A friend of mine is currently undergoing methadone treatment
('methadone maintenance') to help him quit his addiction to opiates.
However, the methadone treatment seems to be making things worse for
him, rather than better.  He is having a lot of difficulty with the
side effects, including profuse sweating, nervous twitches, physical
weakness, and severe emotional instability.  And these symptoms are
getting worse and worse as the months go by.  In short, he appears to
be in a worse state of physical and emotional health than when he
began the treatment.

In my reading online it appears that methadone is itself more
addictive than heroin and has a more severe withdrawal period. The
impression I get from the methadone clinic he's visiting is that (a)
the treatment may continue indefinitely (there's been no indication of
when or if the treatment will be stepped down); and (b) they are
either oblivious or unconcerned about the worsening physical/emotional
symptoms. At this clinic, no attempt has been made to involve the
family or friends in his recovery, which also concerns me. I am
concerned that, if he continues on the apparently downhill path the
methadone is leading him on, it could eventually lead to suicide.

At this time I am seeking alternative forms of opiate addiction
recovery and/or methadone recovery for him. Finding a suitable
alternative treatment has been difficult because I have no prior
knowledge of the treatments available, and trying to find information
on the web is like searching through a maze of biases, sales gimmicks,
and conspiracy theories.


The desired answer to this question will include:

1. A light review of methadone maintenance "pros and cons" if
possible, especially with an eye towards presenting both the "for" and
"against" views with equal weight.

2. A review of some different forms of alternative addiction/recovery
therapy, including (at least) Narconon, naltroxene, rapid detox, detox
centers, and anything else that has some evidence of real success. 
12-step programs are discouraged due to their requirement of a certain
religious belief and personal 'disempowerment'.

3. Some information about having a person voluntarily or involuntarily
committed into a setting where they "dry out".

4. Any other information you think might help.


Thanks in advance.

Hello, joelpt-ga!

 You have asked a very detailed question. While I have done my best to
answer it under the price you allotted, I am sure that the topic and
your friend's personal situation could be explored in more depth,
depending on where you live and the types of facilities and programs
you would like to consider.

 I have kept within the guidelines of your question and provided you
with an overview that should provide a good deal of information for
contemplation.


PROS AND CONS OF METHADONE MAINTENANCE - A brief overview
=========================================================

From "Facts about methadone maintenance treatment."
http://www.allsands.com/Science/methadonemainte_bfn_gn.htm

'Advocates of methadone maintenance treatment say that it's a good way
to control an addiction, especially when a patient has tried
everything else without success. Indeed, most studies are agreed that
it is often safer to use than heroin. For many patients who have gone
through many detoxification programs, inpatient rehabilitation,
residential treatment, and outpatient group counseling, methadone
maintenance is often their last chance. Methadone maintenance is also
relatively inexpensive--the cost can range from $50 to $150 per week,
and is low compared to the price of a lengthy hospital stay in a detox
or rehab program. It allows people to function on a day-to-day basis
and reduces the risk of overdose. In addition, since it is given
orally and not injected, it reduces the spread of HIV among
intravenous users.'


'There are, however, a number of problems associated with methadone
use. Among these is the obvious risk of substituting one addiction for
another. Although methadone is safer to use and legal if taken in a
clinic, an addiction to methadone is harder to break than one to
heroin. If a patient decides after several months on methadone
maintenance to discontinue it, the detox is generally longer and more
uncomfortable. Use of methadone reduces cravings for heroin, but
methadone maintenance, unless combined with counseling, will do
nothing to alleviate the social and emotional consequences of
long-term use. Also, methadone's side-effects can include orthostatic
hypotension (low blood pressure), nausea, insomnia, constipation, and
allergic reactions. Although methadone maintenance is inexpensive, as
a maintenance therapy it is frequently not covered by insurance
companies. Finally, because dosages are administered daily, patients
need to arrange their day around their program. Only after a patient
has been shown to be compliant with treatment and abstinent from other
drugs will he or she be allowed to take multiple doses to carry with
him on, say, a vacation or a business trip.'


==


From "Methadone Maintenance."
http://www.shesinrecovery.com/withdrawal/methadone.html 

'Critics point out that methadone patients are still addicts and that
methadone therapy does not help addicts with their personality
problems: in many cases multiple drug use and a strong psychological
dependence undermine the gains made.....

 But supporters point out that methadone maintenance, being oral,
breaks the dangerous ritual of intravenous injection; that it is legal
and eliminates the addict's need to engage in crime to pay for drugs;
and that it gives addicts a chance to reevaluate their lives.'


==


From "Methadone Maintenance." Addiction Recovery Institute.
http://www.methadone.com/methadone.html

Pros of Methadone Maintenance:

* Reduction in and/or cessation of illicit drug use 
* Risk of HIV infection decreases dramatically the longer a client is
in treatment and/or the earlier they get into treatment
* Reduction in and/or cessation of illegal activities 
* Increased stability of home and work life 
* Increased appropriate involvement in relationships (i.e., marriage,
children, parents, friends, and co-workers)
* Decrease in the use of state or federal subsidy programs by
increasing rates of employment
* Increase in the re-engagement of patients in educational activities
and pursuits
* Increased client self-esteem 


Cons of Methadone Maintenance:

* Methadone is an addictive substance 
* Methadone is a highly regulated form of treatment, therefore, it is
not always consumer friendly
* Methadone is an invasive treatment, patients have to come to the
clinic 6-7 days per week for their medication in the beginning of
treatment

==

Methadone treatment may be justified if the following criteria are
met:

* The client is a non-injector who has been opiate dependent for more
than 6 months
* The client is opiate dependent and injecting opiates 

and methadone

* Is not going to increase drug-related harm 
* Will help achieve appropriately set short and long-term aims from
the list above.


However methadone is not an innocuous treatment and inappropriate
methadone prescribing can:

* Cause fatal overdose 
* Simply increase a person's total drug consumption 
* Increase the drug-related chaos in a person's life 
* Supply the illicit market 
* Demoralise prescribing and other staff 
* Reduce respect for the prescribing agency among both drug users and
other helping agencies
* Reduce the client's motivation and ability to achieve abstinence 
* Create opiate dependence. 


===

From the Addiction Recovery Institute:
http://www.detox24.com/drug_information/methadone.html

Methadone

Also known as: Meth (in New York), Dolophine

Basics: This drug is used to treat severe chronic pain from cancerous
and non-cancerous causes. Since the 1960s it has been used to treat
opiate addicts as a substitute for heroin. This drug leads to tissue
dependency in the methadone user; however, it cuts down on needle use,
criminality and gives a structure to those people on it where they
would have no structure at all. There are pros and cons to the
treatment of opiate dependency with Methadone.

Major routes of administration: Oral

Effect: Euphoria, drowsiness, constricted pupils, nausea. Shortly
after beginning methadone maintenance, the drug ceases to cause
euphoria. It simply stops the patient from going into withdrawal. It
also blocks, at least partially, the effect of heroin or other less
"sticky" opiates.

Possible effects of overdose: Shallow respiration, cold and clammy
skin, weak and rapid pulse, coma and possible death. Death is
particularly common among people who get methadone on the street and
are not dependent on opiates.

Risks: Although the benefits of methadone may out way the risks,
please take into consideration the following information. The risk of
taking methadone is that when you want to come off this drug, you will
find it very difficult to do so. In addition, many methadone programs
will discourage you from stopping methadone. Methadone does have its
place in effective substance abuse treatment; however, patients need
to know what their options are with respect to being drug free.



==========================================
OVERVIEW OF ALTERNATIVE ADDICTION TREATMENT
===========================================

*** First, please review a previous answer I wrote in response to
opiate addiction withdrawal. I believe it will provide a good overview
of treatment options:
http://www.answers.google.com/answers/threadview?id=210957 


===

Excerpt from "Section 7: Treatment Aims and Treatment Choices." The
Methadone Briefing.
http://www.drugtext.org/library/books/methadone/section7.html  

Adjuncts or alternatives to methadone treatment
----------------------------------------------
A full menu of services to support methadone treatment would include:

In-patient detoxification 
In-patient assessment 
Out-patient lofexidine detoxification 
Out-patient dihydrocodeine or buprenorphine treatment 
Prescribing injectable drugs 
Prescribing diamorphine (heroin) 
Breathalysing facilities 
Supervised Antabuse 
HIV testing and counselling 
Mental health services 
Counselling 
Psychotherapy 
Alternative therapies 
Employment advice 
Skills training 
Recreational activities 
Residential rehabilitation 
Supervised naltrexone 


** This article has a comprehensive overview of Short-term and
long-term detoxification from methadone which would have to be
accomplished before alternative treatments.

** Please see sections on "Short-term detoxification" and "Long-term
detoxification"


====


From "Important note on long-term detox: reducing doses over 1 month
or longer." The Methadone Briefing.
http://www.drugtext.org/library/books/methadone/addition.html

"For those that become opiate dependent, it is very often a
long-lasting phase of life. The evidence is clear that maintenance
doses of methadone that are within an effective therapeutic range
(usually 60mg - 120mg) are the best intervention for many."

"Quick detoxes are seldom a lasting solution, with very high relapse
rates the outcome for the vast majority."

"Detox should only be attempted where there is an option of long term
maintenance as a 'fall back' option."

"Many opiate users are deeply ambivalent about their drug use, and a
large part of them wants to be opiate free. Unfortunately many drug
workers feel that they aren't succeeding unless they are getting
people drug free."

"Persuaded by the evidence of experience both know that rapid detox
won't work, so all too often a slow detox is agreed upon. The outcome
of this regime in the NTORS studies was in fact a sort of
sub-therapeutic maintenance dosing, with doses fluctuating, and
responding to pressure from workers, and crises in the life of the
drug users."

"The reason that the methadone briefing included the WHO category of
'long-term detoxification' was that it was (and still is) a common
regime and I hadn't been practicing long enough to understand what Dr
Duncan Raistrick from Leeds Addiction Unit was saying when he said to
me, having read a draft of the briefing, "people should either be on a
detox or on maintenance"."

"It was some time before I came to realise that these long term
detoxes were almost always a compromise treatment option that is often
sought by the client and worker because it appears to aim towards a
desirable goal, and avoids having to seriously address the issue that
it isn't likely to be effective."

"My view has changed to believing that the evidence supports
maintenance as the treatment of choice, with the option of supported
7-21 day detoxes as a treatment option that can be followed by a
return to maintenance treatment should it not work."

"I realise that this will be as big a challenge for many practitioners
as it was for me, but we have to work to end the huge amount of
sub-therapeutic methadone dose prescribing in the UK, and the large
numbers of opiate users who are exposed to viral transmission and
overdose risk through trying to make treatment regimes that are proven
to be ineffective work for them."



RAPID DETOX
=============

From "Rapid Detox Revolution." Advanced Treatment of Opiate
Dependency. Waismann Institute.
http://www.getdetox.com/?campaign=looksmart

"Rapid detox has revolutionized the treatment of opiate addictions,
allowing patients to return to a productive life in a matter of days
and eliminating the need to spend months in and out of hospitals or
rehabilitation programs."

"However, not all rapid detox protocols are the same."

"Today, a new form of rapid detox has emerged known as Accelerated
Neuro-Regulation. It is performed by a handful of select treatment
clinics throughout the world. ANR utilizes the most advanced medical
biotechnology available today. It integrates cutting-edge research in
the field of opioid receptors and its significance on the physical and
psychological components of opiate dependency."

"An experienced team of board-certified aneshtesiologists should
perform the ANR treatment. The objective of the procedure is to
achieve a reversal of opiate physical dependency without unnecessary
suffering, fear, or loss of dignity."

"The Accelerated Neuro-Regulation rapid detox protocol treats opiate
dependency at the receptor level, blocking opioid receptors and
precipitating the withdrawal syndrome while monitored in an intensive
care unit by a board certified anesthesiologist."

==

"Frequently Asked Questions about Rapid Detoxification."
http://www.getdetox.com/faq.html




NARCONON
========

 The Narconon program is directly associated with the Church of
Scientology!!! If you are wary of the twelve-step program, you might
also be wary of the strong affilitation with Scientology.

"About the Narconon Program." Narconon International.
http://www.narconon.org/about_narconon.htm
 
"William Benitez, an inmate of Arizona State Prison, founded the
NARCONON program in 1966. Benitez read a book by American author L.
Ron Hubbard, and by applying the principles it contained on increasing
one's abilities, he and dozens of other inmates were able to
permanently end their addictions to heroin. The Narconon program has
evolved from that simple beginning to a worldwide network of drug
prevention and drug-free social education rehabilitation centers."


"The Narconon® Drug Rehabilitation Program." 
http://www.narconon.org/narconon_drug_rehabilitation.htm

"The program steps are entirely drug-free; that is, the Narconon
program does not use drugs or medications to solve the problems caused
by drugs, but does use nutrition and nutritional supplements as an
important component of its delivery. Thus the program is neither a
psychiatric nor medical, but a social education model of
rehabilitation."

"Persons enrolling in the program must receive full medical physicals,
an M.D.’s permission to do the program and periodic medical review as
individually needed. However, Narconon clients are not considered or
treated as "patients" but as "students" who are learning to regain
control of their lives. This is an important distinction. A Narconon
student does not enroll to recover from an "illness; he enrolls to
learn something that he doesn’t already know. He adresses the
disability caused by drug use with new abilities, new skills for
life."
 
"Narconon staff prepare graduating students with "re-entry" programs
to follow as they re-start their lives on a new foot. But the full
Narconon program is intended to produce graduates who can stand on
their own feet and live drug-free, ethical lives thereafter. A
Narconon graduate does not go to weekly meetings for months after
completion, nor does he describe himself as "recovering.'

"A student who has graduated from the Narconon program has recovered.
He or she has obtained a new orientation in life. The premise of the
Narconon model is that a former addict can achieve a new life. This
goal applies (and is routinely achieved) whether the program is
delivered in a free-standing center, daily after work, or even in
prison."

"Once well, if he uses the tools he has practiced and learned to use
at a Narconon center, a Narconon graduate can stay well. This is not
theoretical. There are three decades of graduates who will swear by
it."

"If graduates do run into serious difficulties, they return to their
Narconon center where they inevitably find a specific part of the
program that they earlier failed to fully understand and therefore
could not apply in the travails of daily life. But the majority get it
the first time through."

"The Narconon program takes four to six months. During this time, some
might consider the Narconon program a "therapeutic community,' but it
would be more appropriate to say that Narconon clients are going "back
to school" - this time to get real tools for real life.

"The addict has been found not to want to be an addict, but is driven
by pain and environmental hopelessness...As soon as an addict can feel
healthier and more competent mentally and physically without drugs
than he does on drugs, he ceases to require drugs."

===

Read "Narconon Exposed: Drug Rehab or Scientology Front."
http://www-2.cs.cmu.edu/~dst/Narconon/

Contains numerous links:

"Does Narconon work? 
http://www-2.cs.cmu.edu/~dst/Narconon/doesitwork.htm




NALTROXONE
===========

"NALTREXONE -Naltrexone, Nalorex." Drugscope.
http://www.drugscope.org.uk/druginfo/drugsearch/ds_results.asp?file=%5Cwip%5C11%5C1%5C1%5Cnaltrexone.html

"Naltrexone is a narcotic antagonist. It works by blocking the opioid
receptors in the brain and therefore blocking the effects of heroin
and other opioids. It has also been shown to reduce craving and
consumption for some patients who are alcohol dependent. Those who
take it know that they cannot achieve a 'high' from using heroin and
that any money therefore spent on heroin will be wasted. It does not
directly stop a person wanting to use heroin, although it may reduce
or prevent cravings in some people."
 
"The drug's success in helping someone abstain is dependent on many of
factors, including their willingness to follow a course of medication
and the level of available support. Naltrexone is only one part of a
comprehensive treatment program, which should include regular
counselling. Recent studies have suggested that many clients do not
remain on naltrexone treatment and will often return to heroin use."

"You cannot become physically dependent on naltrexone and it does not
produce any euphoric effects."

"Naltrexone implants can be used to ensure regular dosage. These are
available through private clinics. The implants are about 9mm in
diameter and about 1.9cm in length, and can be inserted through a 1
inch incision in the lower abdomen or at the back of the upper arm.
Implants are usually effectuve for six week periods."

===

Please read Medline Plus Information for Naltrexone:  
http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a685041.html 


====


From "Naltrexone (ReVia)" Peer Assistance. American Association of
Nurse Anesthetists.
http://www.aana.com/peer/foster/naltrexone.asp

"Naltrexone is an agonist used to block the effects of opiates and
most recently alcohol (Hudson, 1998). It can be an effective adjunct
to a quicker reentry time since it places another level of confidence
in the aftercare process. To begin therapy, the patient must be
narcotic free for seven to 10 days. It is dispensed in tablet form for
oral use. Because some addicts have been known to "cheek" their drug
by slipping the pill inside their buccal mucosa rather than swallowing
it, some advocate that the tablet be crushed and given in a small
amount of liquid. The manufacturers recommend a simple syrup solution
in this situation so that the drug is not altered by the pH of acidic
juices. Dosing begins with a test dose of 25 mg, increased in
increments up to 150 mg/day by the third day. One 50 mg tablet will
block the euphoric effects of 25 mg of heroin. Liver enzymes should be
followed up during the course of treatment, which may extend several
years. The screening costs to check liver enzymes and the blood level
or naltrexone, plus the cost of the treatment drug, make it somewhat
expensive."

"Side effects are minimal, with the exception of a 13 percent
incidence of nausea. The remaining effects of insomnia, fatigue,
dizziness, and/or vomiting average around 2 percent. The benefits
include ease of administration (oral), rapid gastric absorption, and a
good narcotic-negating effect should the patient use. Like any drug
treatment, an addict may learn to use the drug of abuse in an amount
sufficient to override the effects of naltrexone. Naltrexone does not
block the effects of cocaine or benzodiazepines. Addicts who try to
override the narcotic blockade by using while taking the drug often
experience profound respiratory depression. Random screens and close
supervision should be adequate to determine whether an individual is
attempting to override the naltrexone block. Individuals receiving
naltrexone should wear a Medic-Alert device."

"The person's condition should be stabilized on naltrexone therapy at
least one week prior to return to work. This therapy is initiated and
maintained under medical direction and should not be terminated
suddenly. A contract that is written with naltrexone as an adjunct
should include a board hearing (attorney, chief
anesthesiologist/CRNA), be a three- to five-year contract that begins
upon reentry, and should include a staff in-service (operating room,
postanesthesia care unit, others). Naltrexone administration should
continue for two years and be discontinued only upon the agreement of
an evaluating team."

"The issue of whether to utilize naltrexone as part the recovery
process requires considerations beyond the risks and benefits of the
adjunctive therapy. CRNAs often relapse within two weeks, even after a
year or more off from work, despite excellent intentions, a rigid
contract, and being cleared for return to work. For the first six
months to a year, naltrexone or disulfiram may be used as an adjunct
to the return-to-work program. The certified addictionologist or
primary physician in charge of the medical and psychological care of
the recovering CRNA should determine the advisability of these two
drugs, as well as other medications prescribed for the anesthetist."

===

Read the following lengthy study"

"A pilot study of naltrexone-accelerated detoxification in opioid
dependence." Radical Assessment of Drugs and Research. MJA 1999; 171:
26-30
http://www.mja.com.au/public/issues/171_1_050799/bell/bell.html 




RAPID DETOX CENTERS
===================

"What Is Rapid Detox?" Rapid Detox
http://www.rapid-detox.org/What-is-rapid-detox.html

"The rapid opiate detox process is generally conducted in a hospital
setting and under general anesthesia. Also referred to as 'ultra rapid
opiate detox,' rapid detox for opiate based substances and addictions
such as heroin, vicodin, methadone, or any prescribed narcotic pain
killers."

Other narcotic opiate-based substances that can be treated through the
rapid detoxification process include:

Codeine
Dilaudid 
Morphine
Percocet
Percodan
Lortab
Oxycontin 

"The rapid opiate detox process is generally conducted in a hospital
setting and under general anesthesia. In fact, the process is most
often overseen by certified and qualified anesthesiologists and a
nursing staff that specializes in such procedures. While under
anesthesia, the patient is administered medications that accelerate
the physical reactions to the rapid withdrawal process which can last
from 4 to 6 hours."


From "Find A Rapid Detox Now. Rapid Detox.
http://www.rapid-detox.org/get-help-now.html
 You may call to find the nearest facility to your area.

==

Also read "About Rapid Detoxification for Opiate Dependency." Rapid
Detox Services and Referral.http://www.opiate-rapid-detox.com/about-rapid-opiate-detox.html


==

Please see the Detox services offered by the Addiction Recovery
Insitute:
http://www.detox24.com/detoxification_overview.html 
 


INVOLUNTARY COMMITTMENT vs VOLUNTARY COMMITTMENT
================================================

 Involuntary committment rules vary from state to state. I would have
to address a separate question about that. All I can say is that it
would certainly be better if one admitted themselves voluntarity,
since the desire to be free of addiciton must come from within.

 However, depending on where you live, you will have to look into the
conditions that allow for involuntary committment.
 
=============


 If you would like to explore this problem in more depth, I will be
happy to assist you. Opiate withdrawal is a severe problem, as you
have experienced.

 I commend you wholeheartedly for standing by your friend. There are
not enough people like you to go around!

Sincerely,

umiat  

Google Search Strategy
methadone maintenance +pros +cons
narconon
naltrexone
rapid detox centers
rapid detox pros and cons

Complete and thorough answer. I hope this will provide the necessary
information to make a difference.

There is one other option.  It would fall under the general category
of Rapid Detox, but with a twist.  I have a personal interest in your
question, and regret not finding it first.

...my son has been on Methadone for a year and a half.  I carefully
and thoroughly researched Methadone and became convinced that --with
abstinance treatment's very low  success rate --long term opiate
replacement treatment must be the only way out.  Then, like you, I
started seeing the reality of Methadone.

Then, thankfully, I found Ibogaine.

Read this question, answered by me:

http://answers.google.com/answers/threadview?id=190192
This questioner was asking about the more spiritual qualities of
Ibogaine, and was considering taking it without a doctors supervision.
Hence, the long disclaimer.  However, Ibogaine is approved for
clinical trials somewhere in the US, and there is a clinic in B.C.,
Canada that offers FREE Ibogaine treatment. Don't let the disclaimer
scare you.  Read on.

It's main action is rapid detox from specifically: OPIATES, and that
after a single use, there is a long period of time, usually months,
with no opiate craving whatsoever. It is said to actually, literally,
reset the brain chemistry back to a pre-addiction state.

After ingestion, for the next 10 or so hours, repressed memories flood
the conscious mind --without unplesant feelings associated with the
remembering, just a new awareness. Then, the next 12-20 hours os so
the mind processes this information.  It's said to be a very, very,
powerful experience that literally changes peoples lives, overnight.

Please click on the links I gave in the other answer. If you like, I
can give you more, related to opiate detoxing.

This is another topic, besides Methadone that I have fully researhed,
...I'm trying to get my son into the clinic. I'll check back at this
question to see if you have any more thoughts or questions.

Here is the link to the Iboga Therapy House, read the entire site,
it's not large, and then go to their links page and begin your journey
into Ibogaine awareness.

Iboga Therapy House
http://www.ibogatherapyhouse.org/

Good luck to you, and God Bless,
~~Cynthia

Thank you for that information Cynthia.  I'll post an update later to
let you know how things go.

HI!  I found your question interesting due to very personal battles of
my own with addictions.  I enjoyed reading all of it, the answer and
comment as well.  I just had one comment that I would like to add.  I
noticed in your question that you did not want information regarding
any 12 step recovery program.  I hardly blame you because the failure
rate is 90%, however, I think that is universal in all
addiction/recovery based programs.  Although, there are many, many
people that HAVE recovered through AA/NA or whatever 12 step program
they needed.  I do not know what your definition of "religion" is, but
in 12 step programs they do not force you into anything, especially a
religion.  That is against our constitutional rights.  They do,
however, ask you to believe in and turn your life over to a "higher
power".  Probably 99% of the people in there choose that to be God. 
Again, why I can understand that, if you do not want to be affiliated
with a religious based program, you would not be interested.  However,
I just wanted to point out that in the meetings they always stress
that religious belief is not required for membership, only a desire to
quit drinking or using are the requirements for membership.  Everyone
that I have remotely come across in NA/AA are so free spirited and
open, non judgemental that I found it to be one of my favorite places
to be.  Understand that it took me a long time to actually WANT to be
there!  I do have to add that at every meeting they do end in prayer
and prayer is part of the steps of recovery.  It just seems like
semantics sometimes, but when you are at a point that I was at, either
go or die, then my loved ones, not me, were willing to do anything
with me they needed to!!

I hope your friend finds what he needs to get help and good for you to
be his friend in his time of need!!  If there were only more people
like YOU.  You'd be amazed at how many people I lost as friends when I
decided to become clean, but they were friends with me when they knew
I was using.  strange.

Good luck!!

kahig-ga: Thanks for your comments. My main objection to the 12 step
programs hasn't had as much to do with the religious aspect as the bit
about 'turning your life over to a higher power'. This in particular
has always struck me as replacing one addiction (which is to say, an
unnecessary dependency) with another. Whether the one is less harmful
than the other is a matter for another debate, but suffice to say it
_seems_ to me to be a disempowering requirement of the program. 
Indeed, it would seem to foster dependency on the program as well as
any imagined external higher power.  Fostering some kind of
self-reliance and self-confidence seems better here.

This site covers one alternative to the 12-step program, and isn't
based on fostering a dependency on an external entity. Rational
Recovery: http://www.rational.org/

--

An update: my friend has found his way into an inpatient detox program
in Canada to recover from the methadone maintenance and the original
addiction.

Thanks to all for their answers; they are literally responsible for
getting my friend to finally take the necessary steps to get where he
is now.

joelpt,

I am still following this question to see the outcome.  I would like
to know which clinic your friend went to and what the results are. 
Specifically, if the outcome is good, I would like the address and
phone number.  I would appreciate any information you can forward to
me about an effective treatment for opiate addiction.

My son is still struggling.  I quit paying for his Methadone because
he was "riding the fence" and continuing to use other drugs, although
it did seem effective for heroin, it was not for cocaine and alcohol.

I am still trying to get him into the Iboga house, but we are stalled
because of the testing requirements, I have no funds, and the
requiirement for short-term Canadian health insurance.  Did the center
your friend go to have a similar requirement, and if so, what did s/he
do about it?  Can you recommend a company that does this?  How much
did it cost?  My son is now receiving state funds including medical
assistance, and we could probably get the blood work and EKG done.

I await your response,

~~Cynthia

cynthia,

The clinic is the Edgewood clinic located on Vancouver Island in
British Columbia. I believe the cost of the program is
US$10,000-12,000.

http://edgewood.bc.ca

Briefly, the treatment program is an 8-week inpatient (on site)
program. They step patients down from methadone at a measured pace,
accompanied with necessary meds for safe detox and withdrawal.

Patients are residents in shared rooms with other patient-residents.
The residents' days are rigidly scheduled to keep the residents moving
towards beating their addictions. The counseling program used is the
AA/NA format. The counseling aspect is completely integrated with the
physical aspect of recovery.

As for my friend, he is roughly three weeks into the program now, and
the results so far have been overwhelmingly positive.  He was stepped
down from 125mg to 0mg of methadone over this period.  His situation
is similar to your son's -- prescribed methadone use combined with
non-opiate substance abuse.

The facility is impressive. Instead of looking like a hospital, it
more closely resembles a vacation resort lodge.  Residents roam freely
inside the building, and are allowed off-site in controlled settings
(e.g. daily walks).

Apparently some of the patients live near the main facility in houses
owned by the organization; these are 'extended treatment' settings
where the patients can eventually get a job, etc.


My friend was able to pay for the cost of treatment with partial
assistance from (US-based) health insurance. You might consider
calling the facility to see if they can help you figure out how to pay
for it in your circumstances; they were very knowledgeable in
assisting my friend arrange payment.

One thing to note if coming from US: if a planned withdrawal from
methadone at the facility is needed, you'll need to get enough
methadone prescribed to cover his needs while he's at the facility. In
this case, I strongly recommend trying to get the prescription filled
in Canada.  The supply of methadone my friend required would have cost
US$1000+ in the US; in Canada it was CDN$35! (no typo)

I'll post an update at the end of the program.