PATIENTS PERSPECTIVE ON THE PROCESS OF CHANGE IN SUBSTANCE-ABUSE TREATMENT

Understanding how methadone patients view treatment for their cocaine dependence and the process of recovery from cocaine addiction, is impo rtant in helping to design treatment strategies that will effectively motivate and engage these patients. There has been little development or testing of treatment approaches for cocaine-dependent, methadone-ma intained patients and research on the effectiveness of outpatient coca ine treatment has excluded the perspectives of patients. This article presents the patient's view, using ethnographic interviews with 17 pat ients enrolled in a relapse prevention treatment program for cocaine d ependence, that was set up in an inner-city methadone maintenance clin ic. Findings suggest that despite initial ambivalence or resistance, p atients became highly engaged by the positively reinforcing treatment intervention. In addition, patients found the highly structured nature of the program and the cognitive behavioral techniques critical in re ducing their cocaine use. Finally, patients responded positively to th e psychodynamic issues addressed within a cognitive behavioral format, and reported improvements in certain areas of psychological functioni ng.