Analysis of behavioral patterns in five cohorts of patients retained in methadone maintenance programs.

BACKGROUND: Various techniques have been devised to evaluate the effectiveness of long-term methadone maintenance treatment. Traditional comparative analyses of behavior patterns at the time of admission and discharge would be inappropriate, because the majority of patients leave the programs prematurely and under unfavorable circumstances. One approach has been to collect available data on patients who are actively undergoing methadone treatment. METHODS: The sampling population for this study was limited to methadone maintenance patients in New York State who have remained in treatment for 1-6 years. Samples of active patients were drawn from five time-in-treatment cohorts (1-2 years, 2-3 years, 3-4 years, 4-5 years and 5-6 years). A total of 673 patients were included in the study. RESULTS: All five cohorts experienced significant reductions in the number of patients arrested, the number of patients incarcerated, and the number of days incarcerated per patient. Each cohort also experienced large reductions in arrests per patient and moderate increases in employment-related activities, although current rates of employment are still relatively low. A decreased number of child-protective cases were noted over time for those under treatment, along with higher rates of insurance and self-pay for treatment. The self-pay group, however, remained relatively small. No patterns were detectable in the areas of patient hospitalization or emergency room admissions, although the 5-6 year cohort experienced reductions on all measures. CONCLUSIONS: Some favorable changes in the behavior of patients are associated with long-term methadone treatment.

Selected in-treatment outcomes of long-term methadone maintenance treatment patients in New York State.

The New York State Office of Alcoholism and Substance Abuse Services (OASAS) licenses the largest system of methadone maintenance clinics nationwide. In 1996, a survey was undertaken to evaluate the functioning of patients continuously active in treatment for ten or more years. Information was obtained on a 10% random sample from the OASAS client data system and the records of the clinics. Data were collected concerning methadone dose, illicit drug and problematic alcohol use, employment, criminal activity, health, living situations, and the primary type of payment for treatment. A contrast group was constructed of discharged patients who had no more than 5 years of continuous treatment. The long-term active patients in the study sample showed superior outcomes on all variables, although some of the differences were small. However, the arrest rate for the discharged contrast group was 20 times as large as the arrest rate for the active study sample. These results are consistent with nationwide evaluations of methadone maintenance treatment. Factors that negatively impacted on the adjustments of the active patients were heavy use of crack/cocaine and disabilities. The long-term active patients in this sample belong to distinct subgroups with different levels of functioning, achievement, and ongoing health and social needs that must be investigated and addressed.

Estimating the size of a heroin-using population: an examination of the use of treatment admissions data.

This paper examines the feasibility of using information on treatment admissions to infer the size of a heroin-using population. Several variants of capture-recapture and truncated Poisson models which have been used for this purpose are assessed here, and are generally found to be unsuited to the task at hand. A cohort model is developed which is consistent with the dynamics of drug use and help-seeking behavior, and which would allow estimation of the size of the treatment susceptible or "inbound" population, but its information requirements are difficult to meet. The analysis suggests that capture-recapture and truncated Poisson models should be evaluated in terms of their potential for reformulation and application within the present context, or alternatively, that other methods be developed for this purpose.