Ward S. Condelli

Cocaine use by clients in methadone programs: significance, scope, and behavioral interventions.

Widespread use of cocaine by methadone clients is undermining the effectiveness of methadone treatment programs in reducing illicit drug use, decreasing criminal behavior, and slowing the spread of the human immunodeficiency virus (HIV). In response, methadone programs are implementing a range of behavioral interventions to manage this growing problem. Many of these interventions, however, have yet to be evaluated for effectiveness for reducing cocaine use among methadone clients. Interventions that are effective for cocaine use in the general population may not be as effective with cocaine users in methadone programs because these clients differ from other cocaine users in ways that are likely to affect how they respond to the interventions. This paper reviews the literature on the significance and scope of the problem of cocaine use by methadone clients and on the behavioral interventions that have been evaluated for these clients.

Exposure to Methadone Programs and Heroin Use

The aims of this study were to: (a) assess the effects of various patterns of exposure to methadone programs on heroin use; (b) assess the effects of other patient, program, and treatment variables; and (c) identify variables that promote the type of exposure to methadone programs that is most effective for reducing heroin use. The sample was 526 patients who were admitted from 1979 to 1981 into 17 methadone programs that participated in the Treatment Outcome Prospective Study. The study differs from previous research in that it addresses the time that patients spent in methadone programs during the follow-up period in defining exposure patterns. Heroin use was lowest among patients who were continuously exposed to methadone programs. Retention was highest among patients who attended programs that informed them of their methadone dose levels, were easy to access, and provided them with high quality social services.

Strategies for Increasing Retention in Methadone Programs

Data from the nationwide Treatment Outcome Prospective Study were analyzed to develop strategies for increasing patient retention in methadone programs. The sample comprised 351 daily or weekly heroin users who were admitted to 17 publicly funded methadone programs and completed intake, one month in treatment, and one-year follow-up questionnaires. The analysis suggests three strategies for increasing patient retention: providing more high-quality social services, making programs more easily accessible, and individualizing treatment. The analysis also identifies characteristics of patients and programs to which these strategies should be targeted to increase patient retention in methadone programs.

Issues to consider when predicting retention in therapeutic communities.

Many studies have focused on retention in therapeutic communities (TCs) because research shows that retention is an important predictor of client outcomes from these programs. A comparison of the three largest studies found there was little overlap between predictors of retention in TCs. Treatment Outcome Prospective Study data were analyzed to assess whether these findings may have been due to differences in times when the data were collected, measures of length of stay, and domains of variables used to predict retention. While the results suggest that each of these factors contributed to some differences between predictors of retention, the predictors still were unable to explain more than a small amount of the variance in retention. Research indicates that other variables need to be taken into account if future studies are to be more successful in predicting retention in TCs.

Treatment refusal/attrition among adults randomly assigned to programs at a drug treatment campus: The New Jersey Substance Abuse Treatment Campus, Seacaucus, NJ.

The New Jersey Substance Abuse Treatment Campus was funded to assess the feasibility of establishing a new model for delivering substance abuse treatment services and to serve as a research laboratory for conducting comparative evaluations of those services. The 350-bed campus was designed to improve treatment effectiveness by providing special services needed by underserved populations, and reduce treatment costs by serving large numbers of clients, centralizing services, and sharing facilities. First-time clients who met preliminary eligibility requirements during phone screening were randomly assigned to therapeutic community and chemical dependency programs. We used data collected on 1,573 adults who were ultimately accepted for admission to analyze treatment refusals and attrition during the 25 days after admission. Only 6.4% of the clients refused admission when informed of their treatment assignment. Planned duration of the residential phase of treatment, gender, and language spoken (English/Spanish) interacted with one another and differentially predicted treatment refusal/attrition. These findings may be useful for understanding treatment refusal and attrition in substance abuse treatment programs.

Intermediate care programs to reduce risk and better manage inmates with psychiatric disorders

Intermediate Care Programs were jointly established by the New York State Office of Mental Health and Department of Correctional Services to reduce risk and better manage inmates with psychiatric disorders. In an earlier study, we collected data from the mental health and corrections records of 209 inmates who were admitted to Intermediate Care Programs. Our analysis of those data showed there were significant reductions in the mean number of serious problem behaviors, correctional restrictions, and mental health crisis services during the six months before and after admission. In the present study, we used Wilcoxon tests to assess changes in the distribution of scores on variables assessed by the earlier study. The Wilcoxon tests showed there were significant changes in the distribution of scores on most of the variables. We then focused on inmates who scored positive on the respective variables, either before admission or after admission, and determined the percentage who improved, stayed the same, or worsened on those variables. The highest reductions occurred in mental health observations (65%), suicide attempts (63%), and emergency medications (43%). Lower reductions occurred in correctional infractions and restrictions (26% to 31%). Overall, the data from this study and our earlier one suggest that Intermediate Care Programs are effective in reducing risk and managing inmates with psychiatric disorders.