Some Dynamic Considerations in the Resistance to Methadone Maintenance

Patients who presented with a request for a dosage change of their maintenance methadone were intensively evaluated to understand the dynamic significance and precipitating factors of this request. The types of precipitating stresses and the meanings of these stresses to the patient were studied. While 100 per cent of the patients presented with medication change as a chief and sole request or complaint, 74 per cent of the patients were clinically depressed at the time of their presentation. Ninety-three per cent of these patients had precipitants of major entrances or exits (separations) into or out of their life within the seven days prior to presentation; most of these events occurred within forty-eight hours of presentation. In examining the dynamically significant predecessors to these events and the implication of sensitivities subsequently in the patient, 74 per cent of these patients were found to have lost a parent during their development (up to age eighteen) by a divorce, death, or separation. Implications of these findings are discussed regarding the meaning of “methadone-maintenance resistance,” the dynamic significance of drugs (heroin and methadone), and treatment intervention.