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A Look Toward the Future

Editor's Note: We asked Dr. John C. Ball, senior author of The Effectiveness of Methadone Treatment, to comment on the future of methadone maintenance treatment in light of the results of his study (see New Study of Methadone Treatment Assesses Program Variables).

In the 27 years since Drs. Vincent Dole and Marie Nyswander initiated methadone maintenance treatment in New York City, there has been a vast expansion of this modality throughout the United States. Currently, there are more than 700 such programs with a census in excess of 110,000 patients.

Methadone maintenance treatment has been extensively studies and its efficacy established. At the same time, it has recently been found that programs vary greatly in their effectiveness due to diverse treatment policies, staffing patterns, and the quality of services provided. A challenge for the 1990s is to ascertain how programs can be systematically improved. This need for improvement is especially acute in this era of AIDS.

The task of improving programs

The task of improving hundreds of methadone maintenance programs throughout the United STates is formidable. There are a number of reasons why this is so. In many States, the level of funding has not kept pace with inflation or with the increasing complexity of treatment demands. Programs in different cities and States are subject to diverse treatment policies, regulations, and accountability procedures. The history of drug abuse treatment, as well as professional and public attitudes toward methadone maintenance treatment, vary by neighborhood, city, and State. Consequently, the professional, technical, and financial resources available to effect improvement of treatment differ markedly.

To address the increasing needs of drug abuse programs, the Federal Government has allocated new resources and special agencies to promote treatment improvement. Among the initiatives underway at the Office for Treatment Improvement and other agencies are the following: enhancement of medical and psychiatric services for pregnant women and their children; expanded vocational and educational training; aftercare demonstration projects; technical assistance to programs, cities, and States; staff training in numerous areas; and AIDS counseling.

The need for further research

In addition to direct efforts to improve drug abuse treatment programs, there are the following pressing needs:

• To classify, measure, and evaluate program characteristics
  
  
• To ascertain how program variables affect patient outcomes
  
  
• To establish citywide data systems that will make it possible, for the first time, to determine the comparative effectiveness of drug treatment programs

Research and evaluation initiatives to address these needs are currently underway.

During the next decade, methadone maintenance programs face new challenges and continuing hardships. How far treatment improvement efforts will go toward alleviating or solving these problems remains to be seen.

Last Updated May 17, 2001