Sk. Avants et al., Day treatment versus enhanced standard methadone services for opioid-dependent patients: A comparison of clinical efficacy and cost, AM J PSYCHI, 156(1), 1999, pp. 27-33
Objective: This study examined the differential efficacy and relative costs
of two intensities of adjunctive psychosocial services-a day treatment pro
gram and enhanced standard care-for the treatment of opioid-dependent patie
nts maintained on methadone hydrochloride. Method: A 12-week randomized cli
nical trial with 6-month follow-up was conducted in a community-based metha
done maintenance program. Of the 308 patients who met inclusion criteria, 2
91 began treatment (day treatment program: N=145; enhanced standard care: N
=146), and 237 completed treatment (82% of those assigned to the day treatm
ent program and 81% of those receiving enhanced standard care). Two hundred
twenty of the patients participated in the 6-month follow-up (75% of those
in the day treatment program and 73% of those in enhanced standard care pr
ovided a follow-up urine sample for screening). Both interventions were 12
weeks in duration, manual-guided, and provided by master's-level clinicians
. The day treatment was an intensive, 25-hour-per-week program. The enhance
d standard care was standard methadone maintenance plus a weekly skills tra
ining group and referral to on- and off-site services. Outcome measures inc
luded twice weekly urine toxicology screens, severity of addiction-related
problems, prevalence of HIV risk behaviors, and program costs. Results: Alt
hough the cost of the day treatment program was significantly higher, there
was no significant difference in the two groups' use of either opiates or
cocaine. Over the course of treatment, drug use, drug-related problems, and
HIV risk behaviors decreased significantly for patients assigned to both t
reatment intensities. Improvements were maintained at follow-up. Conclusion
s: Providing an intensive day treatment program to unemployed, inner-city m
ethadone patients was not cost-effective relative to a program of enhanced
methadone maintenance services, which produced comparable outcomes at less
than half the cost.