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The effect of intake procedures on performance in methadone maintenance
J Bell1, J R Caplehorn, D R McNeil
1Drug and Alcohol Unit, Prince of Wales Hospital, Sydney, Australia.
Addiction (Abingdon, England)
|April 1, 1994
Summary
Rapid intake procedures improve outcomes for methadone maintenance treatment. Formal assessment deterred applicants and was linked to higher dropout and heroin use rates, suggesting a negative impact on patient performance.
Area of Science:
- Addiction Medicine
- Clinical Psychology
- Public Health
Background:
- Methadone maintenance treatment (MMT) is a cornerstone of opioid addiction therapy.
- Standardized intake procedures may influence patient retention and treatment success.
- Variations in assessment protocols warrant investigation for their impact on MMT outcomes.
Purpose of the Study:
- To investigate the differential effects of rapid versus formal assessment intake procedures on MMT outcomes.
- To determine if intake procedures influence illicit drug use and treatment retention.
- To evaluate the impact of formal assessment on patient prognosis and in-treatment performance.
Main Methods:
- A natural experiment comparing two patient groups at a single methadone clinic.
- Group 1: 89 patients admitted via rapid intake.
- Group 2: 74 patients admitted after formal assessment and a waiting period. Outcome measures included urine drug tests and dropout/expulsion rates.
Main Results:
- Patients undergoing formal assessment were more likely to be expelled and leave treatment within 400 days (RR 1.1-5.2).
- Formal assessment was associated with double the odds of heroin use in the first 6 months (OR 1.5-2.2).
- The formal assessment deterred 50% of initial applicants, suggesting selection bias or negative treatment effects.
Conclusions:
- Rapid intake procedures appear more effective for MMT, associated with better retention and lower illicit drug use.
- Formal assessment may deter suitable candidates or negatively impact patient performance during treatment.
- Optimizing intake procedures is crucial for enhancing MMT efficacy and patient outcomes.
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