Boston’s Methadone Mile: Finding Support

In 2022, an average of 224 people died in the U.S. every day from an opioid overdose, according to the Centers for Disease Control and Prevention (CDC). Throughout the country, many areas are thoroughly impacted by the opioid epidemic, from Los Angeles’s Skid Row to the Kensington neighborhood of Philadelphia and Boston’s Methadone Mile.

Community members and volunteers in these cities work hard to help people with opioid use disorder (OUD) access the resources they need to recover, secure housing, heal physically and mentally, and live full lives. The process from start to finish, however, is a journey colored with tremendous transformation and growth. For some people with OUD, medication-assisted treatment (MAT), which involves the use of methadone or other medications to reduce withdrawal symptoms and cut cravings, is an incredibly helpful first step and harm reduction measure. Nonetheless, MAT shouldn’t be the only step considered to achieve sobriety.

‘Methadone Mile’ Vs. ‘Recovery Road’: Fighting Addiction Stigma

Methadone Mile, also known as Recovery Road or Mass. and Cass, sits south of downtown Boston. Located at and around the intersection of Massachusetts Avenue and Melnea Cass Boulevard in the city’s Newmarket section, Methadone Mile is nicknamed the “epicenter of the region’s opioid addiction crisis,” reports WBUR. The area is also home to a stretch of methadone clinics, homeless shelters, sober living facilities, and other services for people struggling with substance use disorder (SUD).

Mass. and Cass saw many changes transpire over the last decade. The closing of the Long Island bridge in 2014 transformed the region. The bridge allowed buses to transport people to and from the largest homeless shelter in Newmarket. The closure displaced hundreds of people in a matter of hours, and many of them took refuge on sidewalks and in alleyways, underneath overpasses and bridges, and in tunnels. From then to 2023, the area was known as “tent city” because of its large homeless encampment. In 2023, the encampments were removed by the city, but Mass. and Cass remains a meeting point for unhoused people and people with SUD.

It’s been a decade since the closing of the Long Island bridge and still, there is much room for reform. However, the city of Boston, community leaders, and volunteers are making efforts to make it into a safer place to live and work. Local clinics, shelters, and halfway houses serve people who need accessible and immediate assistance. Those involved in the response effort prefer using “Recovery Road” instead of “Methadone Mile,” as the former implies hope for positive change and reduced stigma, especially with growing support from Boston methadone clinics to combat the opioid crisis.

Today, the local methadone clinics help many people in the Boston area recover from OUD. Methadone is an opioid and synthetic analgesic, or pain reliever, used to treat moderate to severe pain and OUD. Methadone changes the way the brain responds to pain, which allows for fast relief, and prevents people from experiencing a high from drugs like heroin, morphine, oxycodone, hydrocodone, and codeine. On Recovery Road and elsewhere, MAT using methadone helps people stop using opioids without experiencing harsh withdrawal symptoms.

The Pros Of Methadone

The greatest benefit of methadone is that it saves lives. A report published by the National Academies Press stated that people addicted to opioids are 50 percent more likely to survive their addiction if they take methadone or buprenorphine, which serves the same purpose as methadone.

Other benefits of methadone for people with OUD include:

• it helps manage or eliminate opioid cravings
• it reduces the sensation of intoxication, or being “high,” if someone taking methadone were to take other opioids
• it alleviates symptoms of withdrawal
• it lowers the risk of overdose

For people with OUD, methadone can significantly help to improve their quality of life. It allows for a safer and more comfortable way to withdraw from opioids. Concern about the intensity of withdrawal symptoms is one of the main reasons why people struggle to stop using opioids. Because it helps people to regain control, methadone also reduces the likelihood that someone will partake in illegal or dangerous activities to acquire their drug of choice.

The Cons Of Methadone

Although methadone poses many prospective benefits to people with OUD, there are also negatives associated with ongoing use. One of the main cons is, because methadone itself is an opioid, it has the potential to produce euphoric effects, though much milder when compared to other opioids. The effects can compromise a person’s ability to drive or operate heavy machinery, which can interfere with their ability to work or manage their day-to-day life in the long term.

Some of the other cons to methadone include:

• potential for addiction
• unpleasant side effects, e.g., dizziness, fatigue, nausea and/or vomiting, sweating, etc.
• risk of overdose
• harmful interactions with other medications, including benzodiazepines

Unfortunately, there is also a stigma that comes with methadone treatment and methadone maintenance. People have differing opinions about methadone, with some perceiving its use as not being fully sober. When methadone is the route of treatment suggested by your care team, it’s important to remember that other people may not understand, especially those who don’t share similar experiences. Methadone is used for harm reduction, because it increases the possibility of recovery, while also lowering the risk of relapse and overdose.

The Nature Of Addiction

Addiction is a chronic, lifelong disease of the mind that affects the way a person thinks and acts. It is not a choice. No one with an addiction consciously decides to become addicted to drugs or alcohol. Rather, addiction is both complex and progressive; it does not have a single cause, but forms at the intersection of various contributing factors, and tends to worsen over time. For some people, their addiction may develop over years, and for others, it escalates seemingly overnight.

For many people, their addiction started as a coping mechanism. When a person doesn’t develop healthy tools to deal with difficult emotions and circumstances, especially stress, and begins using substances, they may learn to resort to substances for immediate relief, albeit temporary. Long-term, ongoing stress, on its own, can make a person significantly more susceptible to addiction, according to the Annals of the New York Academy of Sciences.

As substance use continues, the ongoing presence of the substance in the body changes the brain’s chemistry. Drugs and alcohol act on the brain’s reward circuit, its mesolimbic system, which plays a role in reward, reinforcement, and motivation. With continued use, cravings develop, as the brain learns to seek out more of these substances. The brain may also become accustomed to the substance over time, requiring larger and larger quantities than originally used to experience the same effects. This is known as tolerance. Physical dependence is another aspect to consider, which is when a person needs the substance to function normally or faces the risk of paralyzing withdrawal symptoms.

It’s common for people who aren’t familiar with SUD, how it works, and especially how it feels to experience firsthand, to pose the question, “Why don’t they just stop?” The answer is because addiction is insidious. SUD may start out as experimental, with a person drinking alcohol on weekends with friends, for example. Over time, the habit may evolve into drinking for relief after a long workday or a tough conversation. Eventually, the person may start having a few drinks every day to “wind down” before bed, and perhaps this continues for some time. Then, suddenly, a traumatic or emotionally overwhelming experience occurs, which kicks their habit into drinking in the morning and throughout the day simply to function.

There are many reasons why one person can “just stop,” but another progresses on to develop a serious addiction. Because addiction and its causes are rooted in the brain, and addiction acts on several areas of the brain, it’s influenced by a combination of nature, or genetic makeup, and nurture, or environmental experiences.

Some of the factors that may influence addiction include but are not limited to:

• accessibility
• adverse childhood experiences (ACEs)
• age of first use
• behavioral or impulse control issues
• coping with chronic diseases and health issues
• family conflict
• family history of substance use or SUD, and/or mental illness
• history of substance abuse
• lack of social support
• long-term prescription to addictive medications, e.g., after a surgery
• loss of a loved one and/or grief
• mental illness
• ongoing high stress
• peer pressure
• social isolation
• substance of choice
• trauma

Relapse Is Not A Failure

Relapse, or the return to substance use after a period of sobriety, is not indicative of defeat. Rather, it’s a normal part of the recovery process for many people. According to Alcoholism: Clinical and Experimental Research, people may experience anywhere from two to five relapses before maintaining consistent sobriety. The important part of relapse is accessing help as fast as possible to prevent it from continuing on and/or resulting in troubling consequences.

In addiction, the brain becomes conditioned to think, behave, and respond to stimuli in a certain way. In recovery, a person must learn new ways of thinking and behaving, and develop tools for managing experiences they previously used substances to handle. In early recovery, especially, it’s common to have intense cravings to use and/or resort to past behaviors. For this reason and others, it’s necessary to have support from addiction treatment facilities and/or professionals, as well as peer-led recovery groups like Alcoholics Anonymous (AA) or Narcotics Anonymous (NA), for help managing a life of sobriety. If a relapse occurs, it can be helpful to use the experience as a source of information and reflect on troubles you weren’t vocalizing and stressors that may have contributed to the relapse.

Contributing Issues Requiring Treatment

Some of the contributing factors to an SUD require their own treatment, such as trauma and co-occurring mental and/or physical health issues. People who experience one or more of these issues may benefit from attending a treatment facility that specializes in dual diagnosis care, such as Bedrock Recovery Center. These programs are structured to treat co-occurring disorders while treatment is administered for SUD.

It’s so important to receive treatment for the issues mentioned because their symptoms can contribute to an SUD, and an SUD can also worsen their symptoms. For example, a person with chronic physical pain may have, in part, developed an SUD in an attempt to manage their pain. Or, a person may struggle with depression and anxiety, and they may have started using substances to manage the symptoms of these illnesses but, over time, it actually worsened these issues. In cases such as these, recovery from addiction is largely dependent on the ability to receive support for these contributing issues.

How Addiction Treatment Is Like Formal Education

For his recent documentary “Methadone Mile: Inside Boston’s Drug Epidemic,” YouTube influencer Tommy G spoke with Bedrock Recovery Center’s own Mathematics, LADC II/group facilitator, who shared an analogy comparing addiction treatment to formal education. Like formal education, addiction treatment supports skill development, which ultimately serves to enhance the quality of one’s life. While traditional classroom learning aims for mastery of subjects like English, mathematics, history, and science, addiction treatment empowers individuals with social-emotional tools, encourages healing through one-on-one, group, and experiential therapies, and prepares them to live independent, full, and satisfying lives that are free of drugs and alcohol.

Like classroom learning, addiction treatment occurs in phases. In order to reap the benefits of comprehensive addiction treatment, a person must undergo the treatment process firsthand. Similarly, if a person doesn’t complete all 12 years of elementary, middle, and high school, they are not eligible to obtain a high school diploma because they lack the qualifications. If a person does not receive enough treatment, or if they leave treatment early, they will not have the skills to safely return to the real world as a newly sober person, and face a high risk of relapse.

Detox = Grammar School

Detox, or detoxification, is a preliminary stage of addiction treatment. On its own, detox is not a form of treatment for SUD. Detox simply functions to safely help people withdraw from drugs and alcohol, and only afterwards, they can begin formal treatment with a clearer mind and recovering body. Some withdrawal processes are life-threatening, like from alcohol and benzodiazepines, and medical detox is necessary. Withdrawal from opiates is not necessarily life-threatening, but it can be incredibly uncomfortable and physically painful. Not everyone needs to go to detox, but such can be determined by a health care professional.

Grammar school provides students with a preliminary education. Students learn the basics, but these basics are developed in subsequent years, similar to building blocks. If a person leaves detox and doesn’t pursue another measure of treatment, they are not likely to remain sober. Although they are physically sober, the mind hasn’t learned the tools to deal with people, places, and things in a healthy way, or how to manage heavy emotions without substances. These tools are taught in treatment, and it doesn’t happen overnight. More than 130 people die in the U.S. each day from opioid-related overdoses, according to the Health Resources & Services Administration. Returning to the real world immediately after detox simply isn’t worth it.

30-Day Treatment = High School

When a person enters into 30-day treatment, they begin a phase of treatment akin to being in high school. Their daily regimen becomes filled with a variation of individual and group therapy sessions, experiential therapies, AA and NA meetings, recreational time, and may eventually involve responsibilities at the treatment facility, such as serving as a greeter, helping in the kitchen, or performing managerial duties. They also experience the treatment process side-by-side with like-minded peers who they may develop close friendships with.

Spending time away from their home environment helps to keep the focus on recovery. During this time, the body continues to recover physically; something that varies depending on the substances taken. For people with OUD, withdrawal symptoms can last for days or weeks, with general but subtle improvements each day. An onsite psychiatrist may recommend medication for people with comorbid mental health conditions. People will also participate in groups that teach relapse prevention techniques.

30-Day+ = Bachelor’s Degree

After completing a 30-day stay at an inpatient treatment center, many people start feeling better about themselves, both physically and mentally. The improvement in feeling makes sense; it’s the first time that many of them are away from substances consistently. In recovery groups, the feel-good sensations of newfound sobriety are referred to as the “pink cloud.” Similarly, this sensation can be compared to the likeness of going away to college. It’s the first time that many young people live away from their families, which comes with newfound freedom to become who they want and do what they want. Unfortunately, the overnight freedom of being at college can prove detrimental to people who aren’t ready. These feelings are also one of the reasons why people may leave treatment early or decide not to continue their treatment past the 30 days.

Remaining in treatment, if suggested and feasible, is important because it allows people to start implementing the skills they learned during their first 30 days. For example, having acquired more social-emotional learning tools may support their healing journey through cognitive behavioral therapy (CBT). Remaining in treatment past 30 days can also extend the buffer that exists between people in recovery and the realities of the real world, keeping the focus on their sobriety.

‘Step-Down’ Outpatient = Master’s Degree

After completing inpatient treatment, many people go on to participate in outpatient programs. There are variations of outpatient programs, e.g., intensive outpatient programs (IOPs), day programs, and general outpatient programs (OPs). The appropriate program is determined by each individual’s care team and considers factors such as health insurance, the requirements of a job’s employee assistance program (EAP), and more.

Outpatient programs offer a scheduled regimen that helps people to gradually reintegrate into their lives while keeping recovery in center focus. It represents the master’s degree-level of recovery because, at this point, people are emboldened with the tools to live a sober lifestyle, but may need support with implementing these tools. If it’s recommended that a person goes into outpatient only after inpatient treatment, it’s important to follow these phases consecutively. While outpatient treatment can help to teach some necessary skills, there is far more time dedicated to skill development, and one-on-one support offered, in inpatient treatment.

Solutions To Consider

“Recovery is not a straight line” is a quote commonly shared in recovery meetings. One person’s recovery will not mirror another person’s recovery, even if they share similar histories, substance use patterns, or personalities. Recovery is unique to the individual, just as each student’s journey through school is filled with their own highlights and hardships, despite attending school side-by-side with other students.

Like life, recovery is filled with achievements, milestones, and exciting times, as well as fluctuations, moments of uncertainty, plateaus, mishaps, and solemn times. Though your journey will be unique to your own experience, the following suggestions may help to inform some of your decisions.

Never Give Up

There is no perfect plan of recovery. Your recovery needs will change with the seasons, just as life does. However, if you attend groups like AA or NA, you’ll meet people with decades of sobriety under their belts. These folks continue to abstain from drugs and alcohol because they never gave up—and neither should you. Because the disease of addiction lives in the mind, it can never fully disappear, even after years of sobriety. People who have been in recovery for 10, 20, or 30 years and up, accept the power of their disease and possess the humility to be honest and ask for help, regardless of the challenges they face.

Recovery can be challenging, especially in the beginning and during periods of high stress. However, a life of happiness and fulfillment is possible to obtain, so long as you continue working toward it by remaining sober. Remember to be patient, give yourself grace, and don’t be afraid to ask for help.

Complete Treatment

If you enter a treatment program, whether it entails inpatient and/or outpatient programs, it’s recommended that you finish what you started. Few benefits can come from leaving treatment early, and if you are in treatment, it’s because a decision, experience, or consequence led to the present moment. While in treatment, you’ll begin learning ways to cope with emotions and handle day-to-day stressors, while also receiving therapy for contributing issues like trauma, and having a buffer from potential triggers in your daily life.

If you’re eager to return home, remember that if you are unable to maintain sobriety, you run the risk of losing everything important to you as a result of your addiction. If you want to be a supportive and present person, spouse, parent, friend, employer or employee, then you need to follow through with your treatment plan. It’s the best way to invest in your future in the short and long term.

Consider A Dual Diagnosis Facility

If you have a concurring mental health issue, like depression, an anxiety disorder, bipolar disorder, or schizophrenia, then it’s suggested that you consider a dual diagnosis treatment facility. Dual diagnosis treatment, as stated above, simultaneously provides treatment for SUDs and mental illness. Because the two diagnoses directly influence each other, a full recovery is not likely if only one condition is treated. These facilities are designed to help people develop the tools to manage both conditions in their daily lives.

Try Family Therapy And Psychoeducation

Addiction is a family disease. When one person deals with an SUD, it affects the entire family system. Family members may feel angry, sad, and frustrated with their loved one who is struggling. Others may have enabling tendencies and develop codependent patterns. In such a case, the loved one who is worried about their family member becomes just as addicted to their health, safety, and whereabouts as the person with an SUD. Collective healing requires all family members to understand their patterns as they relate to the loved one with an SUD, and also as individuals. Family therapy can provide the gateway for this healing to occur little by little, and over time.

Likewise, family psychoeducation can help family members and spouses of people with SUDs understand their loved one’s addiction and/or mental health conditions, and how to cope and provide support.

These options may be especially important to consider if a family member has forced a loved one into treatment, as understanding what their loved one is experiencing and knowing how to offer support can be critical to their long-term recovery.

Stick To Your Aftercare Plan

As a person completes treatment, their care team will typically work with them to develop an aftercare plan. Aftercare consists of any of the actions taken to support recovery post-treatment. Aftercare efforts can and should last for the duration of a person’s life, because addiction is a chronic disease. In recovery meetings, people who relapse and return commonly share that their substance use returned to how it was previously, and even worse. Living a sober lifestyle requires ongoing effort, but it is absolutely worth it.

Aftercare plans differ depending on a person’s needs, schedules, and access, which will likely change over time. The important thing is to start somewhere and stick with it.

Aftercare options for SUD include:

• participating in outpatient treatment after completing residential treatment
• residing in a sober living facility
• participating in your treatment center’s alumni program
• attending 12-step recovery meetings
• going to therapy
• building a support system of sober, like-minded individuals
• working with a peer recovery coach and/or sponsor in a 12-step program
• maintaining speaking and other commitments in a 12-step program

Remember: You Are Not A Problem—Your Addiction Is

When a person suffers from an SUD, it can help to view their disease separately from them. The disease of addiction hijacks a person’s personality and sense of self, and seeps into all areas of life, poisoning their experience with and connection to family and friends, work, hobbies, and more.

Addiction is recognized as a mental illness because that’s exactly what it is. Having a mental illness has nothing to do with a person’s inherent worth, though unfair stigmas may indicate otherwise. It’s important to fight these stigmas until addiction and mental illness are seen for what they are: medical conditions requiring treatment.

People with active and serious addictions live in survival mode. Once given the opportunity to recover and heal, they can step out of fighting to exist and experience how it feels to live freely and unapologetically.

You are not “bad” because of your SUD; you just need some support to let your true self shine. You didn’t choose to suffer, and neither does anyone with an addiction; it’s simply a result of life going haywire, but it’s possible to create calm out of chaos. So long as you’re living, there is always hope.

Find Freedom From Addiction At Bedrock

If you are dealing with a drug or alcohol addiction, you don’t have to handle it alone. Help is available whenever you’re ready. Call Bedrock Recovery Center in Canton, MA, for more information today.