‘We’re Gonna Be Addressing Your Pepsi Use’

How Recovery Limits Methadone Maintenance Treatment’s Ability to Help People in the Era of Overdose

Abstract

Methadone Maintenance Treatment (MMT) in the United States has recently adopted an approach based on the principles of the Recovery movement — a view of treatment informed by addiction-as-disease models but also incorporating social, psychological, and spiritual components. Although organizations that administer drug treatment services claim that the shift represents a more client-centered, individualistic approach, it may not meet the needs of the many individuals who use MMT to reduce the harms of drug use, like overdose, rather than as a way to become abstinent. In this article, I use interview data from treatment providers to argue against institutional claims of Recovery as an individualistic model. My research demonstrates how — despite the wide variety of treatment goals among people on MMT — the Recovery discourse positions and organizes treatment strictly as abstinence-based, self-help. Moreover, I show how the Recovery model serves as the justification for an expansion of clinics’ ability to surveil and intervene in aspects of people’s lives which had previously been seen as outside of MMT’s purview, including nutrition, public service, and spirituality. In conclusion, I argue that Recovery restricts MMT’s ability to reduce harms, like overdose, in the lives of people who use drugs, and recommend that MMT adopt a more open-ended, low-threshold approach to treatment.