google Scholar
  18. Vaillant, G.E. 1975. Sociopathy as a human process. Arch. Gen. Psychiatry. 32: 178–183.CrossRefGoogle Scholar
  19. Weiner, I. 1975. Principles of Psychotherapy. New York: Wiley.Google Scholar

Copyright information

© Plenum Press, New York 1981

Authors and Affiliations

  • John A. RennerJr.
    • 1
  • Howard Shaffer
    • 1
  1. 1.City of Boston Drug Treatment ProgramUSA

Personalised recommendations