Randomized trial of standard methadone treatment compared to initiating methadone without counseling: 12-month findings

• Published in: Addiction (Abingdon, England) England), 2012-05, Vol.107 (5), p.943-952
• Main Authors: Schwartz, Robert P., Kelly, Sharon M., O'Grady, Kevin E., Gandhi, Devang, Jaffe, Jerome H.
• Format: Article
• Language: English
• Subjects: Addiction; Addictive behaviors; Adult; Adult and adolescent clinical studies; Ambulatory Care; Arrest; Attrition; Baltimore; Biological and medical sciences; Care and treatment; Clinical trials; Cocaine; Cocaine-Related Disorders - rehabilitation; Counseling; Counseling - methods; Counselling; Crime and criminals; Desintoxication. Drug withdrawal; Drug Abuse; Drug addiction; Drug addicts; Female; Heroin; heroin addiction treatment; Heroin Dependence - rehabilitation; Humans; interim methadone; Male; Maryland; Medical sciences; Medical treatment; Methadone; Methadone - administration & dosage; methadone treatment; Middle Aged; Narcotics - administration & dosage; opiate agonist treatment; opiate dependence; Patient Compliance; Patients; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Substance abuse treatment; Treatment Outcome; Treatment Outcomes; Treatment Programs; Treatments; Trials; U.S.A
• ISSN: 0965-2140; 1360-0443
• DOI: 10.1111/j.1360-0443.2011.03700.x

ABSTRACT Aims  This study aimed to determine the relative effectiveness of 12 months of interim methadone (IM; supervised methadone with emergency counseling only for the first 4 months of treatment), standard methadone treatment (SM; with routine counseling) and restored methadone treatment (RM: routine counseling with smaller case‐loads). Design  A randomized controlled trial was conducted comparing IM, SM and RM treatment. IM lasted for 4 months, after which participants were transferred to SM. Setting  The study was conducted in two methadone treatment programs in Baltimore, MD, USA. Participants  The study included 230 adult methadone patients newly admitted through waiting‐lists. Measurements  We administered the Addiction Severity Index and a supplemental questionnaire at baseline, 4 and 12 months post‐ baseline. Measurements included retention in treatment, self‐reported days of heroin and cocaine use, criminal behavior and arrests and urine tests for heroin and cocaine metabolites. Findings  At 12 months, on an intent‐to‐treat basis, there were no significant differences in retention in treatment among the IM, SM and RM groups (60.6%, 54.8% and 37.0%, respectively). Positive urine tests for the three groups declined significantly from baseline (Ps