The psychiatrically severe drug abuse patient: methadone maintenance or therapeutic community?

The present research was conducted to examine the effects of pretreatment psychiatric status and treatment duration on improvement following drug abuse rehabilitation. Percent improvement from admission to 6-month follow-up was measured on three criteria: drug use, employment, and criminality. Analyses of the total samples in both the Therapeutic Community (TC) and Methadone Maintenance (MM) programs indicated some quantitative differences between the two modalities but all measures showed a strong and positive relation between treatment duration and percent improvement. When patients in the two program samples were divided, on the basis of admission psychiatric status, into LOW, MID, and HIGH severity groups, different findings emerged. LOW severity patients in both programs showed the greatest absolute levels of improvement in most measures, more improvement at shorter treatment durations, and less additional improvement at longer treatment durations. MID severity patients in both programs showed the most dramatic effects of treatment duration, with generally large improvements in all criteria at greater treatment lengths. Qualitatively different results were seen between the treatment programs for the HIGH severity patients. HIGH severity MM patients showed low absolute levels of improvement but longer treatment durations were associated with modest improvements. HIGH severity TC patients also showed low absolute levels of improvement but unlike any other group, greater lengths of treatment were associated with negative change (worsened status) across all measures. The authors discuss these results with regard to the general efficacy of drug-dependence treatment and the specific issue of the psychiatrically impaired drug abusers.