Academic journal article Journal of Drug Issues

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

Academic journal article Journal of Drug Issues

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

Article excerpt

Survival analysis was used to determine the predictors of discharge from a methadone maintenance treatment program for heroin addicts at highrisk for HIV infection and/or transmission. A consistent set of predictors was identified that was associated with treatment discharge at 90 days, 12 months, IS 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.

Introduction

Although the American public largely regards methadone treatment with skepticism, if not antagonism, its value as a treatment for opiate addiction is beyond dispute within the scientific community of addiction researchers (Institute of Medicine 1994). WIth the recognition that injection drug use is a predominant mode of transmission of HIV, through the sharing of infected injection equipment, interest in methadone maintenance treatment (MMT) has increased among the medical and public health communities as a drug treatment modality that can be used to reduce HIV risk among injection drug users (IDUs) (Ball et al. 1988; Cooper 1989). Identifying determinants of successful MMT, therefore, is important for improving its efficacy both as a drug treatment modality and as a vehicle for HIV risk reduction.

One of the most widely used outcomes for evaluating MMT is retention (Ball and Ross 1991; Hubbard et al. 1989). The positive benefits of retention in MMT is evident in the reduced mortality rates for addicts in MMT compared to those not in treatment (Caplehorn et al. 1994). Previous research has demonstrated that subject characteristics such as age, sex, ethnicity, level of drug use, employment status, marital status, and legal status are predictors of treatment retention in MMT (Condelli 1993; Hser et al. 1990; Hser et al. 1988; McLellan 1983). Characteristics of MMT programs have also been linked with treatment retention, such as methadone dose (Maddux et al.1993; McGlothlin and Anglin 1981), treatment fees (Maddux et al. 1993), and perceived quality of social services, ease of access, and availability of information on methadone dose level (Condelli 1993).

There is ample evidence that longer time in MMT reduces opiate use (Gottheil et al. 1993; Stark and Campbell 1991; Rounsaville et al. 1987; Joe et al. 1983; Simpson 1981; McGlothlin and Anglin 1981). Although retaining clients in MMT is a goal in and of itself to reduce heroin use, it is also a means to effecting changes across a wide variety of behavioral domains (Fisher and Anglin 1987). Longer time in MMT has been associated with improvements in social, economic, and legal status (Stark and Campbell 1991); with a small increase in rate of employment and earnings 12 months after program departure (French et al. 1991), and with a lower level of involvement in criminal activities (Hser et al. 1988; Kang and De Leon 1993b). Simpson (1981) reported a linear relationship between length of time in MMT (among other modalities) and improvement across several domains; subjects who were in treatment 3 months or less demonstrated significantly lower levels of outcomes, at the same level as subjects in outpatient detoxification or individuals who were admitted but not treated. …

Search by... Author
Show... All Results Primary Sources Peer-reviewed

Oops!

An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.