The Organization of a Methadone Maintenance Program

Abstract

This paper examines the organizational structure and operation of a methadone maintenance program whose major emphasis is on rehabilitation. Explicit program goals include teaching clients real life problem solving and enabling some program members to give up methadone. The program is hierarchically structured and rule making and rule enforcement are managed through a clearly defined “chain of command”. Small counseling groups are the major rehabilitative structure. They help to motivate client collaboration and teach problem solving in order to enhance skills, model behaviors, provide success experiences and allow individuals to master difficulties in order to limit social anxiety. These small groups engage and maintain addicts in treatment. However, they may paradoxically impede full return to the community because the client's dependency needs are met in the group setting. Problems for the program's organization include 1) monitoring psychiatric disorder in the client population since deviant behaviors and affective experiences in the small group are routinely identified as reflecting socially determined individual problems, and 2) development of more adequate structures to help to prepare clients for withdrawal from methadone, graduation from the program and the loss of small group and organizational supports.