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Behavioral Therapies Development Program - Effective Drug Abuse Treatment Approaches

Individualized Drug Counseling for Methadone Maintenance Opiate Addicts

The goal of individual drug counseling (McLellan et al., 1993) is to change the patients' behaviors with regard to drug use, employment status, illegal activity, and family/social relations. Failure by the patient to reduce illicit drug or alcohol use may result in suggestions (but not demands) from the counselor for increases in the methadone dosage (when opiate use is seen), and/or a requirement for additional counseling visits (when continued cocaine, alcohol, or other drug use is observed). During the first month of treatment, patients are required to attend counseling once per week. In the second through sixth months of treatment, if the patient shows signs of positive social change and abstinence, the patient can meet on a less intensive basis (biweekly). When abstinence is not observed, the patient is asked to attend sessions twice per week until the problem behavior is reduced.

Thomas McLellan and colleagues from the University of Pennsylvania examined whether the addition of drug counseling, medical care, and psychosocial services improves the efficacy of methadone hydrochloride therapy in the rehabilitation of opiate-dependent patients. Intravenous opiate addicts enrolled in methadone maintenance treatment at the Philadelphia Veterans Administration Medical Center were randomly assigned to one of three groups for a 6-month clinical trial: (1) methadone (a minimum of 60mg/d) with no other services; (2) methadone plus individual drug counseling; or (3) methadone plus individual drug counseling and on site medical/psychiatric, employment, and family services.

While methadone treatment alone was associated with reductions in opiate use, 69% of these subjects had to be "protectively transferred" from the trial because of unremitting use of opiates and cocaine or medical/psychiatric emergencies. This was significantly different from the 41% of the methadone plus individual counseling and 19% of the methadone, individual counseling and services patients who met the criteria. End of treatment data showed minimal improvements in the methadone only participants who completed the trial. The addition of counseling produced significantly more and larger improvements and enhanced services further improved outcome over counseling alone. Methadone alone may only be effective for a minority of eligible patients.

McLellan, A.T., Woody, G.E., Luborsky, L. & O'Brien, C.P. (1988). Is the counselor an 'active ingredient' in substance abuse treatment? Journal of Nervous and Mental Disease, 176, 423-430.

McLellan, A.T., Arndt, I., Metzger, D.S. Woody, G.E. & O'Brien, C.P. (1993). The effects of psychosocial services in substance abuse treatment. Journal of the American Medical Association, 269 (15), 1953-1959.

Woody, G.E., Luborsky, L., McLellan, A.T., O'Brien, C.P., Beck, A.T., Blaine, J., Herman, I. & Hole, A. (1983). Psychotherapy for opiate addicts: Does it help? Archives of General Psychiatry, 40, 639-645.

[Behavioral Therapies Development Program Index] [Effective Treatment Approaches Index]

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