PRETREATMENT CHARACTERISTICS, PROGRAM PHILOSOPHY AND LEVEL OF ANCILLARY SERVICES AS PREDICTORS OF METHADONE-MAINTENANCE TREATMENT OUTCOME

Predictors of methadone maintenance treatment outcome have not been ex tensively studied as they relate to variations in program philosophy, nor have such predictors received much examination among recently trea ted, older cohorts of opioid addicts for whom drug use patterns have c hanged. Predictors of outcome were examined at 18 months post-treatmen t entry for 353 admissions to methadone maintenance who received rando m assignment to one of three counseling conditions: (1) medication onl y, (2) standard counseling and (3) enhanced services; and one of two c ontingency conditions: (1) no contingencies, and (2) contingency contr acting in a six-cell 3 x 2 design. Subjects in contingency contracting conditions were placed on contingency contracts for positive urine to xicology results and ultimately discharged for unremitting drug use. A ll subjects completed the Addiction Severity Index (ASI) and provided weekly urine specimens. Predictors of urinalysis results and treatment retention were determined using bivariate and multivariate techniques . Interactions between subject characteristics by experimental conditi on assignment were also examined as predictors. Higher rates of total positive urine specimens were predicted by younger age, greater pre-tr eatment frequency of smoking cocaine, lower ASI psychiatric composite scores, and higher ASI legal composite scores. Higher rates of opiate positive specimens were predicted by younger age, lower pre-treatment frequency of alcohol intoxication, higher ASI legal and lower ASI empl oyment and psychiatric composite scores, and assignment to medication only/no contingencies condition. Higher rates of cocaine positives wer e predicted by younger age, black race, lower ASI psychiatric composit e score, greater pre-treatment frequency of intravenous and smoked coc aine use, less pre-treatment frequency of marijuana use, and lower met hadone dose level. Assignment to enhanced/contingency contracting pred icted lower rates of cocaine positives. Treatment retention was predic ted by older age, non-black race, lower ASI legal composite score, hig her methadone dose level and assignment to non-contingent conditions. While subject variables over which treatment providers have little con trol were, thus, related to outcome, type of treatment provided and me thadone dose also influenced outcome.