Skills-training groups to reduce HIV transmission and drug use among methadone patients

Although methadone maintenance may be one of the more effective means of slowing the spread of human immunodeficiency virus among intravenous drug users, methadone patients continue to engage in high-risk behavior. Opiate relapse, alcohol and cocaine use, program attrition, and sexual risk-taking all present serious challenges to methadone maintenance treatment programs. These concerns underscore the need for enhancing the nonpharmacological elements of methadone clinics. This article describes the components and process of a skills-building intervention designed to reduce relapse, program attrition, and high-risk behavior in methadone-maintained populations. The authors offer a research agenda for determining whether the skills-building approach is feasible and efficacious in community- and hospital-based methadone clinics. In learning from social workers and other helping professionals, it is hoped that investigators will be able to recast and retest models that will be useful in freestanding clinical settings.