The results of a 2-year-study of the relationship between methadone dosage and treatment outcome are reported. For discharged patients, higher doses of methadone were significantly related to successful treatment and lower doses to treatment failure. Based on these findings and the review of literature as well as the senior author's clinical experience, a theoretical formulation is offered to provide a rationale for methadone maintenance treatment. The tenability of the formulation is readily testable by clinical research.

Counselors play a central role in most methadone maintenance programs. Yet the choice of who should be employed as counselors is based on little more than personal whims of decision makers. And in evaluating the effectiveness of this highly controlled rehabilitative therapy, the influence of the counselors as an important factor is often ignored. The total changeover of the counselors from an ex-addict to a nonaddict group in an otherwise stable clinic provided an unusual opportunity to compared the performance of the two groups. Both the objective and subjective data supported the hypothesis that ex-addicts as a group compared unfavorably with a similar group of nonaddicts when employed as counselors in a methadone maintenance clinic.

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This study concentrates on methadone dosage as a critical factor influencirtg abuse of other psychoactive drugs (including alcohol) by patients maintained on methadone. The study population were patients who remained on methadone for at least two years. The effects of dosage levet on a group of 46 patients (tow dosage n=27, x = 48.32; high dosage n = 19, x=S6.43) is reported. Signijicant increases (p <0.0I) were found in the abuse o/6ar6it«Tafes, ataractics, and akoholfoy the low dosage group. Dosage tevel had no significant relationship with heroin and amphetamine abuse. These results suggest that higher doses of methadone may provide the patients with a generalized central nervous system depressive effect.

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