Abandoning rehabilitation and reclaiming recovery: Methadone maintenance treatment and the undoing of a ‘boundary object’, 1966–74

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.