Ethical Treatment of a Methadone Client in a Public Detoxification Facility
In order for a clearer understanding of the content of this paper I will provide the reader with a very brief history of substance abuse treatment in the United States.
The policy of this country, surrounding substance abuse, has always focused on either the illegality of the substance or in the case of alcohol, moralizing the way the substance is used.
There are two basic approaches to treating substance abuse in the United States today. By far the most popular is that in which total abstinence is the primary goal. This approach could be summarized as a confrontational technique. The client is told that their life is out of control due to the abuse and use of a chemical substance. In a harm reduction approach the client would be supported hoping that they would come to the conclusion and realization that their life is out of control due to use of a substance. Secondly that the substance is the central organinizing principle of their lives, meaning that the individuals focus in life has become obtaining and using the substance of their choice.
In the confrontational approach many tools are utilized: detoxification centers, inpatient substance abuse treatment, residential treatments facilities (half-way houses and therapeutic communities), individual and group counseling. Education is the keystone.
Most of these services focus on the Medical Model of addiction and the 12 Step Model of recovery, commonly referred to as Alcoholics Anonymous. The Medical Model encompasses the basic belief of the disease concept, that the alcoholic is biologically different from the non-alcoholic. The alcoholic, it is felt, can never safely drink any alcohol. In the disease concept, the person is viewed as unable to control drinking as opposed to being unwilling or weak. Although the individual is not blamed for his/her disease, he/she is thought to be responsible for behavior. We do not blame diabetics for
their diabetes but we expect them to control their diet and take medication. The alcoholic is seen to have responsibility for managing the disease on a day-to-day basis.
Again it must be emphasized that Alcoholics Anonymous is very closely linked to this model of treatment. Although these principles were first used to treat alcoholism, they have been widely accepted and used in the treatment of all individuals abusing substances.
But the larger question that is not addressed, especially in the United States is what happens to the estimated 90% of the substance abusing population that is not yet ready for the total abstinence approach?
For years now the Europeans have taken a different and less invasive approach. It is called Harm Reduction. The first priority of harm reduction is to decrease the negative consequences of drug use. Harm reduction establishes a hierarchy of goals, with the more immediate and realistic...