Douglas S. Lipton

The Validity of Methadone Clients' Self-Reported Drug Use

Drug use self-reports were compared with urinalysis for 248 clients in four methadone treatment programs. The validity of self-reporting based on urinalysis as a criterion depended on the type of drug examined. Opiate reporting was least valid, while benzodiazepine and cocaine reporting were moderately and highly valid, respectively. EMIT urinalysis was far more useful as a criterion of validity than TLC urinalysis. Self-reports helped identify drug users who were missed by urinalysis because of the latters limited detection period, but urinalysis in turn detected an equal number of drug users missed by the interviews. The age of clients and the type of interviewer directly affected the rate of underreporting. Some respondents systematically denied disvalued behaviors (i.e., drug use and criminality), leading to a spurious correlation between these behaviors. This has important implications for future research.

Patterns of Cocaine Use among Methadone Clients

This paper presents data on cocaine use and its consequences among 368 methadone-maintained clients. Data come from the Tristate Ethnographic Project (TRISEP), a study of methadone maintenance at four treatment programs in three states. Cocaine is a part of the drug use and social life of clients in methadone treatment; it is found not only among a handful of deviant clients but also among one-fifth of clients otherwise compliant with program rules. Cocaine is reported to be a high-status drug among clients, but one with potentially dangerous consequences. Cocaine is associated with increased criminal activity and exposure to violence and the addict life-style. It is reported to be a substitute high, an economic drain on the client user, and a possible route back into the life-style of addiction. Cocaine use, and the consequences stemming from that use, may affect the success or failure of treatment and, therefore, is of critical importance to the treatment community.

Contingency contracting with polydrug-abusing methadone patients

The study assessed the effects of contingency contracting for medication take-home privileges on the polydrug use of methadone patients. Comparisons were made among 20 patients using cocaine, 13 using other illicit drugs, and seven exhibiting other noncompliant behavior. A within-subjects reversal design showed that there was no overall difference in the percentage of positive urines between the pre-contingency and contingency periods, nor between the pre- and post-contingency periods. During the first contingency month, however, one group of patients eliminated drug use, while the remaining had an increased percentage of positive urines. This increase may have been due to the heightened urinalysis regimen during the contingency period rather than to more actual drug use. During the first month, drug-related contracts not involving cocaine were more successful than those targeting cocaine, and non-drug-related contracts were more successful than drug-related ones. The study concluded that contracting had a favorable, though transient, effect primarily on non-cocaine-abusing methadone patients. Further research using stronger or multiple reinforcers is indicated.

Patterns of Criminal Activity among Methadone Clients and Current Narcotics Users Not in Treatment

Much prior research has looked at the changes in criminal activity of narcotics addicts when they enter methadone maintenance treatment programs. Because of the special nature of methadone, a drug which produces a cross-tolerance to other opiates in the user making continued heroin use difficult, the methadone treatment population has also been examined for answers to basic questions about the relationship between drug use and crime. This paper draws on interviews and ethnographic data collection with 368 methadone maintenance clients and 142 narcotics users not currently in treatment to explore the relationship between drug use and criminal activity. Results indicate that methadone clients are not only less involved in criminal activity than users not in treatment, but also among those clients who do continue criminal activity, there is less involvement in more serious crimes such as robbery, burglary, or dealing heroin and cocaine. The differences between those in treatment and those not in treatment are not a function of a lower level or criminal activity prior to treatment, but relate to being in treatment. Methadone clients who continue to commit crime are either clients continuing to use heroin and/or cocaine or clients for whom crime is an income or an income supplement.

Cocaine Use and Help-Seeking among Methadone Patients

To better understand the causes of cocaine abuse among methadone patients, the research compared 207 current cocaine users with 78 currently cocaine-free patients. A majority of both samples were using cocaine at the time of program admission. Although most users ceased or decreased cocaine use after entry, for some this respite was only temporary. Pleasure, stimulation, stress relief and self-medication for depression were the main factors precipitating cocaine use. Most of the current cocaine users held distinctly negative attitudes toward cocaine and were seeking help for their problem. The study makes several recommendations for improved services for cocaine-abusing patients.

Program accreditation and correctional treatment

In the correctional field, treatment program accreditation requires the support of correctional administrators and program providers for successful introduction. How accreditation criteria are developed and a support structure for the process in corrections is achieved is in itself an interesting story. Her Majestys Prison Service has, in 3.5 years, accelerated the effectiveness of correctional treatment programming, established a platform for program integrity, obtained acceptance by the institutional leadership, and increased pride and morale among prison officers. In this article we describe the development, structure, content, and benefits of correctional treatment program accreditation as it has occurred in England and Wales.

The Development and Validation of a Heroin Addiction Scale with the MMPI

A 57 item Heroin (He) scale was developed by comparing MMP1 responses of 63 incarcerated, adult, male heroin addicts (HAs) and 56 similar non-addicts (NAs). In a cross-validation study with 160 HAs and 160 NAs the He scale correctly identified 83% of the former and 81% of the latter. In a second validation study the He scale correctly identified 81% of the 63 adolescent HAs and 70% of 56 adolescent NAs. A limited follow-up of 10 Caucasian adolescent NAs of the latter group indicated that 4 of 6 who had been “incorrectly identified” as HAs by the He scale had begun using heroin, while none of 4 correctly identified NAs contacted had begun using heroin. Analyses of variance indicated that addiction status and ethnicity had significant effects on He scores (P <.01). Further research is suggested to determine the predictive validity of the He scale.

An Instant Shot of “Aah”: Cocaine Use Among Methadone Clients

†This research was supported by a grant from the National Institute on Drug Abuse (1 H81 DA 02300-01) to Narcotic and Drug Research, Inc., New York, and the Division of Substance Abuse Services, New York State. Opinions expressed in this article do not necessarily reflect the policy of NIDA or the Division of Substance Abuse Services.

Outcomes of an AIDS Prevention Program for Methadone Patients

Methadone maintenance patients are at risk of contracting or transmitting HIV through intravenous drug use and/or unsafe sexual practices. An outcome evaluation of a voluntary AIDS prevention program for methadone patients in three clinics (two experimental, one control) is reported. The prevention program included three components: didactic AIDS education, HIV antibody counseling/testing, and facilitated peer support groups. Participation in AIDS education was associated with increased knowledge of AIDS risks and with improved attitudes toward condoms. Peer group participation was associated with improved attitudes toward the use of condoms and with increased use of condoms. Learning of HIV seronegativity was related to increased self-efficacy and decreased intravenous drug use risk behaviors. Rates of participation in the prevention program were disappointing, but the program seemed beneficial for those patients who did become involved.

Methadone Diversion: A New Look

This paper examines the nature and extent of methadone diversion, drawing on interviews and ethnographic data collection with methadone maintenance clients and current narcotics users not in treatment. We explore the social as well as the economic role of diversion in the drug world and find that it is a more complex phenomenon than the simple monetary transaction it is often portrayed to be. Our data indicate that selling or sharing of methadone by methadone clients, though still uncommon, is the primary source of street methadone. We find that removal of take-home dosages from the client population would have deleterious effects on retaining in treatment many otherwise compliant clients and would have minimal effect on diversion. A flexible and differentiated approach might help to reduce diversion while a singular, punitive administrative approach is unlikely to do more than simply contain the situation on the surface and drive it underground.