Day treatment versus enhanced standard methadone services for opioid-dependent patients: A comparison of clinical efficacy and cost

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.