Methadone patients in the therapeutic community: A test of equivalency

Abstract

Background Residential therapeutic communities (TCs) have demonstrated effectiveness, yet for the most part they adhere to a drug-free ideology that is incompatible with the use of methadone. This study used equivalency testing to explore the consequences of admitting opioid-dependent clients currently on methadone maintenance treatment (MMT) into a TC. Methods: The study compared 24-month outcomes between 125 MMT patients and 106 opioid-dependent drug free clients with similar psychiatric history, criminal justice pressure and expected length of stay who were all enrolled in a TC. Statistical equivalence was expected between groups on retention in the TC and illicit opioid use. Secondary hypotheses posited statistical equivalence in the use of stimulants, benzodiazepines, and alcohol, as well as in HIV risk behaviors. Results Mean number of days in treatment was statistically equivalent for the two groups (166.5 for the MMT group and 180.2 for the comparison group). At each assessment, the proportion of the MMT group testing positive for illicit opioids was indistinguishable from the proportion in the comparison group. The equivalence found for illicit opioid use was also found for stimulant and alcohol use. The groups were statistically equivalent for benzodiazepine use at all assessments except at 24 months where 7% of the MMT group and none in the comparison group tested positive. Regarding injection- and sex-risk behaviors the groups were equivalent at all observation points. Conclusions Methadone patients fared as well as other opioid users in TC treatment. These findings provide additional evidence that TCs can be successfully modified to accommodate MMT patients.

Residential Treatment Modifications: Adjunctive Services to Accommodate Clients on Methadone

“…Participants receiving methadone had higher ASI drug use severity scores than those not receiving methadone [t (228) = −3.88, p < .001; M = .25 vs. M = .17]. While most participants (84%) had completed TC treatment by the end of month 12, some participants remained in treatment modalities that were part of the TC, such as outpatient treatment (9). Additionally, retention in treatment was statistically equivalent between the methadone and non-methadone groups, with a mean number of 166.5 days in treatment for the methadone group and a mean of 180.2 days in treatment for the non-methadone group (9).…”

“…Details on the main outcomes study can be found elsewhere (9). For the purposes of this report, we report on interview data gathered at baseline and on service utilization data received from providers for 12 months after admission.…”

Congress 60: An Addiction Recovery Community within the Islamic Republic of Iran

“…This raises the question of whether combining or sequencing potent ingredients of ABT and MAT may produce outcomes superior to either used in isolation. Studies that have attempted Downloaded by [New York University] at 03:09 21 July 2015 such combinations, including combining methadone maintenance with varied levels of counseling or psychotherapy (Gruber, Delucchi, Kielestein, & Batiki, 2008;McLellan, Woody, Luborsky, & Goehl, 1988;Schwartz, Kelly, O'Grady, Gandhi, & Jaffe, 2011), ancillary social services (McLellan et al, 1998), recovery mutual aid participation (White et al, 2014), or concurrent treatment in a therapeutic community (De Leon et al, 1995;Sorensen et al, 2009), have produced promising but mixed results. Such studies need to be continued using different combinations of pharmacotherapy and psychosocial recovery support in different cultural contexts.…”

Access to Care for Methadone Maintenance Patients in the United States

“…Cherry (2008) points out that philosophical differences can so deeply divide mental health and addiction services that it is impractical to integrate them. While further research is needed on this topic, Sorensen et al (2009) recently completed a trial that found similar outcomes of residential treatment for matched MMT and non-MMT patients. In the trial, MMT patients were found to have residential treatment and substance abuse outcomes that were no different than their non-MMT counterparts, painting an optimistic picture of the possibility of equal access to residential care for MMT patients.…”

“…Greenberg, Hall, & Sorensen (2007) point out that there was similar ideological contention years ago, when psychiatric medications were first being utilized in addiction treatment centers, but now psychiatric medications are seen as the standard of care for patients with co-occurring disorders. In addition, at least two published articles have demonstrated that the potential barriers to integration of MMT and residential treatment can be successfully overcome with appropriate staff training and collaboration between sites (Zweben et al, 1999, Sorensen et al, 2009). …”