Methadone patients in the therapeutic community: A test of equivalency

• Published in: Drug and alcohol dependence 2009-02, Vol.100 (1), p.100-106
• Main Authors: Sorensen, James L, Andrews, Siara, Delucchi, Kevin L, Greenberg, Brian, Guydish, Joseph, Masson, Carmen L, Shopshire, Michael
• Format: Article
• Language: English
• Subjects: Addictive behaviors; Adult; Adult and adolescent clinical studies; Biological and medical sciences; Drug addiction; Drug dependency; Female; Follow-Up Studies; Humans; Longitudinal Studies; Male; Medical sciences; Methadone; Methadone - therapeutic use; Middle Aged; Opioid dependence; Opioid-Related Disorders - drug therapy; Opioid-Related Disorders - epidemiology; Opioid-Related Disorders - psychology; Opioids; Psychiatry; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Residential treatment; Stimulants; Substance Abuse Treatment Centers - methods; Substance Abuse Treatment Centers - trends; Therapeutic communities; Therapeutic Community; Therapeutic Equivalency
• ISSN: 0376-8716; 1879-0046
• DOI: 10.1016/j.drugalcdep.2008.09.009

Abstract 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.