Effectiveness of a Psycho-Social Intervention Aimed at Reducing Attrition at Methadone Maintenance Treatment Clinics: A Propensity Score Matching Analysis.

Xiaoyan Fan,Joseph T.F Lau,Chun Hao,Yuantao Hao,Huifang Xu,Fan Yang,Jinghua Li,Xiao Zhang,Yuteng Zhao,Jing Gu

doi:10.3390/ijerph16224337

Abstract

Methadone maintenance treatment (MMT) is an important approach to address opioid dependence. However, MMT clinics usually report high attrition rates. Our previous randomized controlled trial demonstrated additional psycho-social services delivered by social workers could reduce attrition rates compared to MMT alone. This study aimed to evaluate the effectiveness of psycho-social service in a real-world context. A quasi-experimental design and propensity score matching was adopted. 359 clients were recruited from five MMT clinics in Guangzhou from July 2013 to April 2015. One 20-minute counseling session was offered to the control group after enrolment. The intervention group received six sessions of psycho-social services. The baseline characteristics were unbalanced between two arms in the original sample. After propensity score matching, 248 participants remained in the analysis. At month six, the intervention group had a lower attrition rate [intervention (39.5%) versus control (52.4%), P = 0.041], higher monthly income [monthly income of 1000 CNY or higher: intervention (55.9%) versus control (39.0%), P = 0.028)], higher detoxification intention score [full intention score: intervention (51.6%) versus control (32.5%), P = 0.012)], higher family support in MMT participation [intervention (77.9%) versus control (61.4%), P = 0.049)]. This study demonstrated that psycho-social services delivered by social workers can reduce MMT clients’ attrition and improve their well-being in real-world settings.

Highlights

By the end of 2017, there were 40.48 million people with opioid dependence, accounting for 55% of the total number of people with a drug use disorder globally. [1]
In our previous randomized controlled trial (RCT) of three clinics, we demonstrated that the combination of standard maintenance treatment (MMT) with behavioral theory-based, social worker-delivered psycho-social services effectively reduced the probability of attrition by 18%
After propensity score matching (PSM), 124 matched participants were included in each group

Summary

Introduction

By the end of 2017, there were 40.48 million people with opioid dependence, accounting for 55% of the total number of people with a drug use disorder globally. [1]. By the end of 2017, there were 40.48 million people with opioid dependence, accounting for 55% of the total number of people with a drug use disorder globally. Methadone can alleviate withdrawal symptoms and reduce an addicted individual’s cravings and drug-seeking [3]. Methadone use can reduce criminal activity and improve employment rates and social well-being [7,8]. Despite these advantages, suboptimal retention in MMT programs remains a significant concern worldwide. One meta-analysis including 43,263 Chinese MMT participants reported 1-year retention rate of 55.2% [95% confidence interval (CI): 48.5–61.7%] [15]. Studies conducted in different cities reported retention rates varying from 30.0% in Shanghai at month six to 70.3% in Xi’an at month 12 [16]

Objectives

Methods

Results

Discussion

Conclusion