ARE SUPPLEMENTARY SERVICES PROVIDED DURING METHADONE-MAINTENANCE REALLY COST-EFFECTIVE

Objective: Previous research has suggested that support services suppl ementing methadone maintenance programs vary in their cost-effectivene ss This study examined the cost-effectiveness of varying levels of sup plementary support services to determine whether the relative cost-eff ectiveness of alternative levels of support is sustained over time. Me thod: A group of 100 methadone-maintained opiate users were randomly a ssigned to Ih?three treatment groups receiving different levels of sup port services during a 24-week clinical trial. Method:A group of metha done treatment with a minimum of counseling, the second received metha done plus move intensive counseling, and the third received methadone plus enhanced counseling, medical, and psychosocial services. The resu lts at the end of the trial period have been published elsewhere. This article reports the results of an analysis at a 6-month follow-up. Re sults: The follow-up analysis reaffirmed the preliminary findings that the methadone plus counseling level provided the most cost-effective implementation of the treatment program. At 12 months, the annual cost per abstinent client was $16,485, $9,804, and $11,818 for the low, in termediate, and high levels of support, respectively. Abstinence rates were highest, but modestly so, for the group receiving the high-inten sity, high-cost methadone with enhanced services intervention. Conclus ions: This study suggests that large amounts of support to methadone-m aintained clients are not cost-effective, but it also demonstrates tha t moderate amounts of support are better than minimal amounts. As fund ing for these programs is reduced, these findings suggest a floor belo w which supplementary support should not fall.