Westend, a methadone clinic: structural aspects of addiction.

A case of a 1970s methadone clinic is presented within the context of a theory of family dynamics which includes a "perverse triangle." The study of the clinic, its clients, and their families reveals a number of pervasive conflicts and covert coalitions. In the clinic, clients and paraprofessionals combine to undercut professionals and limit the effects of any meaningful treatment. Nontherapeutic alliances, first experienced in the family of the addict, are replicated not only in the clinic but in the treatment system as a whole. The effects of these pathogenic relationships, at any organizational level, are to inhibit the maturation of the addict.