Abstinence versus agonist maintenance treatment: an outdated debate?

ate brief wellbeing measures could facilitate discussions about broader life needs to be addressed. Further, insights from the literature on subjective wellbeing may inform services and interventions to help people establish happier, more meaningful lives within which addiction holds less attraction.’ The increasing acceptance and availability of agonist maintenance treatment is well documented: in Europe, the number of countries providing methadone maintenance increased from 7 in 1980 to 28 by 2005, and the number of countries providing buprenorphine maintenance rose within a few years to 21 [2] . Globally, opioid maintenance treatment was available in 70 countries by 2009 [3] . Even an increasing number of prison systems are offering methadone maintenance treatment to prisoners [4] . Driving forces were the HIV/AIDS epidemic among drug injectors with increasing risks for the general population, and the ensuing need to bring as many injectors as possible into treatment arrangements. Have the expectations been met? The research evidence is quite clear and has been well documented and reviewed. The World Health Organisation has included methadone and buprenorphine, the two mainly used agonists in maintenance treatment, into the lists of essential medicines and summarized the state of research results After two decades of increasing acceptance and availability of agonist maintenance therapies, we hear more about limitations of this approach and about a new quest for abstinence-oriented recovery. What is the state of these trends, and what are the facts and arguments? Part of this development is already visible from the differential terminology in use: abstinence is perceived as instrumental for health and social improvements (‘abstinence-based therapy’) or else as the final objective (‘abstinence-oriented therapy’). Recovery is used to describe a rehabilitation process in various shades (‘back to normal’), but also to describe a socialization process to model citizenship (‘better than well’). Maintenance therapy goes as a temporary approach to engage those in treatment who otherwise cannot be reached (‘maintenance to abstinence’) or else as the treatment of a chronic condition (‘unlimited maintenance’). The diverse terms mirror dissatisfaction with the crude opposition abstinence versus maintenance, but in fact they present a new version of the old controversy: what are the goals of addiction treatment? Is the ultimate goal abstinence, or is it well-being with or without abstinence? In other words [1] : ‘To what extent is your program making peoples’ lives better, rather than simply suppressing alcohol/drug use? Structured assessment using appropriPublished online: May 7, 2013 European Addiction c Re e s ar h