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This study examines the process of discharge and treatment reentry for six participants who entered treatment voluntarily but were administratively discharged from methadone treatment programs. The participants completed semistructured interviews at treatment entry and at four, eight and 12 months post-treatment entry. Grounded theory methodology was used to examine the phenomenon of treatment reentry from the perspective of the patients, who often viewed their recovery as an accumulation of positive changes. Differences in terms of the patients’ goals and motivations for seeking treatment from those of the treatment programs, combined with difficulties encountered during the treatment process eventually led to discharge. However, these patients were then able to navigate their way through the treatment system in different ways in order to remain in treatment. The authors conclude that failure to abide by treatment clinic rules do not necessary constitute “treatment failure” from the perspective of patients, who often wish to remain in treatment even if it is not progressing optimally from the program’s perspective. As a result, the recovery process can be more fragmented and is often characterized by a series of cyclical treatment episodes rather than continuous time in treatment, thereby impeding their progress towards recovery.

Japanese social order emphasizes a superior's responsibility for their subordinates' well-being. This traditional "right to benevolence" is a wellspring of hope for workers. This paper describes how, in the wake of changes in employment practices since the mid-1970s, citizens' groups and labor lawyers creatively combined advances in medicine and legal knowledge with this right to benevolence in lawsuits seeking compensation for injuries caused by overwork. The social movement against karōshi (death due to overwork) that arose from these suits first sought workers' compensation system reforms. Later, they won legislative remedies. Rulings in Japanese courts, including the Supreme Court, affirmed employers' legal responsibility for worker well-being to include care for accumulated fatigue and mental health. Buoyed by these successes, activists and victims' families hopes of preventing karoshi reached new heights with the June 2014 passage of the Karoshi Prevention Countermeasures Promotion Law (Karōshi tō bōshi taisaku suishin-hō). Karoshi compensation victories, administrative rule changes, and legislative reforms raised public awareness of overwork and exploitative management practices. Nevertheless, we must conclude that, although karoshi legislation gives hope for a legal regime of employee care rights, the current law is weak and remediation only addresses the worst cases. Moreover, participation in the legislative process risks limiting the movement's future influence.

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