Predictors of treatment retention in a major methadone maintenance treatment program in Iran: a survival analysis

To identify correlates related to retention time of a cohort study of the opioid-dependent patients participating in the Methadone Maintenance Treatment [MMT] program offered by a major addiction treatment clinic in Tehran, Iran between April 2007 and March 2011. Several parametric Survival models assuming Weibull, Log-normal and Log-logistic distributions were compared to search for association between covariates and risk of relapse and dropping out of treatment among 198 patient participants. According to Akaike Information Criterion [AIC], Log-normal model had the best fitting. Estimates of this model indicated that increase in average methadone dosage was associated with longer retention time. Correlates associated with shorter retention time were suffering from mental disorders, using stimulant drugs, being poly-substance dependents and having prior treatments. Findings of this study provide support for giving more attention to patients who are poly-substance or stimulant-drug dependents, have non-substance psychiatric comorbidity and the ones with addiction treatment history. Independent of patient characteristics, retention improved as the dose of methadone increased

Effectiveness of relapse prevention cognitive- behavioral model in opioid - dependent patients participating in the methadone maintenance treatment in Iran

To evaluate the effectiveness of relapse prevention cognitive-behavioral model, based on Marlatt treatment approach, in Opioid-dependent patients participating in the Methadone Maintenance Treatment [MMT] in Iran. The study consisted of 92 individuals treated with methadone in Iranian National Center of Addiction Studies [INCAS]. Participatns were randomized into two groups: educational intervention group [N=46] and control group [N=46]. The intervention was comprised of 10 weekly 90 minute sessions, done during a period of 2.5 months based on the most high risk situations determined using Inventory Drug Taking Situation instruments. Relapse was defined as not showing up for MMT, drug use for at least 5 continuous days, and a positive urinary morphine test. While, only 36.4% of the intervention group relapsed into drug use, 63.6% of the control group relapsed. The result of the logistic regressions showed that the odd ratio of the variable of intervention program for the entire follow up period was 0.43 [P<0.01]. Further, the odd ratio of this variable in one month, three months, and 195 days after the therapy were 0.48 [P<.03], 0.31 [P<.02], and 0.43 [P<.02] respectively that revealed that on average, the probability of relapse among individuals in the intervention group was lower than patients in control group. Relapse prevention model based on Marlatt treatment approach has an effective role in decreasing relapse rate. This model can be introduced as a complementary therapy in patients treated with methadone maintenance