Methadone Patients Fare as Well as Other Patients in Therapeutic Community Treatment for Opioid Dependence

Many therapeutic communities (TCs) adhere to a drug-free philosophy and refuse to admit patients receiving methadone maintenance treatment (MMT). Many drug-treatment professionals also believe MMT patients do less well in treatment. To learn whether MMT and non-MMT patients benefit equally from participation in a TC, researchers compared outcomes in 125 patients receiving MMT and 108 patients not receiving MMT who participated in a 12-month treatment program for opioid dependence. Psychiatric history, criminal justice pressure to undergo treatment, and expected lengths of stay were similar between groups. Interviews and urine testing were conducted at baseline, 6, 12, 18, and 24 months.

• The mean number of days in treatment was similar between groups (166.5 days for the MMT group and 180.2 days for the comparison group).
• At each assessment, the proportion of the MMT group testing positive for illicit opioids was indistinguishable from the proportion testing positive in the comparison group.
• Stimulant and alcohol use, injection, and sex-risk behaviors were similar between the 2 groups.
• Benzodiazepine use was similar between groups for all assessments except at 24 months, where 7% of the MMT group and none of the comparison group tested positive for benzodiazepines.

Comments by Michael Levy, PhD
These results demonstrate that MMT patients in TC treatment do as well as non-MMT patients with opioid dependence. Although members of the TC in this study had the benefit of prior training and experience working with MMT patients, results suggest residential treatment programs should accept MMT patients. Prior staff training and preparation should occur.