COMPARATIVE TREATMENT EFFECTIVENESS - EFFECTS OF PROGRAM MODALITY ANDCLIENT DRUG-DEPENDENCE HISTORY ON DRUG-USE REDUCTION

This study examined treatment outcome as a function of program modalit y, clients' lifetime patterns of drug dependence, and their interactio n, controlling for current level of drug use at treatment intake. Data were based on 2,966 clients who were interviewed at intake and at 1-y ear follow-up as part of the Drug Abuse Treatment Outcome Study (DATOS ), which included programs of four major modalities. Subjects' lifetim e patterns of drug dependence were classified into nine groups accordi ng to Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R ; American Psychiatric Association; 1987) diagnostic criteria and time of onset of drug use career. Outcome measure was the reduction of her oin use or cocaine use at follow-up from levels at intake. The results showed that rates of lifetime drug dependence and current drug use at DATOS admission were highest among methadone maintenance clients and lowest among outpatient drug-free clients. Drug use reduction was obse rved for all modalities. The presence of dependence diagnosis was asso ciated with less improvement when current use level at intake was cont rolled. Clients dependent on heroin but not currently daily users bene fited most from inpatient and residential programs. Methadone programs were also relatively ineffective in reducing cocaine use. Characteris tics of the client's drug dependence history, in addition to the curre nt or presenting drug problem, should be assessed to guide treatment p lanning. The high rate of cocaine dependence among methadone clients, most of whom were dependent on heroin, poses considerable challenge to contemporary opiate substitution treatments. Published by Elsevier Sc ience Inc.