This study of 252 methadone maintained men used four of the most widely accepted measures of antisociality and then did a multistage cluster analysis to develop six subtypes of antisociality in methadone patients. (A Typology of Antisociality in Methadone Patients, Journal of Abnormal Psychology [1998]). While prejudiced people consider those who use illegal substances and methadone treatment as "bad," addiction experts consider opiate addiction a brain disease. This typology can be useful in thinking about prognosis, treatment planning, and sentencing, and is likely to be of wide interest to clinicians, lawyers, judges and those interested in public policy. The subtypes range from early onset, high antisociality, and late onset, high antisociality, to low antisociality.

A major subset (28 percent) of methadone maintenance patients do not have antisocial features. At the other extreme, those with childhood conduct disorder, severe antisocial personality, and on methadone maintenance are at high risk for crime and recidivism. In between lies a spectrum of those who tend to commit crimes just to get drugs and those with emotional instability and problems in addition to drug problems. The non-antisocial methadone maintenance patients probably would be those who could do better in abstinence oriented programs although many of them may still prefer or do better on methadone maintenance. Those patients who are most likely to commit crimes in order to get drugs may, if on methadone maintenance, have lower rates of criminality and be more likely to be employable.

With New York City Mayor Rudolph W. Giuliani's decision to eliminate city-run methadone maintenance programs to the consternation of most addiction field experts, the methadone maintenance issue has received widespread attention. We have good science demonstrating that addiction to opioids is a brain disease. Methadone maintenance has been found to be the most effective treatment for opiate addiction and in reducing crime, joblessness, mortality, homeless-ness, rates of infection, spread of HIV, hepatitis, and tuberculosis. It is effective at helping people get off the welfare roles. Having politicians dictate treatment based on ideology rather than science is a major problem. When a city the size of New York closes down its' methadone programs, the bell tolls for all of us who treat addicted patients.