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New Study of Methadone Treatment Assesses Program Variables

A long-term study on the effectiveness of methadone treatment found that 71 percent of patients had ceased use of intravenous drugs after several years of methadone maintenance treatment, according to John C. Ball and Alan Ross, researchers and authors of The Effectiveness of Methadone Maintenance Treatment. However, this figure varied widely for the individual programs, ranging from a high of 90.2 percent of successful patients in one program to a low of 42.9 percent in another.

Although methadone maintenance treatment was found to be effective for patients who remained in treatment 1 year or more, most patients who left treatment quickly relapsed. Of those who left treatment, 82 percent relapsed to intravenous drug use within 1 year.

The study also found a 79 percent decrease in the number of criminal offenses among patients who remained in treatment for 6 months or longer. There was a direct positive relationship between length of treatment and reduction of criminal behavior—the longer the period of treatment, the lower the level of crime. Because none of the programs studied focused on reducing criminal behavior as a treatment outcome, this was viewed as a positive secondary effect of methadone maintenance treatment.

Research methodology

During the 5-year study period, the authors and their research team collected detailed data on six methadone maintenance treatment programs in three cities in the Northeast—New York City, Philadelphia, and Baltimore. The study focused on the "black box" of drug abuse treatment, collecting comprehensive data about the treatment domain. For each program in the study, the authors collected information about the neighborhood, physical plant, aggregate patient census, treatment and administrative staff, methadone-dispensing practices, counseling and medical services, treatment policies, and administrative procedures and practices. Each of these elements was described, classified, and measured during data analysis. To ascertain the effectiveness of treatments, the researchers obtained detailed information about a sample of 100 or more male patients at each of the programs; this included conducting face-to-face interviews with 633 male patients.

Determinants of treatment success

To determine whether treatment was effective, definite outcome criteria were used. These criteria included: 1) the extent to which patients' drug abuse was reduced or eliminated as a consequence of treatment; and 2) the extent to which criminal behavior was reduced as a result of treatment. In examining drug abuse behavior, the authors set up comparative baseline periods for each patient, consisting of the patient's lifetime preadmission drug abuse, the prevalence of drug abuse during the patient's last addiction period, and the change in the patient's drug abuse during treatment.

In addition to collecting and analyzing outcome data, the authors also demonstrated that multivariate analysis of the treatment domain is a feasible, helpful way of sorting out which variables contribute most to positive patient outcomes. This multivariate analysis showed three sets of variables to be associated with treatment success: patient characteristics, components of the treatment domain, and process variables.

The patient characteristics found to be related to treatment outcome include race, age of onset of heroin use, history of cocaine use, and criminal behavior before admission. However, these patient characteristics had less impact on successful outcome than two other factors: 1) the characteristics of the treatment program; and 2) what happened to the patient after admission.

The programs with higher success rates had the following characteristics:

• A focus on rehabilitation
• An orientation toward long-term maintenance
• High levels of counseling services provided to patients
• Very effective directors

In this study, the programs that delivered more treatment and rehabilitation services had better patient outcomes than programs which happened to have higher staff/patient ratios and better facilities and management—but also provided fewer patient services. In terms of process, the study found an inverse relationship between methadone dose and current use of heroin. Patients maintained on higher doses of methadone were less likely to be current heroin users than those on lower doses.

In accounting for the outcomes used in these analyses, the authors note: "It is concluded that differences among the programs—especially in the care delivered regularly to patients—overshadowed baseline differences among individual patients."