When is less treatment better? The role of social anxiety in matching methadone patients to psychosocial treatments

In response to a need to match drug users to the most appropriate and cost- effective level of care, it was hypothesized that socially anxious methadon e-maintained patients would attain greater benefit from coping skills train ing provided in the context of a low-intensity enhanced standard methadone maintenance intervention (E-STD) than in the context of a high-intensity, s ocially demanding day treatment program (DTP). Social anxiety was assessed in 307 methadone-maintained patients using the Social Anxiety and Distress Scale prior to randomization to either E-STD or DTP. The hypothesis was sup ported: Socially anxious patients were drug free longer during treatment, w ere more likely to be abstinent at treatment completion, and had greater re ductions in HIV risk behaviors if assigned to the lower intensity intervent ion, which was provided at 1/3 the cost of the DTP.