Academic journal article Journal of Drug Issues

Changes in the Number of Methadone Maintenance Slots as Measures of "Fighting Back" Program Effectiveness

Academic journal article Journal of Drug Issues

Changes in the Number of Methadone Maintenance Slots as Measures of "Fighting Back" Program Effectiveness

Article excerpt

This study examined trends in the number of available methadone maintenance treatment (MMT) slots to evaluate a community-based drug prevention program. In the 1990s, the "Fighting Back" (FB) initiative sought to reduce substance use and harm through community-based coalitions in 14 sites across the U.S. Nine state agencies provided MMT data for 28 FB and control communities for a 10-year period prior to and during the program. Opioid use data from a general population survey conducted in the same communities by the national evaluation team were also examined. Counter to expectation, implementation of the FB program was associated with significantly less expansion of MMT slots when compared to control communities. This trend was not attributable to opioid use in those communities, which did not change during the same period. The implication of the findings as well as the historical context of methadone maintenance treatment since the 1990s is also discussed.

INTRODUCTION

The "Fighting Back" (FB) initiative, sponsored by the Robert Wood Johnson Foundation (RWJF) in the late 1980s, developed a plan for community-based coalitions as a central approach toward reducing the demand for and abuse of alcohol and other drugs (AOD), and the harm arising from their use (Saxe et al., 1997). The intervention could involve consolidation of existing community alcohol and drug treatment and prevention efforts as well as the development of new community-based activities to address the harmful impact of drug use (Jellinek & Hearn, 1991). After a national competition, 14 communities were awarded planning funding for two years and subsequent program funding for at least five and as many as nine years. FB took different forms within each community, depending on what a community coalition felt would be most useful and ranging from a program housed in local government to a United Way agency to a grassroots community organization. Approaches to the reduction of illicit substance use and abuse varied among FB communities, including citizen empowerment, criminal justice emphases, neighborhood revitalization, and different treatment models.

As part of the CUNY Graduate Center-Brandeis University evaluation of FB, we conducted a study of changes in the extent to which methadone maintenance treatment (MMT) was used by FB communities. This study was one way of evaluating the community's response to treatment needs and what it felt to be important in dealing with its drug abuse problem. At its outset, each community was free to give as much or as little attention to treatment as it wished, in implementation of the FB program. The community could use any forms of treatment that were believed to enable the community to achieve its goals.

As originally formulated in the 1960s at Rockefeller University, MMT was to be part of a broader treatment approach that included psychosocial and vocational support (Ball & Ross, 1991; Dole & Nyswander, 1965). Nationally, the incidence of heroin use as well as the drug's quality have increased since the FB program began. Although there was a concurrent increase in the number of MMT programs in the U.S. (from 586 in 1988 to 871 in 1998), estimates suggest that only around 20% of opioid addicts are in treatment (Office of National Drug Control Policy [ONDCP], 2000).

Among those providing substance abuse treatment, MMT has very strong associations: it represents a medical model approach to addictions, which may be at odds with abstinence or similar treatment approaches or which presume drug use to be the outcome of a moral or psychological deficit (Mavis, DeVoss, & Stoffelmayr, 1991 ; Winick, 2001 ). Although MMT is consistent with a harm reduction approach condoned by the Office of National Drug Control Policy (ONDCP, 2000), support is weak. Forman and colleagues (Forman, Bovasso, & Woody, 2001) found treatment professionals were less enthusiastic about MMT than other medical approaches such as Naltrexone or other psychiatric drugs. …

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