Magazine article Clinical Psychiatry News

VA to Enhance Opioid Counseling, Long-Term Maintenance. (Take-Home Privileges)

Magazine article Clinical Psychiatry News

VA to Enhance Opioid Counseling, Long-Term Maintenance. (Take-Home Privileges)

Article excerpt

AMELIA ISLAND, FLA. -- Optimizing treatment outcome through enhanced services and long-term maintenance is the objective of a new Veterans Administration program designed to assist opioid-agonist clinics, Hildi Hagedorn, Ph.D., reported at the annual meeting of the American Academy of Addiction Psychiatry.

Eight Veterans Administration opioid-agonist clinics are voluntarily participating in the program, known as the Opioid Agonist Therapy Effectiveness (OpiATE) Initiative. OpiATE counselors based at the VA Medical Center in Minneapolis have been tasked to help the clinics focus on illicit opioid use and program retention, said Dr. Hagedorn, OpiATE's program director.

The program's objectives, which "are easy to measure and [are] strongly predictive of later outcomes," were inspired by results achieved in two separate earlier studies that looked at various opioid-agonist treatment management approaches, she commented.

The first study, in which the benefits of enhanced counseling and services were successfully demonstrated, compared three levels of psychosocial services for opioid agonist treatment: no counseling, standard counseling, and standard counseling plus enhanced medical and social services. The latter group received additional psychiatric referrals, family therapy, and job counseling. Participants experienced a decreased use of illicit opiates and improved psychosocial and physical functioning (JAMA 269[15]:1953-59, 1993).

"The results were not that surprising," Dr. Hagedorn said. "Patients in the enhanced group had better outcomes than those in the standard counseling group, and the standard group fared better on all outcomes [compared with] the no-counseling group."

Roughly 80% of participants receiving methadone through the enhanced program had good outcomes. Poor outcomes were defined as at least three medical crises or consistent positive urine tests during the 6-month study period. Results showed 69% of the no-counseling group had to be protectively transferred to the counseling group because of poor outcomes.

Overall, standard counseling was the most cost-effective approach used. "It paid for itself in terms of reduced emergency visits," Dr. Hagedorn said. The enhanced services cost a bit more, but patients did better.

The long-term approach is supported by another study in which researchers compared program retention in a 24-month abstinence-oriented program with that of a long-term maintenance program (Int. …

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