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methadone patients in the therapeutic community: a test of equivalency

James L. Sorensen a,b, Siara Andrews a,b, Kevin L. Delucchi a, Brian Greenberg c, Joseph Guydish a, Carmen L. Masson a,b, Michael Shopshire a,b

a:  Department of Psychiatry, University of California, San Francisco, 401 Parnassus Avenue, San Francisco, CA 94143, United States
b: Department of Psychiatry, University of California, San Francisco at San Francisco General Hospital, 1001 Potrero Avenue, San Francisco, CA 94110, United States
c: Walden House, Inc., 520 Townsend Street, San Francisco, CA 94103, United States

Abstract

Background: Residential therapeutic communities (TCs) have demonstrated effectiveness, yet for the most part they adhere to a drug-free ideology that is incompatible with the use of methadone. This study used equivalency testing to explore the consequences of admitting opioid-dependent clients currently on methadone maintenance treatment (MMT) into a TC.

Methods: The study compared 24-month outcomes between 125MMTpatients and 106 opioid-dependent drug-free clients with similar psychiatric history, criminal justice pressure and expected length of stay who were all enrolled in a TC. Statistical equivalence was expected between groups on retention in the TC and illicit opioid use. Secondary hypotheses posited statistical equivalence in the use of stimulants, benzodiazepines, and alcohol, as well as in HIV risk behaviors.

Results: Mean number of days in treatment was statistically equivalent for the two groups (166.5 for the MMT group and 180.2 for the comparison group). At each assessment, the proportion of the MMT group testing positive for illicit opioids was indistinguishable from the proportion in the comparison group. The equivalence found for illicit opioid use was also found for stimulant and alcohol use. The groups were statistically equivalent for benzodiazepine use at all assessments except at 24 months where 7% of the MMT group and none in the comparison group tested positive. Regarding injection- and sex-risk behaviors the groups were equivalent at all observation points.

Conclusions: Methadone patients fared as well as other opioid users in TC treatment. These findings provide additional evidence that TCs can be successfully modified to accommodate MMT patients.

© 2008 Elsevier Ireland Ltd. All rights reserved.

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