Retention In Methadone Treatment Research Articles

Predictors of Linkage to an Opioid Treatment Program and Methadone Treatment Retention following Hospital Discharge in a Safety-Net Setting

Background: Methadone is increasingly initiated during hospitalization for the treatment of opioid use disorder (OUD). However, little is known about which factors are associated with linkage to opioid treatment programs (OTP) and retention in methadone maintenance therapy (MMT) following hospital discharge. Materials & Methods: This is a retrospective study of adults with OUD hospitalized in an urban, safety-net hospital referred by inpatient clinicians to an onsite OTP for post-discharge MMT follow-up from October 2017 to July 2019. We used multivariable modified Poisson regression models to generate adjusted risk ratios (aRR) for associations of sociodemographic factors, mental health disorders, alcohol use, stimulant use, and prior care engagement with post-discharge OTP enrollment and MMT retention at 30 and 90-days. Results: Of the 125 patients referred, 40% enrolled in the OTP post-discharge. Among enrollees, 74% were retained at 30-days and 52% were retained at 90-days. Patients with co-occurring stimulant use were less likely to enroll in the OTP post-discharge compared to those without stimulant use (aRR 0.65, 95% CI 0.44–0.97). We found no associations with 30-day MMT retention, but patients who reported stable housing were more likely to be retained in MMT at 90-days compared to those without stable housing (aRR 1.66, 95% CI 1.03–2.66). Conclusion: Our findings suggest that hospitalized patients with co-occurring stimulant use may need additional support to optimize post-discharge OTP linkage. Stable housing may improve retention in MMT. Additional research is needed to identify trends in MMT engagement among those referred from the acute hospital setting.

Adapting a Behavioral Activation Intervention for Opioid Use Disorder and Methadone Treatment Retention for Peer Delivery in a Low-Resource Setting: A Case Series

While methadone treatment (MT) is effective in treating opioid use disorder (OUD), retention remains an issue nationwide, especially among low-income, minoritized populations. Peer recovery specialists (PRSs), individuals with lived substance use experience, are particularly well suited to support vulnerable populations, though often are not trained in delivering evidence-based interventions. Thus, our team developed a Type 1 hybrid effectiveness-implementation open-label pilot trial to evaluate the effectiveness of PRS-delivered BA (Peer Activate) in improving MT retention and establish feasibility, acceptability and PRS fidelity of the intervention. In this case series, we provide a more in-depth depiction of the adaption of Peer Activate and present three cases to illustrate how Peer Activate can be implemented among patients in routine MT care and adapted to meet the needs of varying clinical presentations. We include descriptive data on participant substance use and MT outcomes to supplement the narrative discussion. While varying participant presentations and needs presented challenges to the PRS interventionist, the PRS utilized his shared, lived substance use and recovery experiences and met participants where they were at, as well as successfully used BA techniques, ultimately leading to intervention success.

“Sometimes you have to take the person and show them how”: adapting behavioral activation for peer recovery specialist-delivery to improve methadone treatment retention

BackgroundDespite efficacy of medication for opioid use disorder, low-income, ethno-racial minoritized populations often experience poor opioid use disorder treatment outcomes. Peer recovery specialists, individuals with lived experience of substance use and recovery, are well-positioned to engage hard-to-reach patients in treatment for opioid use disorder. Traditionally, peer recovery specialists have focused on bridging to care rather than delivering interventions. This study builds on research in other low-resource contexts that has explored peer delivery of evidence-based interventions, such as behavioral activation, to expand access to care.MethodsWe sought feedback on the feasibility and acceptability of a peer recovery specialist-delivered behavioral activation intervention supporting retention in methadone treatment by increasing positive reinforcement. We recruited patients and staff at a community-based methadone treatment center and peer recovery specialist working across Baltimore City, Maryland, USA. Semi-structured interviews and focus groups inquired about the feasibility and acceptability of behavioral activation, recommendations for adaptation, and acceptability of working with a peer alongside methadone treatment.ResultsParticipants (N = 32) shared that peer recovery specialist-delivered behavioral activation could be feasible and acceptable with adaptations. They described common challenges associated with unstructured time, for which behavioral activation could be particularly relevant. Participants provided examples of how a peer-delivered intervention could fit well in the context of methadone treatment, emphasizing the importance of flexibility and specific peer qualities.ConclusionsImproving medication for opioid use disorder outcomes is a national priority that must be met with cost-effective, sustainable strategies to support individuals in treatment. Findings will guide adaptation of a peer recovery specialist-delivered behavioral activation intervention to improve methadone treatment retention for underserved, ethno-racial minoritized individuals living with opioid use disorder.

Peer recovery specialist-delivered, behavioral activation intervention to improve retention in methadone treatment: Results from an open-label, Type 1 hybrid effectiveness-implementation pilot trial.

Despite the efficacy of methadone to treat opioid use disorder (OUD), retention is an urgent priority, particularly among low-income, minoritized populations. Peer recovery specialists are well-positioned to engage vulnerable patients, particularly when trained in an evidence-based intervention to promote retention. This hybrid effectiveness-implementation pilot trial aimed to demonstrate the proof of concept of a peer recovery specialist-delivered behavioral activation and problem solving-based approach (Peer Activate) to improve methadone retention. Implementation outcomes included feasibility, acceptability, and fidelity. Feasibility and acceptability were defined by the percentage of participants who initiated the intervention (≥75%) and completed ≥75% of core sessions, respectively. Fidelity was assessed via independent rating of a randomly selected 20% of sessions. The primary effectiveness outcome was methadone retention at three-months post-intervention vs. a comparison cohort initiating methadone during the same time period. Secondary outcomes included methadone adherence, substance use frequency, and substance use-related problems. Benchmarks for feasibility and acceptability were surpassed: 86.5% (32/37) initiated the intervention, and 81.3% of participants who initiated attended ≥75% of core sessions. The mean independent rater fidelity score was 87.9%, indicating high peer fidelity. For effectiveness outcomes, 88.6% of participants in Peer Activate were retained in methadone treatment at three-months post-intervention-28.9% higher than individuals initiating methadone treatment alone in the same time period [χ2(1) = 10.10, p=0.001]. Among Peer Activate participants, urine-verified methadone adherence reached 97% at post-intervention, and there was a significant reduction in substance use frequency from 48% of past two-week days used at baseline to 31.9% at post-intervention [t(25)=1.82, p=.041]. Among participants who completed the core Peer Activate sessions (n=26), there was a significant reduction in substance use-related problems [t(21)=1.84, p=0.040]. Given the rapid scale-up of peer recovery specialist programs nationwide and the urgent need to promote methadone retention, these results, although preliminary, have important potential clinical significance. The next steps are to conduct a Type 1 hybrid effectiveness-implementation randomized trial with a larger sample size and longer-term follow-up to further establish the implementation and effectiveness of the Peer Activate approach.

Comprehensive analysis of discharge reasons from methadone outpatient treatment programs.

Methadone treatment (MT) for opioid use disorder is only available in opioid treatment programs (OTPs) in the United States, with retention predictive of positive health outcomes. OTP discharge reason information is needed to develop interventions for facilitating MT retention. We sought to identify discharge reason frequencies and associations between discharge reasons and facility/county-level characteristics. We examined annual OTP discharge reasons for all Florida OTPs from 2014 to 2017 (n = 44,774 discharges). We used multinomial logistic regression analysis to examine associations between patients' discharge reasons and (1) facility-level characteristics (e.g., size, funding type) and (2) county-level characteristics (e.g., race/ethnicity, overdose rates). Lost contact was the most common discharge reason (29%). Only 11% of patients were discharged for treatment completion, with the proportion one-third as low in privately versus publicly-funded OTPs (p < .001). Privately-funded OTPs had a patient share self-terminating treatment against medical advice about 3.5 times higher than publicly-funded OTPs. Inability to pay accounted for 7% of OTP discharges. Noncompliant discharges represented 6% and were more common in counties with larger proportions of Black residents (p < .01). Counties with higher drug overdose rates had significantly more discharges for noncompliance or self-terminating against medical advice (p < .01 and p < .05). Statewide differences in discharge reasons exist between publicly and privately-funded OTPs, possibly reflecting differences in funding incentives and state oversight. State agencies should develop consistent approaches for collecting/reporting discharge reasons. Our study is the first to examine the relationship between OTP funding type and discharge reasons.

Cumulative barriers to retention in methadone treatment among adults from rural and small urban communities

BackgroundThough methadone has been shown to effectively treat opioid use disorder, many barriers prevent individuals from accessing and maintaining treatment. Barriers are prevalent in less populated areas where treatment options are limited. This study examines barriers to retention in methadone treatment in a small Midwest community and identifies factors associated with greater endorsement of barriers.MethodsPatients at an opioid treatment program (N = 267) were recruited to complete a computer-based survey onsite. Surveys assessed demographics, opioid misuse, depression and anxiety symptoms, trauma history and symptoms, social support, and barriers to retention in treatment (e.g., childcare, work, housing, transportation, legal obligations, cost, health). Descriptive statistics were used to examine individual barriers and multiple regression was calculated to identify demographic and psychosocial factors associated with greater cumulative barriers.ResultsMost participants reported at least one barrier to retention in treatment and more than half reported multiple barriers. Travel hardships and work conflicts were the most highly endorsed barriers. Past year return to use (B = 2.31, p = 0.004) and more severe mental health symptomology (B = 0.20, p = 0.038) were associated with greater cumulative barriers. Greater levels of social support were associated with fewer barriers (B = − 0.23, p < 0.001).ConclusionThis study adds to the limited research on barriers to retention in methadone treatment among patients in rural and small urban communities. Findings suggest flexible regulations for dispensing methadone, co-location or care coordination, and family or peer support programs may further reduce opioid use and related harms in small communities. Individuals with past year return to use reported a greater number of barriers, highlighting the time following return to use as critical for wraparound services and support. Those with co-occurring mental health issues may be vulnerable to poor treatment outcomes, as evidenced by greater endorsement of barriers. As social support emerged as a protective factor, efforts to strengthen informal support networks should be explored as adjunctive services to methadone treatment.

Retention in opioid agonist treatment: a rapid review and meta-analysis comparing observational studies and randomized controlled trials

BackgroundAlthough oral opioid agonist therapies (OATs), buprenorphine and methadone, are effective first-line treatments, OAT remains largely underutilized due to low retention rates and wide variation across programs. This rapid review therefore sought to summarize the retention rates reported by randomized controlled trials (RCTs) and controlled observational study designs that compared methadone to buprenorphine (or buprenorphine-naloxone).MethodsWe searched four electronic databases (EMBASE, MEDLINE, Cochrane Central Register of Controlled Trials, CINAHL, up to April 2018) for RCTs and controlled observational studies that compared oral fixed-dose methadone to buprenorphine versus methadone (or buprenorphine-naloxone). Data were extracted separately for two different definitions of retention in treatment: (1) length of time retained in the study and (2) presence on the final day of a study. Separate random effects meta-analyses were performed for RCTs and controlled observational studies. Data from controlled observational studies where retention was measured as the length of time retained in the study were not amenable to meta-analysis.ResultsAmong 7603 studies reviewed, 10 RCTs and 3 observational studies met inclusion criteria (n = 5065) and compared fixed-dose oral buprenorphine with methadone. Across studies, the average retention rate was highly variable (RCTs: buprenorphine 20.0–82.5% and methadone 30.7–83.8%; observational studies: buprenorphine 20.2–78.3% and methadone 48.3–74.8%). For time period retained in the study, we observed no significant difference in treatment retention for buprenorphine versus methadone in RCTs (standardized mean difference [SMD] = − 0.07; 95% CI − 0.35–0.21, p = 0.63; quality of evidence: low). For presence on the final study day, we observed no significant difference between buprenorphine and methadone treatment retention in RCTs (risk ratio [RR] = 0.89; 95% CI 0.73–1.08, p = 0.24; quality of evidence: low) and controlled observational studies (RR = 0.75; 95% CI 0.36–1.58, p = 0.45).ConclusionMeta-analysis of existing RCTs suggests retention in oral fixed-dose opioid agonist therapy with methadone appears to be generally equal to buprenorphine (or buprenorphine-naloxone), with wide variation across studies. Similarly, a meta-analysis of three controlled observational studies indicated no difference in treatment retention although there was significant heterogeneity among the included studies. The length of follow-up did not appear to affect the retention rate.Systematic review registrationPROSPERO CRD42018104452.

Evaluating the Impact of Prescribed Versus Nonprescribed Benzodiazepine Use in Methadone Maintenance Therapy: Results From a Population-based Retrospective Cohort Study.

Objectives:Benzodiazepine (BZD) use is common in patients who are engaged in methadone as a treatment for opioid use disorder. BZD prescribing is generally discouraged for this patient population due to the increased risk of BZD dependence and BZD use disorder, medication-assisted treatment (MAT) discontinuation, and opioid-overdose death. However, some patients have concurrent mental health disorders, where BZD use may be clinically indicated. This study evaluates the impact of prescribed BZD on MAT outcomes.Methods:Linking urine drug screening data (UDS) and prescribing information from single-payer health records, we conducted a retrospective Kaplan–Meier analysis between patients using prescribed and nonprescribed BZD with methadone treatment retention as the primary outcome. Data are from a network of 52 outpatient clinics in Ontario, Canada, between January 1, 2006 and June 30, 2013.Results:We identified 3692 patients initiating methadone-assisted treatment for the first time; 76% were BZD−/UDS− (no BZD prescription and <30% screens positive for BZD); 13% were BZD+/UDS−; 6% BZD−/UDS+; and 6% BZD+/UDS+. Using 1-year treatment retention as a primary outcome, patients using nonprescribed BZD (BZD−/UDS+) were twice as likely (adjusted odds ratio 0.38, 95% confidence interval 0.27–0.53) to discontinue treatment as those not using BZD (BZD−/UDS−), or those using BZD in a prescribed manner (BZD+/UDS+).Conclusions:Our findings suggest that prescribed BZD can be used during methadone MAT without impacting a patient's retention in MAT, but nonprescribed BZD use is predictive of treatment discontinuation. Importantly, we urge both the physician and patient to seek alternative clinical options to BZD prescribing, due to the potential for developing physical dependence (and BZD use disorder) to BZD and the risks of negative interactions with opioids.

A randomized clinical trial of the Recovery Line among methadone treatment patients with ongoing illicit drug use

BackgroundRelapse, drug use, and treatment dropout are common challenges facing patients receiving methadone. Though effective, multiple barriers to face-to-face counseling exist. The Recovery Line (RL), an automated, self-management system based on Cognitive Behavioral Therapy, is a phone-based adjunctive treatment that provides low cost, consistent delivery and immediate therapeutic availability 24 h a day. MethodsThe current study was a 12-week randomized clinical efficacy trial of treatment-as-usual (TAU) only or RL + TAU for methadone treatment patients with continued illicit drug use (N = 82). Previous small trial phases evaluated methods to increase participant engagement and use of the RL and were incorporated into the current RL version. Primary outcomes were days of self-reported illicit drug abstinence and urine screens negative for illicit drugs. ResultsDays of self-reported illicit drug abstinence improved for patients in RL + TAU but not in TAU. Percent of urine screens negative for illicit drugs, coping skills efficacy, and retention in methadone treatment did not differ by condition. Patients in RL + TAU attended more substance use disorder treatment and self-help group sessions during treatment than those in TAU. RL system use was generally low and more system use was correlated with abstinence outcomes. ConclusionsAlthough the RL did not impact urine screen outcomes, it increases self-reported abstinence. Additional methods to increase patient engagement with automated, self-management systems for substance use disorder are needed.

A National Study of the Retention of Irish Opiate Users in Methadone Substitution Treatment

Background: Retention in treatment is a key indicator of methadone treatment success. The study aims to identify factors that are associated with retention. Objectives: To determine retention in treatment at 12 months for Irish opiate users in methadone substitution treatment and to indicate factors that increase the likelihood of retention. Methods: National cohort study of randomly selected opiate users commencing methadone treatment in 1999, 2001, and 2003 (n = 1269). Results: Sixty-one percent of patients attending methadone treatment remained in continuous treatment for more than 1 year. Retention in treatment at 12 months was associated with age, gender, facility type, and methadone dose. Age and gender were no longer significant when adjusted for other variables in the model. Those who attended a specialist site were twice as likely to leave methadone treatment within 12 months compared with those who attended a primary care physician. The most important predictor of retention in treatment was methadone dose. Those who received <60 mg of methadone were three times more likely to leave treatment. Conclusion: Retention in methadone treatment is high in Ireland in a variety of settings. The main factors influencing retention in methadone treatment was an adequate methadone dose and access to a range of treatment settings including from primary care physicians. Scientific Significance: Providing an adequate dose of methadone during treatment will increase the likelihood of treatment retention. Methadone treatment by the primary care physician is a successful method of retaining opioid users in treatment.

A qualitative study exploring the reason for low dosage of methadone prescribed in the MMT clinics in China

Objectives Dosage of methadone maintenance therapy (MMT) is an important factor influencing retention in methadone treatment. MMT clients in China received lower dosages of methadone compared with those provided in other countries. The objective of this study is to elucidate the reason for the low methadone dosage prescribed in MMT clinics in China. Methods Twenty-eight service providers were recruited from the MMT clinics in Zhejiang and Jiangxi Provinces, China. Qualitative in-depth interviews were conducted to ascertain the procedure for prescribing methadone in the MMT clinics. Results The average dosage prescribed in the 28 clinics was 35 mg/person/day. Four major themes resulting in low dosage of methadone were identified: (1) the service providers fear the liability resulting from large doses of methadone in combination with other substances which might result in overdose fatalities, (2) lack of understanding of harm reduction which resulted in low acceptance of the long term maintenance treatment approach, (3) break-down in communication between clients and service providers about dosage adjustment, and (4) dosage reduction is perceived by most service providers as an effective way to treat the side-effects associated with MMT. Conclusions The findings of the study highlighted the necessity to formulate clear guidelines concerning individualized dosage management and to improve training among service providers’ in MMT clinics in China.

Predictors of Attrition from a National Sample of Methadone Maintenance Patients

Background: Methadone substitution therapy is an effective harm reduction treatment method for opioid dependent persons. Ability to retain patients in methadone treatment is an accepted predictor of treatment outcomes. Objectives: The current study evaluates the roles of psychiatric comorbidity, medical comorbidity, and sociodemographic characteristics as predictors of retention in methadone treatment utilizing retrospective analysis of data from a nationwide sample of patients in methadone treatment in the VA. Methods: Data were gathered using the VA's national health services use database. A cohort of veterans with a new episode of “opiate substitution” in fiscal year 1999 was identified, and their continuous service use was tracked through fiscal year 2002. The sample included a total of 2,363 patients in 23 VA medical centers. Survival analysis was used to explore factors associated with retention in methadone treatment. Results: Younger age, having a serious mental illness, being African American, or having race recorded as unknown were associated with lower rates of retention in methadone treatment programs in this population of veterans (controlling for site). Conclusion: Given that extended methadone treatment is associated with improved outcomes while patients remain in treatment, more longitudinal studies using primary data collection are needed to fully explore factors related to retention. For the VA population specifically, further research is necessary to fully understand the relationship between race/ethnicity and treatment retention. Scientific Significance: This is the first retention study the authors are aware of that utilizes data from a nationwide, multisite, population of participants in methadone treatment.

Methadone in pregnancy: treatment retention and neonatal outcomes

To examine the association between retention in methadone treatment during pregnancy and key neonatal outcomes. Client data from the New South Wales Pharmaceutical Drugs of Addiction System was linked to birth information from the NSW Midwives Data Collection and the NSW Inpatient Statistics Collection from 1992 to 2002. Obstetric and perinatal characteristics of women who were retained continuously on methadone maintenance throughout their pregnancy were compared to those who entered late in their pregnancies (less than 6 months prior to birth) and those whose last treatment episode ended at least 1 year prior to birth. There were 2993 births to women recorded as being on methadone at delivery, increasing from 62 in 1992 to 459 births in 2002. Compared to mothers who were maintained continuously on methadone throughout their pregnancy, those who entered treatment late also presented later to antenatal services, were more likely to arrive at hospital for delivery unbooked, were more often unmarried, indigenous and smoked more heavily. A higher proportion of neonates born to late entrants were born at less than 37 weeks gestation and were admitted to special care nursery more often. Continuous methadone treatment during pregnancy is associated with earlier antenatal care and improved neonatal outcomes. Innovative techniques for early engagement in methadone treatment by pregnant heroin using women or those planning to become pregnant should be identified and implemented.

Factors predicting 2-year retention in methadone maintenance treatment for opioid dependence

Factors predicting 2-year retention in methadone maintenance and the impact of repeat treatment episodes on retention are examined. Data ( n=9555 episodes) were drawn from a population-based treatment registry and analyses were performed using episode-weighted data. We estimated a binary logistic regression model with a duration of 730 days or greater as the dependent variable. The odds of remaining in treatment for 730 days or more increase with age and vary by region and provider type, but decrease with increasing number of treatment episodes. In comparison with other studies, these analyses show much higher rates of retention in methadone treatment but suggest that repeat episodes may not be as beneficial as existing research suggests.

Improving treatment engagement and outcomes for cocaine-using methadone patients

A task-based behavioral contingency—the “treatment reinforcement plan” (TRP)—was implemented with cocaine-using methadone patients to increase treatment engagement and retention. Subjects (N=57) were rewarded up to $15 per week in travel/food/entertainment vouchers for the completion of tasks related to their individual treatment needs. Eighteen types of tasks were contracted and completed with varying frequency. The largest categories of tasks were related to therapy attendance (N=272; 58% completed), obtaining public entitlements (N=165; 61% completed), medical/psychiatric appointments (N=155; 70% completed), and obtaining Medicaid (N=96; 54% completed). The highest proportion of tasks completed were related to human immunodeficiency virus (HIV) testing/education (N=19; 100% completed), managing money (N=17, 94% completed), and legal matters (N=16, 88% completed). Successful TRP involvement during months 1–2 predicted longer retention in methadone treatment, greater therapy attendance during months 3–6, and lower proportion of cocaine-positive urines at 6-month follow-up. This research supports recent findings that early treatment engagement is associated with improved therapeutic relationships, increased retention, and reduced cocaine use. Behavioral counseling techniques may be especially helpful in addressing the complex needs of high-risk methadone patients, which in turn may facilitate treatment process and positive outcomes.

Methadone treatment and HIV and hepatitis B and C risk reduction among injectors in the Seattle area.

Drug treatment has the potential to reduce incidence of blood-borne infections by helping injection drug users (IDUs) achieve abstinence or by decreasing the frequency of injection and sharing practices. We studied the associations between retention in methadone treatment and drug use behaviors and incidence of hepatitis B and C in a cohort of IDUs in the Seattle, Washington, area. Data on IDUs entering methadone treatment at four centers in King County, Washington, were collected through face-to-face interviews using a standardized questionnaire at baseline and 12-month follow-up between October 1994 and January 1998. Blood specimens were obtained and tested for human immunodeficiency virus (HIV) and hepatitis B and C. Drug treatment status at follow-up was analyzed in relation to study enrollment characteristics and potential treatment outcomes, including injection risk behaviors, cessation or reduced frequency of injection, and incidence of hepatitis B and C. Of 716 IDUs, 292 (41%) left treatment, 198 (28%) disrupted (left and returned) treatment, and 226 (32%) continued treatment throughout the 1-year follow-up period. Compared to those who left treatment, subjects who disrupted or continued were less likely to inject at follow-up (odds ratio [OR] = 0.5, 95% CI 0.3-0.7; and OR = 0.1, 95% CI 0.1-0.2, respectively). Among the 468 (65%) subjects who continued injecting, those who continued treatment injected less frequently, were less likely to pool money to buy drugs (OR = 0.5, 95% CI 0.3-0.8) and inject with used needles (OR = 0.5, 95% CI 0.2-0.8) compared to those who left treatment. Cooker or cotton sharing was not associated with retention in treatment, but hepatitis B incidence was lowest among those who continued treatment. The results of this study suggest drug use risk reduction is more likely to be achieved by those who remain in drug treatment and by those who stop injecting, but that those who drop out and return and those who continue to inject while in treatment may also benefit. This supports the role of consistent drug treatment in an overall harm-reduction strategy.

Pre- and in-treatment predictors of retention in methadone treatment using survival analysis.

To determine the effects of pre- and in-treatment variables on patient retention in methadone treatment. Retrospective longitudinal study of an admission cohort sample for up to 3 years of treatment or until discharge. Six methadone maintenance programs operating 15 clinics in New York City. A sample of 1206 admissions to these clinics during 1989-90. Data were abstracted from patients' medical charts. Time in treatment for up to 3 years was the dependent variable, analyzed as a survival function. Pretreatment variables were: gender, race/ethnicity, age at admission, employment, education, marital status, living arrangements, child care responsibility, criminal justice status, life-time arrests, referral source, age at first heroin use, polydrug use, route of drug administration, mental health status and methadone treatment history. In-treatment variables were: patient problems during treatment, clinic response to patient problems, patient treatment strengths, methadone dosage, heroin use and cocaine use. The estimated median treatment duration was 23 months. Cox proportional hazards modeling determined that two pretreatment variables (older age and no criminal justice involvement) were associated with longer retention in treatment. Among in-treatment variables, constructive clinic responses to patient problems, higher methadone dosage, more patient treatment strengths and less heroin and cocaine use during treatment were associated with longer retention. Events during treatment are crucial for patient retention in methadone treatment. Only two of 16 pretreatment variables, compared with five of six during-treatment variables, had significant effects on length of stay in a multivariate model.

Treatment variables and gender in client retention in methadone treatment

Information from the medical records of 242 clients (144 males and 98 females) treated in a community based methadone maintenance program were analysed for factors influencing the length of stay in treatment, particularly in relation to gender differences. The analyses revealed that the variable of Length of current habit at first admission was the strongest single predictor of retention in treatment overall and was important for both sexes, although not statistically significantly for females. Gender differences emerged for the variables of dose, age and variables concerning criminal behaviour. Other gender differences were found between marital status, use of other drugs and treatment outcome. The results are discussed in terms of service provision for successful methadone maintenance programs.

Drug abuse treatment retention and process effects on follow-up outcomes

After finding that retention in methadone treatment for a year or longer was a highly significant predictor of patient outcomes following discharge, measures of pretreatment motivation and early therapeutic engagement were examined as predictors of program retention. Personal interviews were conducted with a sample of 435 patients 12 months after discharge from three methadone treatment programs. Logistic regression results showed several patient attributes—i.e. over 35, lower injection frequency before admission, and higher motivation for treatment—were each associated with twofold increases in the likelihood of having favorable follow-up outcomes on illicit drug use, alcohol use, and criminal involvement. Patients staying in treatment a year or longer, however, were nearly five times more likely to have better outcomes. Further analyses established that length of treatment stay was predicted by higher patient motivation at intake and early program involvement. The findings suggest that more comprehensive models of patient attributes, therapeutic process, and environmental influences are needed, and that treatment enhancement efforts should focus on such during-treatment measures as interim criteria for improving posttreatment outcomes.

Predictors of Treatment Retention in Enhanced and Standard Methadone Maintenance Treatment for HIV Risk Reduction

Survival analysis was used to determine the predictors of discharge from a methadone maintenance treatment program for heroin addicts at high-risk for HIV infection and/or transmission. A consistent set of predictors was identified that was associated with treatment discharge at 90 days, 12 months, 18 months, and 24 months. Individuals who, at intake, were HIV seropositive, were younger, used cocaine, drank alcohol daily, and scored high on measures of depression and interpersonal problems were at a higher risk for discharge. Receipt of enhanced methadone treatment, which included case management services, group participation, psychiatric services, contingency-based reinforcers, and transportation assistance, was associated with a higher probability of retention, particularly in the first 90 days. These findings can be used to target individuals who are vulnerable to early discharge from treatment and to provide adjunctive services that may improve retention. Several of these predictors, particularly cocaine use and psychological problems, have also been associated with HIV risk among methadone clients. Increasing retention in methadone treatment will not only improve treatment efficacy but will also address the public health imperative to limit the transmission of HIV.