Methadone patients in the therapeutic community: a test of equivalency.

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.

Outcomes in a Sample of Opiod-Dependent Clients Treated Under California's Proposition 36.

This study evaluated treatment outcomes for the reduction of criminal justice involvement and substance use among opioid dependent clients in a therapeutic community setting under California's Proposition 36. We compared treatment outcomes between those mandated to treatment under Proposition 36 (n = 24) and those on probation but not involved in Proposition 36 (n = 61) over 12 months. Over time, both groups showed significant improvement on drug use and employment measures, were more likely to be involved in job training and less likely to be engaged in work activity, and had similar retention in treatment. There was no evidence that treatment outcomes were different between the two groups. These findings may be helpful in guiding policy makers and clinicians in states where similar initiatives are under consideration.

Knowledge and Attitudes About Methadone Maintenance Among Staff Working in a Therapeutic Community.

Research demonstrates that drug treatment staff members' knowledge and attitudes about methadone are positively correlated with treatment success among opiate-dependent clients. However the bulk of this research is on outpatient treatment in methadone clinics. This study examined a residential treatment program that allowed clients on methadone, a rare treatment opportunity that is growing nationwide. Staff (N = 87) working in four therapeutic community (TC) facilities, were surveyed using the Abstinence Orientation Scale (AOS), Methadone Knowledge Scale (MKS), and Disapproval of Drug Use Scale (DDU). The relationships between TC staff characteristics and scores on the assessment measures were tested for differences. Staff members who affirmed having been in treatment had greater methadone knowledge than those who had not. Staff members who participated in methadone sensitivity training had greater methadone knowledge and lower abstinence orientation than those who did not attend the training. Staff in this study had stronger abstinence orientation than found in studies of methadone clinic staff, which may represent a barrier to methadone in residential settings. This study suggests that staff experience is correlated with attitudes and knowledge about methadone and that staff training is associated with changing attitudes and knowledge about methadone.