Is There aWay Out of this Clinic? - An Adult and Community Education Perspective on Methadone and the Absence of Rehabilitation

Oct 15, 2026

Upload by Đào

This paper critically examines methadone treatment through an adult and community education lens, challenging the absence of rehabilitation. It argues that biomedicine and evidence-based medicine shape how addiction and treatment are understood, including the over-medicalisation of addiction by psychiatry. The study then considers the Crinan project as a model of good practice, asking what enables adult and community education to support treatment outcomes beyond the limits of a purely medical model.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages16

Reading Time40 min

AccessFree to download

Abstract

Introduction

Adult and community education; an emerging discourse in drug treatment

Is There aWay Out of this Clinic? An Adult and Community Education Perspective on Methadone and the Absence of Rehabilitation thomas o’brien Abstract This paper critically examines methadone treatment from the perspective of adult and community education and questions the absence of rehabilitation. It identifies biomedicine and the methodology of evidence based medicine as the discourses that determine our understanding of addiction and treatment. It is especially critical of psychiatry for the over medicalisation of addiction treatment and the communities uncritical acceptance of the assumptions of medicine. The paper then looks at the Crinan project, as a model of good practice in drug treatment and asks what makes adult and community education an effective component of treatment that works uniquely in a way that medical model does not? Introduction “Every revolution evaporates and leaves behind only the slime of a new bureaucracy”,(Kafka, cited in Preece, 2002, p.89). It too seemed like a revolution when in 1996 drug treatment, in the form of methadone maintenance, became more widely available in Dublin, after local protests about the increased number of drug related deaths among young people, during a time now referred to as the second heroin ‘epidemic’. The protests allowed the community to reclaim the streets as the heroin dealers were driven underground. The drug dealers, many of whom were heroin users themselves, did not go away and with the advent of the mobile phone they found new ways to sell heroin. Methadone clinics became key locations where drugs were bought and sold. Like the dealers, the epidemic did not go away either, as deaths associated with methadone became a feature of the drug problem. The new epidemic was a silent one. Death from a prescribed drug has a different impact. Drug users die silently from the longterm side effects of poly drug use, prescribed and un-prescribed and after years of multiple failed or ineffective treatment episodes. The cause of death is often blamed on the drug users for their moral failure, diseased brain, flawed genetics and inability to remain drug free while on methadone. Ten years later, methadone may have silenced the protesters and calmed the fears associated with HIV infection, but it has done little to help the majority of heroin addicts move out of the cycle of addiction. The drug problem has deepened over the intervening period and while today thousands of addicts can avail of methadone, thereis widespread frustration in local communities about the lack of rehabilitation. Methadone promised to reduce drug related crime associated with the demand for heroin and yet, despite the availability of methadone, the demand for heroin remains. Heroin related prosecutions have increased significantly from 296 in 1995 to 778 in 2004 (Connolly, 2006). Alcohol, cannabis, cocaine and benzodizaphine use are widespread among patients on methadone and there are new fears associated with the introduction of crystalmeth, a new and even more dangerous substance. The new bureaucracy left behind in the wake of this treatment revolution, has created a huge network of local drug task forces, national organisations and committees, professional bodies and local communities at an estimated cost of 70 million euro annually. The key positions within this new bureaucracy are held by consultant psychiatrists who effectively control every aspect of addiction treatment in Ireland. Underpinned by the powerful discourse of medicine, psychiatrists exert enormous control and influence over the management, delivery and evaluation of methadone treatment programmes. Adult and community education; an emerging discourse in drug treatment. The drug treatment centre or clinic is not a site usually frequented by researchers from the adult education tradition and yet it is a research site with profound consequences for personal learning and development, conscientization, empowerment and social

FAQs

What does the paper question about methadone treatment?

It questions the absence of rehabilitation, arguing that methadone has not helped most heroin addicts move out of addiction cycles and that communities are frustrated by limited rehabilitative support.

Which discourses does the paper identify as shaping understanding of addiction?

It identifies biomedicine and evidence-based medicine as the discourses that determine how addiction and treatment are understood, including psychiatry’s role in the over-medicalisation of addiction care.

How does adult and community education contribute to drug treatment, according to the paper?

It frames education as conscientization, helping patients unmask oppressive power, overcome alienation, and become critically reflexive and politicised learners, transforming dependency toward liberation.

Oct 15, 2026

Upload by Đào