Kathy Eggert, Ph.D. is a 2023 graduate of the PHD Program in Leadership and Change at Antioch University.
Kathy Eggert at her Dissertation Defense.
From L-R: Dr. J. Beth Mabry, Committee Chair, Dr. Declan T. Barry, Committee Member, Dr. Lemuel W. Watson, Committee Member.
- J. Beth Mabry, Ph.D., Committee Chair
- Lemuel W. Watson, Ed.D., Committee Member
- Declan T. Barry, Ph.D., Committee Member
methadone maintenance, addiction counselor, stigma, structural racism, opioid use disorders, leadership, phenomenology, critical phenomenology
The United States continues to experience unprecedented deaths related to the opioid epidemic. Efforts to address the epidemic remain hampered by war-on-drugs policies that stigmatize people who use drugs and create barriers to accessing evidence-based treatments, particularly methadone maintenance treatments (MMT). Despite 50 years of research regarding MMT, it remains highly regulated, and arguably the most stigmatized treatment. The punitive regulatory structure of MMT remained unchanged until emergency waivers were initiated during the COVID-19 pandemic. The study used an exploratory, critical phenomenological approach to examine the intersection of culture and regulation on the lived experiences of 26 addiction counselors who provide treatment for opioid use disorder employing MMT. The phenomenon is examined through lenses of structural competency, cultural healthcare capital, structural racism, and self-determination theories. Using individual interviews, the study investigated whether counselors perceived, conveyed, or enacted stigma in treating those receiving MMT. The study explored whether the pandemic-era regulatory changes shifted counselors' perceptions of the treatment. Findings indicated that counselors enacted and mitigated stigma, two-thirds expressed moderate to high levels of stigma. Counselors perceived and enacted stigma by expressing frustrations regarding programs that embraced harm reduction strategies fearing approaches enabled symptomatic behaviors. They also expressed frustrations with patients’ symptomatic behavior as reflected in paternalistic attitudes and feeling compelled to surveil patients’ behaviors. A number of factors aligned with counselors’ stigmatizing beliefs and attitudes: their pre-career negative experiences with methadone, personal abstinence-based recovery, recovery- oriented training, and/or their lack of exposure to information about the origins of the methadone regulatory structure. Stigmatization was enacted through labeling, discrimination, social exclusion, and the counselors’ use of power. Counselors who mitigated the stigmatized identities of patients held whole-person views and were more likely to have personally utilized methadone. Counselors’ reactions to the loosening of MMT regulations were mixed, most welcomed some level of change. Regulation changes, however, did not significantly impact counselors’ attitudes. This finding, coupled with counselors' stigmatizing behaviors, appears grounded in the socio- historic, racially-biased cultural roots of MMT. Counselors' mitigation of stigma offers implications for future studies focused on abating ingrained cultural stigmatization of methadone and people who utilize it. This dissertation is available in open access at AURA, https://aura.antioch.edu/, and OhioLINK ETD Center, https://etd.ohiolink.edu.
Eggert, K. F. (2023). Counselors’ Lived Experience Treating Patients Utilizing Methadone: The Intersection of Culture, Policy, and Stigma. https://aura.antioch.edu/etds/964