Methadone Maintenance and the Deconstruction of Addiction: Rethinking Drug Treatment Through Legality, Dependence, and the WOD

• In Event: 1 Substance Use, Misuse and Addiction: A Roundtables Session

Abstract

This paper argues that methadone maintenance treatment’s (MMT’s) success in improving the health and quality of life of people using illegal opioids reveals the limitations of the addiction concept itself. Drawing on personal experience, sociological theory, and critical drug studies, I examine how MMT’s efficacy challenges the dominant biomedical narrative that locates the cause of drug-related suffering within individual pathology. While methadone and heroin are pharmacologically similar opioids, the former’s legal status, regulated dosing, and predictable supply transform the social conditions under which opioid use occurs. The result is that the cluster of experiences typically labeled “addiction”—compulsion, risk-involved behavior, and negative health outcomes—largely disappears, even though physical dependence remains. MMT’s success thus lies in its capacity to reduce, or remove, the harms and difficulties created by criminalization and prohibition; it replaces scarcity and punishment with predictability, legality, and safety. I argue that addiction operates as an etiological category that explains social harm by pathologizing individuals, thereby legitimizing the punitive institutions of the War on Drugs. Reframing MMT as a structural intervention reveals that the improved outcomes associated with MMT are achieved through the end of persecution, not abstinence or self-transformation. Drawing on Norman Zinberg’s model of Drug, Set, and Setting, I propose a post-addiction framework that accounts for both individual and social factors. Methadone thus functions as treatment and critique: it exposes the political origins of addiction and signals toward a world in which stability, legality, and safety—rather than punishment—constitute the foundation of care.

Author

• David Frank, New York University