Naturally Non-Compliant: Mandatory Counseling for Methadone Clients in Arizona, 2021

The US is unique in dispensing methadone for opioid dependent people only via opioid treatment programs (OTP), or “methadone clinics”. These OTP are governed by federal regulations which outline rules, such as mandatory counseling. Mandatory counseling in this context is a tool to determine which individuals may gain access to a sanctuary for safer drug use and who may not.This dissertation is an analysis of data previously collected from a larger parent study, but which had remained unexamined until now. Utilizing a qualitative thematic approach to data analysis, this study seeks to answer two central research objectives. Firstly, what does the mandatory counseling consist of and what is the professional background of the counselors. When participant responses were analyzed, it was found that clients at OTP were provided scarce details regarding the professional background of their counselors and which, if any, therapeutic modality is offered. Clients have very little control over their treatment plans or counseling, and the role of the counselor is focused more directly on surveillance than therapeutic goals. Secondly, this analysis explores client beliefs about mandatory counseling. While most participants generally held positive views about counseling independent of the mandate, responses bifurcated into two distinct groups. Participants were very supportive of the mandatory counseling, or they expressed a desire for more autonomy and freedom of choice regarding counseling. The findings of this dissertation indicate the need for comprehensive reform of methadone dispensation in the United States.