If you understand addiction to be a compulsive use of something (alcohol, drugs, etc.) that reaches the point of being self-destructive, then you’d see methadone as an effective treatment, it’s very effective harm reduction.
Unfortunately, 12 step programs embed a kind of puritanical moralizing about abstinence that redefines addiction as a permanent disease, an innate attribute of the person they are powerless to change, with the puritanical terror of the power of temptation of any intoxication to pull the addict into sin. So the 12 step view is that any kind of intoxication is a complete moral downfall (that will inevitably cascade to death), even if that intoxication is a maintenance drug. Many 12 step participants actually have had sponsors push them off their psych. meds to great harm.
Because of the way that puritanical moralizing about abstinence got embedded in 12 step programs, and the way 12 step thinking dominates our culture’s approach to addiction and recovery, ideas of harm reduction, moderation, self-empowerment to permanently change behavior, and other things that are contrary to the 12 step dogma get very little traction, even when evidence suggests that they can be very effective.
