The early course of change in methadone maintenance

Aims. This study examined the functional and substance use status of methadone maintenance (MM) patients at treatment entry and 2 and 7 months later Design. Two groups of subjects were identified for longitudinal follow-up, those in continuous MM treatment and those who left treatment. Setting. The study was conducted at the Philadelphia Veterans Affairs Medical Center MM Program. Participants. Subjects were 157 men admitted to treatment. Measurements. Change was evaluated using the Addiction Severity Index and urinalysis results. Findings. Both groups of subjects reported significant reductions in drug use and increases in psychosocial functioning from admission to month 2, but demonstrated no significant changes from months 2 to 7. Subjects who left treatment, however, had more heroin use and criminal activity at all evaluation points than subjects who remained in treatment. Urinalysis data also suggested that subjects who left treatment were using drugs more frequently while in treatment than were those subjects who remained continuously enrolled in MM. Finally, subjects who left treatment spent more time in restricted environments (e.g. inpatient treatment, jail) at follow-up. Conclusions. Services may need to be enhanced to foster continuing progress in patients who remain in MM treatment and to retain those patients with more severe problems who leave treatment early.