The Psychiatrically Severe Drug Abuse Patient: Methadone Maintenance or Therapeutic Community?

Abstract

The present research was conducted to examine the effects of pretreatment psychiatric status and treatment duration on improvement following drug abuse rehabilitation. Percent improvement from admission to 6-month follow-up was measured on three criteria: drug use, employment, and criminality. Analyses of the total samples in both the Therapeutic Community (TC) and Methadone Maintenance (MM) programs indicated some quantitative differences between the two modalities but all measures showed a strong and positive relation between treatment duration and percent improvement. When patients in the two program samples were divided, on the basis of admission psychiatric status, into LOW, MID, and HIGH severity groups, different findings emerged. LOW severity patients in both programs showed the greatest absolute levels of improvement in most measures, more improvement at shorter treatment durations, and less additional improvement at longer treatment durations. MID severity patients in both programs showed the most dramatic effects of treatment duration, with generally large improvements in all criteria at greater treatment lengths. Qualitatively different results were seen between the treatment programs for the HIGH severity patients. HIGH severity MM patients showed low absolute levels of improvement but longer treatment durations were associated with modest improvements. HIGH severity TC patients also showed low absolute levels of improvement but unlike any other group, greater lengths of treatment were associated with negative change (worsened status) across all measures. The authors discuss these results with regard to the general efficacy of drug-dependence treatment and the specific issue of the psychiatrically impaired drug abusers.

Depression among heroin users: 12-Month outcomes from the Australian Treatment Outcome Study (ATOS)

“…Those with depression at 12 months had spent an average of 50 fewer days in treatment for heroin dependence than those without depression. This is consistent with the general observation that a longer treatment duration corresponds to more favorable treatment outcomes, whether it be for drug use the programs were designed to treat or for more peripheral outcomes such as criminality and employment Gossop et al, 1999;Hubbard et al, 1997;McLellan et al, 1984;Simpson, 1981). More specifically, lower levels of depression have been shown to accompany longer stays in treatment (DeLeon et al, 1973;Rounsaville et al, 1982).…”

“…Longer treatment durations have consistently been associated with more favorable treatment outcomes in terms of drug use, criminality, and employment Gossop, Marsden, Stewart, & Treacy, 1999;Hubbard, Craddock, Flynn, Anderson, & Etheridge, 1997;McLellan, Childress, Griffith, & Woody, 1984;Sanchez-Carbonell, Cami, & Brigos, 1988;Simpson, 1981). In contrast, individuals who have undertaken more treatment episodes (reflecting less treatment stability) tend to demonstrate poorer treatment outcome (Anglin, Hser, & Grella, 1997;Darke et al, 2005;Gossop et al, 1999;Hser, Grella, Hseih, Anglin, & Brown, 1999).…”

Predicting Methadone Maintenance Treatment Outcomes Using the Addiction Severity Index and the MMPI‐2 Content Scales (Negative Treatment Indicators and Cynism Scales)

“…This domain also entered into the regression equation predicting counseling attendance (or lack thereof). These results are consistent with previous studies that demonstrated that patients rated high in psychological/psychiatric severity levels show poorer treatment outcomes than patients rated lower on this dimension (31,32).…”

The association of early risk factors to opiate addiction and psychological adjustment

“…In addition to their manifestation of addiction, adult opiate addicts are disproportionately more likely than never-addicted persons to experience serious mental health problems and personality disorders (Anglin & Hser, 1990;Khantzian & Treece, 1985;Kosten et al, 1985;McLellan et al, 1983McLellan et al, , 1984. It has been found that addicts with severe psychological problems tend to have less favourable drug abuse treatment outcomes than addicts who do not exhibit such problems (McLellan et al, 1983(McLellan et al, , 1984, and are more likely to relapse to opiate drug addiction and criminal activity following treatment (Nurco et al, 1994). Finally, there is evidence that within the United States, white opiate addicts tend to manifest significantly higher levels of psychopathology than addicts from other ethnic groups (Kosten et al, 1985;Shaffer et al, 1982Shaffer et al, , 1988.…”