This article uses the early history of methadone maintenance treatment (MMT) as a lens to draw out the epistemic and ethical-political stakes of rehabilitation as an overarching aim of addiction treatment in the United States. It does so by bringing into focus the various factors that led to the undoing of rehabilitation as a ‘boundary object’ for the evolving addiction treatment field in the early 1970s. In the two preceding decades, rehabilitation had advanced to a central yet ill-defined category, consistently invoked by policy makers and treatment providers. However, with the introduction of MMT, along with the expansion of a competing treatment modality, therapeutic communities, the aims and means of rehabilitation became more contested. Political exigencies, federal regulations, and efforts to establish treatment efficacy led to a focus on steady employment as a neutral, seemingly uncontroversial treatment aim. At the same time, this goal moved increasingly out of reach with vocational rehabilitation efforts lacking political and institutional support. The loss of the concept’s interpretive flexibility, skepticism about using employment as a marker for treatment success, and the perception of MMT as a biomedical intervention, I argue, prompted the abandonment of rehabilitation and the reclaiming of the more individualized notion of ‘recovery’ as an overarching aim of addiction treatment.
AckerC. J. (2003) Creating the American Junkie: Addiction Research in the Classic Era of Narcotic Control. Baltimore, MD: Johns Hopkins University Press.
2.
AllenF. A. (1978) ‘The Decline of the Rehabilitative Ideal in American Criminal Justice’, Cleveland State Law Review27(2): 147–56.
3.
AllenF. A. (1981) The Decline of the Rehabilitative Ideal: Penal Policy and Social Purpose. New Haven, CT: Yale University Press.
4.
AMA Council on Mental Health (1970) ‘Recovery From Drug Dependence’, Journal of the American Medical Association214(3): 579.
5.
AnthonyW. A. (1993) ‘Recovery From Mental Illness: The Guiding Vision of the Mental Health Service System in the 1990s’, Psychosocial Rehabilitation Journal16(4): 11–23.
6.
BestemanK. H. (1992) ‘Federal Leadership in Building the National Drug Treatment System’, in GersteinD. R.HarwoodH. J. (eds) Treating Drug Problems: Vol. 2. Washington, DC: National Academy Press, pp. 63–88.
7.
BrotmanR.FreedmanA. M.EinsteinS. (1966) ‘Intervention Targets in the Community Mental Health Rehabilitation of Drug Users’, in Rehabilitating the Narcotic Addict. Washington, DC: Vocational Rehabilitation Administration, US Department of Health Education and Welfare, pp. 131–40.
8.
CampbellN. (2007a) Discovering Addiction: The Science and Politics of Substance Abuse Research. Ann Arbor, MI: University of Michigan Press.
9.
CampbellN. (2007b, 7 July) ‘Jaffe, Jerome Interview Conducted by Campbell/Spillane’, University of Michigan Library, available at:https://doi.org/10.7302/22540.
10.
CattesD. (1973) ‘What Is a Successful Patient, and Must Detoxification Be a Factor?’ in Proceedings of the 5th National Conference on Methadone Treatment. New York, NY: NAPAN, pp. 17–20.
11.
ClarkC. (2012) ‘“Chemistry Is the New Hope”: Therapeutic Communities and Methadone Maintenance, 1965–71’, Social History of Alcohol and Drugs26(2): 192–216.
12.
ClarkC. D. (2017) The Recovery Revolution: The Battle Over Addiction Treatment in the United States. New York, NY: Columbia University Press.
13.
CourtwrightD. T.JosephH.des JarlaisD. (2013) Addicts Who Survived: An Oral History of Narcotic Use in America Before 1965. Knoxville, TN: University of Tennessee Press.
14.
CranstonA. (1974) ‘Legislative Approaches to Addiction Among Veterans: The Nation’s Unmet Moral Responsibility’, Journal of Drug Issues4(1): 1–10.
15.
de LeonG. (1981) ‘The Role of Rehabilitation’, in NahasG. G.FrickH. C. (eds) Drug Abuse in the Modern World: Perspective for the Eighties. New York, NY: Pergamon Press, pp. 298–307.
16.
DoleV. P. (1971) ‘Research on Methadone Maintenance Treatment’, in EinsteinS. (ed.) Methadone Maintenance. New York, NY: Marcel Dekker, pp. 13–28.
17.
DoleV. P.NyswanderM. E. (1965) ‘A Medical Treatment for Diacetylmorphine (Heroin) Addiction: A Clinical Trial With Methadone Hydrochloride’, Journal of the American Medical Association193(8): 646–50.
18.
DoleV. P.NyswanderM. E. (1967) ‘Heroin Addiction – A Metabolic Disease’, Archives of Internal Medicine120(1): 19–24.
19.
DoleV. P.NyswanderM. E. (1973) ‘Rehabilitation of Patients on Methadone Programs’, in Proceedings of the 5th National Conference on Methadone Treatment. New York, NY: NAPAN, pp. 1–7.
20.
DumontM. P. (1973) ‘Drug Abuse: The Junkie as Political Enemy’, in GartnerA.GreerC.RiessmanF. (eds) What Nixon Is Doing to Us. New York, NY: Harper & Row, pp. 139–54.
21.
EpsteinE. J. (1974) ‘Methadone: The Forlorn Hope’, Public Interest36: 3–24.
22.
Food and Drug Administration (1972) ‘Rules and Regulations’, Federal Register37(242): 26790–806.
23.
FrenchM. T.DennisM. L.McDougalG. L.KaruntzosG. T.HubbardR. L. (1992) ‘Training and Employment Programs in Methadone Treatment: Client Needs and Desires’, Journal of Substance Abuse Treatment9(4): 293–303.
24.
GagneC.WhiteW.AnthonyW. A. (2007) ‘Recovery: A Common Vision for the Fields of Mental Health and Addictions’, Psychiatric Rehabilitation Journal31(1): 32–7.
25.
GarrettJ. F. (1966) ‘Objectives of the Vocational Rehabilitation Administration in the Rehabilitation of the Narcotic Addict’, in Rehabilitating the Narcotic Addict. Washington, DC: Vocational Rehabilitation Administration, US Department of Health Education and Welfare, p. 5.
26.
GoldenbergI. (1972) Employment and Addiction: Perspectives on Existing Business and Treatment Practices. Final Report. Cambridge, MA: Harvard University.
27.
JaffeJ. H. (1971) ‘Further Experience With Methadone in the Treatment of Narcotics Users’, in EinsteinS. (ed.) Methadone Maintenance. New York, NY: Marcel Dekker, pp. 29–44.
28.
JaffeJ. H. (1977) ‘Some Reflections on the Evolution of Current American Approaches to Problems of Drug Abuse and to the Treatment of Drug Abusers’, Journal of Drug Issues7(1): 1–12.
29.
KochU. (2023) ‘“Heroin Mothers”, “Methadone Babies”, and the Medical Controversy Over Methadone Maintenance in the Early 1970s’, Bulletin of the History of Medicine97(1): 127–56.
30.
LaVorM. L.DuncanJ. C. (1974) ‘Rehabilitation Act of 1973, PL 93–112’, Exceptional Children40(6): 443–9.
31.
LawrieP. R. (2014) ‘“Salvaging the Negro”: Race, Rehabilitation, and the Body Politic in World War America, 1917–1924’, in BurchS.RembisM. (eds) Disability Histories. Urbana, IL: University of Illinois Press, pp. 321–44.
LinkerB. (2011) War’s Waste: Rehabilitation in World War I America. Chicago, IL: University of Chicago Press.
34.
LowinsonJ. (1966) ‘The Methadone Maintenance Research Program’, in Rehabilitating the Narcotic Addict. Washington, DC: Vocational Rehabilitation Administration, US Department of Health Education and Welfare, pp. 271–84.
35.
MadduxJ. F. (1966) ‘Treatment of Narcotic Addiction: Issues and Problems’, in Rehabilitating the Narcotic Addict. Washington, DC: Vocational Rehabilitation Administration, US Department of Health Education and Welfare, pp. 11–22.
36.
MartinW. R. (1971) ‘Commentary on the Second National Conference on Methadone Treatment’, in EinsteinS. (ed.) Methadone Maintenance. New York, NY: Marcel Dekker, pp. 199–206.
37.
MassingM. (1998) The Fix. Berkeley, CA: University of California Press.
38.
MullenR.ArbiterN. (1992) ‘Against the Odds: Therapeutic Community Approaches to Underclass Drug Abuse’, in SmithP. H. (ed.) Drug Policy in the Americas. Boulder, CO: Westview Press, pp. 178–201.
39.
MustoD. F.KorsmeyerP. (2002) The Quest for Drug Control: Politics and Federal Policy in a Period of Increasing Substance Abuse, 1963–1981. New Haven, CT: Yale University Press.
NewmanR. G. (1973a) ‘Involuntary Treatment of Drug Addiction’, Yale Review of Law and Social Action3(3): 246–53.
42.
NewmanR. G. (1973b) ‘We’ll Make Them an Offer They Can’t Refuse’, in Proceedings of the 5th National Conference on Methadone Treatment. New York, NY: NAPAN, pp. 94–100.
43.
PlattJ. J. (1997) ‘Vocational Rehabilitation of Drug Abusers’, Psychological Bulletin117(3): 416–33.
44.
President’s Advisory Commission on Narcotic and Drug Abuse (1963) Final Report. Washington, DC: US Government Printing Office.
45.
RazM. (2017) ‘Treating Addiction or Reducing Crime? Methadone Maintenance and Drug Policy Under the Nixon Administration’, Journal of Policy History29(1): 58–86.
46.
RettigR. A.YarmolinskyA., eds (1995) Federal Regulation of Methadone Treatment. Washington, DC: National Academies Press.
47.
RobertsS. (2012) ‘“Rehabilitation” as Boundary Object: Medicalization, Local Activism, and Narcotics Addiction Policy in New York City, 1951–62’, Social History of Alcohol and Drugs26(2): 147–69.
48.
RobertsS. K. (2022) ‘The Politics of Stigma and Racialization in the Early Years of Methadone Maintenance Regulation’ [Unpublished manuscript], National Academies of Science, Engineering and Medicine.
49.
Robinson v. California, 370 U.S. 660 (1962).
50.
RoomR. G. W. (1978) ‘Governing Images of Alcohol and Drug Problems: The Structure, Sources, and Sequels of Conceptualizations of Intractable Problems’, PhD thesis, University of California, Berkeley.
51.
RoomR. G. W. (2001) ‘Governing Images in Public Discourse About Problematic Drinking’, in HeatherN.PetersT. J.StockwellT. (eds) Handbook of Alcohol Dependence and Alcohol-Related Problems. Chichester: Wiley, pp. 33–45.
52.
SenayE. C.WrightM. (1972) ‘Critique of Theories of Methadone Use’, International Pharmacopsychiatry7(1–4): 64–70.
53.
ShellyJ. A. (1966) ‘Daytop Lodge – A Two Year Report’, in Rehabilitating the Narcotic Addict. Washington, DC: Vocational Rehabilitation Administration, US Department of Health Education and Welfare, pp. 239–48.
54.
SlawsonR. M. (1966) ‘A Small City Begins Assuming Responsibility for Its Narcotics Problem’, in Rehabilitating the Narcotic Addict. Washington, DC: Vocational Rehabilitation Administration, US Department of Health Education and Welfare, pp. 303–10.
55.
SpiegelD. K.SellsS. B. (1974) ‘Part I: Evaluation of Drug Users in the DARP’, in SellsS. B. (ed.) Evaluation of Treatments: Vol. 1. Cambridge, MA: Ballinger, pp. 3–223.
56.
StarS. L. (1988) ‘The Structure of Ill-Structured Solutions: Boundary Objects and Heterogeneous Distributed Problem Solving’, in HunsM.GlaserL. (eds) Readings in Distributed Artificial Intelligence. Menlo Park, CA: Stanford University Press, pp. 37–54.
57.
StarS. L. (2010) ‘This Is Not a Boundary Object: Reflections on the Origin of a Concept’, Science, Technology, and Human Values35(5): 601–17.
58.
StarS. L.GriesemerJ. (1989) ‘Institutional Ecology, “Translations”, and Boundary Objects: Amateurs and Professionals on Berkeley’s Museum of Vertebrate Zoology’, Social Studies of Science19(3): 387–420.
59.
Substance Abuse and Mental Health Services Administration (2023) Strategic Plan: Fiscal Year 2023–2026. Rockville, MD: National Mental Health and Substance Use Laboratory.
60.
US House of Representatives (1971) Treatment and Rehabilitation of Narcotics Addicts: Hearing Before the Subcommittee on the Judiciary to Amend the Narcotic Rehabilitation Act of 1966 of the Committee on the Judiciary of the United States House of Representatives. 92nd Congress, 1st Session. Washington, DC: US Government Printing Office.
61.
US Senate (1972) Hearings Before the Subcommittee on the Handicapped of the Committee on Labor and Public Welfare. 92nd Congress, 2nd Session. Washington, DC: US Government Printing Office.
62.
WhiteW. (2005) ‘Recovery: Its History and Renaissance as an Organizing Construct’, Alcoholism Treatment Quarterly23: 3–15.
63.
WolksteinE.Hastings-BlackD. (1979) ‘Vocational Rehabilitation’, in DupontR. I.GoldsteinA.O’DonnellJ. (eds) Handbook on Drug Abuse. Washington, DC: National Institute on Drug Abuse, pp. 159–64.
