Means and Ends – The methadone Case Story by Harry Korman

2025. 12. 07.

In the late 80’s, John, a man in his late 20’s came to the “Heroin-program”. At the time I was still trying to learn and experiment with SFBT. There were many things I didn’t know about the model, but I had understood the fundamental difference between mean and ends.

I started the session asking: “What needs to be different as a result of you coming here for you to feel that this has been useful?”

After a couple of seconds of hesitation, he answered: “I’d have methadone.”

I knew that there was an ongoing research program in the Malmö-Lund area where methadone was tested to see if it reduced mortality among heroin addicts. So, I asked him if he was sure that he had come to the right placesince we could not dispense of prescribe methadone.

He assured me that he was at the right place, so I asked him to explain this, and he said:

“I’m in the queue for getting into the research project in Lund to get Methadone, but in order to become eligibleI have to have three prior failures in treatment” (he paused briefly, then looked up and said:) “and this is the third.”

I still remember thinking: “So his goal for therapy is failing in therapy. But that is not a goal! It’s a means to get methadone. But is being on methadone really desirable or is that only a means to something else?”

So I asked:

“Suppose you’re successful in failing here (he smiled) and you get your methadone.” He nodded and I continued: “what difference will it make in your life?”

He answered quite quickly: “I’d have a functioning social life.” And I echoed: “You’d have a functioning social life.” He nodded and I added: “So that’s what you want?” and he answered with an emphatic “Yes”.

So, I asked the miracle question, stating that the miracle would be that when he woke up, he would be living a functioning social life. Since he would be sleeping when the miracle happened, he wouldn’t know it had happened, so how would he discover that he was a suddenly living a “functional social life”?

His first response was: “I’d wake up hungry for food instead of hungry for heroin.”

There was a longer pause and his eyes wandered around the room, and he then added:

I asked him “what would happen next this morning after the miracle?” and he recounted how he would have his breakfast and read the morning paper and perhaps check out job advertisements. He would then call his ex-girlfriend and talk to her about what she needed to see him do for her to allow him to see their child. He would then call his parents and ask them over for dinner, not for the same day but for the week-end. They’d be verysurprised and happy.

After having spent quite some time detailing the activities of ordinary daily life after the miracle, getting lots of details about John’s view of what a “functioning social life” meant I asked him:

He thought about that for a while and then said: “I’d say I’m about at a 3.”

I tried to look puzzled: “A 3…. Hm ….. So how did you get from 0 to 3…. (leaning forward and frowning)without methadone?”

A slightly confused look appeared on his face. He lifted his right arm and scratched his head and said: “That is a damned good question.”

We then went on describing what he had already done that had moved him from 0 to 3 on the miracle scale and finished the first session with getting him to describe how he would know that he was one step, or half a step closer to his miracle.

Harry Korman

July 2023