Pre-print version of Day E (2012) Methadone Treatment as Palliation or an Individualised Process of Recovery Management? Addiction 107:953-4 DOI: 10.1111/j.1360-0443.2012.03785.x. The definitive version is available at www.blackwell-synergy.com 1 Commentary on Schwartz et al (2012): Methadone Treatment as Palliation or an Individualised Process of Recovery Management? Ed Day From my perspective as a clinician and a researcher, the study by Schwartz et al throws up two important findings. Firstly, the results demonstrate that the prescription of methadone benefits a group of individuals with opioid dependence and a range of other serious psychological and social deficits, at least when the primary outcome measure is reduction of illicit heroin use. This is entirely in keeping with the large research literature on this topic (1). Therefore preventing people from getting access to this treatment is to deny them a potentially very effective way of improving their health, and the limitations imposed on services by compulsory provision of counselling are a potential barrier. Secondly, having shown that easier access to opiate substitution is beneficial, the results suggest that psychosocial interventions are not necessary to achieve the desired treatment outcomes. Although the need for ancillary services is enshrined in the quality standards of methadone maintenance programmes worldwide (2, 3), the evidence base for their efficacy is relatively limited. Besides the classic study by McLellan et al (4), there are only a handful of good studies that support this view, and a recent Cochrane review that casts doubt on it (5). Taken together, these findings might suggest that policy makers should facilitate access to opiate substitution prescribing, whilst limiting unnecessary adjunctive counselling interventions. However, before doing so, they should consider our experience over the past 10 years in England. The formation of the National Treatment Agency for Substance Misuse in 2001 saw an unprecedented increase in the provision of drug treatment, with the predominant treatment modality being opiate substitution. However, treatment in England has never been as tightly regulated as in the USA, with