1 Status of Methadone Maintenance Treatment and Research in the United States.- Current Status of Methadone Maintenance Treatment.- The AIDS Era.- Prior Research and Treatment Evaluation of Methadone Maintenance.- The "Black Box" of Methadone Maintenance Treatment.- Four-Domain Schema for Treatment Evaluation.- Conclusion.- References.- 2 Research Plan and Data Collection Procedure at the Programs.- Objective of the Study.- Development of the Research Design.- Data Collection at the Programs.- Collecting Treatment Domain and Output Data in 1985.- Patient Interviews in 1985 and 1986.- Treatment Domain Data Collection in 1986.- Record Data Collection and Assessment in 1986.- Other Sources of Data.- Conclusion.- References.- 3 Pretreatment Characteristics of 617 Male Methadone Maintenance Patients.- Characteristics of the Addict Patients.- Commonality Among the Addict Patients.- Conclusion.- References.- 4 Candid Descriptions of the Six Programs.- On-Site Data Collection During 3 Years.- The Six Programs.- Discussion.- References.- 5 Treatment Domain.- Elements of the Treatment Domain.- Measurement of the Treatment Domain.- Additional Areas of Measurement.- Conclusion.- 6 Treatment and Rehabilitation Provided to Patients at the Six Programs in 1985 & 1986.- Measurement of Services Provided.- Daily Hours of Operation.- Methadone Dispensing Practices at the Six Programs.- Urinalysis.- Counseling Services.- Medical Services.- Year to Year Change in the Provision of Treatment Services.- Overview of Measurement and Assessment.- Conclusion.- 7 Reduction in Drug Abuse During Methadone Maintenance Treatment.- Issues and Plan of Analysis.- Pretreatment Drug Abuse Prevalence.- Reduction in Drug Abuse During Methadone Maintenance Treatment.- Differences Among the Six Programs in Reducing IV Drug Use.- Discussion.- Conclusion.- References.- 8 Follow-up Study of 105 Patients Who Left Treatment.- Rates of Retention in Treatment.- Follow-up of Patients Who Left Treatment.- Relapse to IV Drug Use After Treatment.- Discussion.- Conclusion.- References.- 9 Prevalence and Change in Psychiatric Symptomatology Among Methadone Maintenance Patients.- Lifetime Prevalence of Psychiatric Symptoms.- Recent Psychiatric Symptoms.- Psychiatric Severity Composite Scores by Time in Treatment.- Discussion.- References.- 10 Reduction of Crime Through Methadone Maintenance Treatment.- Measurement of Crime Among Heroin Addicts.- Pretreatment Criminality of Addict Patients.- Reduction in Crime During Methadone Maintenance Treatment.- Discussion.- References.- 11 Treatment Success: Association With Patient Baseline, Program Elements, and In-treatment Process.- Research Questions Addressed.- The Data.- Patient Groups.- Statistical Procedures.- Findings: Outcomes and Independent Variables.- Discussion and Conclusion.- References.- 12 Summation of Findings and Conclusion.- Obtaining Comprehensive Program Data.- Interviewing Patients at the Six Programs.- Candid Program Descriptions.- Treatment Domain.- Treatment Provided.- Determination of Effectiveness.- Reduction in Crime.- Multivariate Analysis.- Local Environment and City.- Conclusion.- References.- Appendix A: 89 Measures of the Treatment Domain.- Appendix C: Further Analysis with Regard to Chapter 11.
Legislators, journalists and concerned citizens in general, when consider ing what to do about the plague of heroin addiction in large cities, ask an obvious question: "Is methadone treatment effective?" This question is a critical one since maintenance with methadone is at present the only prac tical alternative to leaving tens of thousands (in New York City, hundreds of thousands) of untreated addicts on the streets. Other treatments, although effective for limited groups, could not conceivably be expanded to stop heroin use in as much as 10% of the addicted population. The present study, sponsored by the National Institute on Drug Abuse, was undertaken to provide an authoritative answer to this question. Under the direction of a distinguished expert, the evaluation team made an inten sive examination of techniques and outcomes in six different methadone programs located in New York, Philadelphia, and Baltimore, and followed this by two yhears of data analysis and literature review. The present re port is the product of this work. The primary conclusion-namely that methadone treatment is substan tially effective in reducing heroin use and associated criminal behavior-is consistent with the findings of several previous independent evaluations.
The most important finding of this study of drug abuse treatment programs is the establishment of a successful procedure for evaluating such programs. This procedure, with modifications, could serve as a basis for evaluating other programs in the United States and elsewhere.