This article looks at the link between methadone and alcohol. It has been known for some time that there is a link between alcoholism and opiate abuse. Studies from as far back as the 1970’s showed that those in methadone maintenance programs were more likely to abuse alcohol. Further, those enrolling in such programs were more likely to take on an addiction to alcohol while they lost one for heroin. This hasn’t stopped methadone maintenance programs from moving forward, but it has changed the way patients are handled somewhat.
Previous policies that kept alcoholism counseling separate from drug addiction counseling were changed. Instead of waiting until a methadone treatment cycle was completed, enrollment in AA or other group therapies for alcohol became part of the treatment early on. Evidence of alcohol abuse was screened for as part of the normal urinary checks to monitor heroin use. This has been known since the late 1980’s. Unfortunately, not everyone who needs the additional treatment is getting it. Patients sometimes complain that after they become enrolled in a methadone maintenance program, the focused counseling is dropped – as if methadone alone were a cure-all. There have even been lawsuits filed alleging this.
Studies continue to show (one from 2000) that alcohol consumption increases in patients who are drinkers during methadone treatment, the link between methadone and alcohol.
There are several problems here with methadone and alcohol. Not the least of which is that methadone is a long-acting respiratory and nervous system depressant – in combination with alcohol, it can cause coma and death. Even patients who are tolerant to opioids (heroin, methadone, morphine) will gradually lose that tolerance as their dose is decreased (part of the methadone treatment protocol). Later on, if they combine methadone and alcohol, they are just as much at risk as anyone else would be.
The real tragedy is that a large portion of patients entering a methadone maintenance program are at risk leaving it as an alcoholic – even when they wouldn’t meet the criteria of alcoholism going in. Patients may be unaware of this methadone and alcohol link or underrate this possible side effect in the hope of kicking heroin. Trading one addiction for another, an illegal one for a legal one, isn’t a good enough. Treatment programs that use methadone have a responsibility to prevent new harm while helping with the old. It’s even written in stone somewhere: “First, do no harm.”
