The trouble with morality: the effects of 12-step discourse on addicts' decision-making

Since its development in the 1960s, researchers have extensively scrutinized methadone maintenance treatment (MMT) as a medical response to heroin addiction. Studies consistently find that MMT is more successful than other treatment models in the reduction of opiate/opioid misuse, the transmission of diseases like HIV/AIDS and hepatitis C, and criminal arrest and conviction rates. Nonetheless, a significant portion of active and former heroin addicts view MMT negatively and-perhaps as a result-MMT is vastly underused. This study examines the effects of 12-Step discourses on the opinions and treatment decisions of active heroin addicts, addicts in MMT, and addicts in 12-Step treatment programs. The study finds the abstinence/morality based discourse of drug addiction and treatment is pervasive among addicts and their non-drug using relations and peers alike; moreover, addicts have internalized this narrative, oftentimes despite their own knowledge of MMT's success and positive personal experiences. The findings suggest that the dominance of abstinence/morality narratives contributes to MMT's poor reputation among, and low use rate by current and former heroin addicts and that the power of the dominant discourse is such that it produces a desire to buy into its values and tenets even when it is against the individual's interests to do so.

Recovery and Spiritual Transformation Among Peer Leaders of a Modified Methadone Anonymous Group

This analysis of five recovery narratives from leaders of a peer-led, 12-Step-based self- help group in a methadone treatment program highlights the importance of spiritually-mediated role transformation in the recovery process. For these men and women in their forties and fifties, their progression to a leadership role helping others with their recovery validated the spiritual transformation they regarded as underlying their own recovery process. Assumption of this new leadership/helper role marked a tangible sign that their deepened spirituality allowed them to assume a new, higher function in a struggle with the addiction that had plagued their lives. For these peer leaders, methadone was at the core of the group experience and an aid to spiritual transformation.