Question 14: Are there patient characteristics associated with the success of methadone maintenance treatment?

Answer: Yes. Patient characteristics associated with treatment success include the following:

• Age
• Age of first heroin use
• Overall drug-use history
• Severity and duration of drug use
• Emotional health
• Psychiatric health
• Social health
• Vocational stability
• Criminal history

Research Highlights

One review found the following characteristics to be associated with improved methadone outcomes: older age, absence of criminal behavior, shorter duration of opioid use, less severe psychopathology, being employed, being married, less polysubstance use, and higher expressed desire in getting help with a drug problem (Ward, Mattick, Hall, et al., 1998).

• In a review of 113 studies that attempted to evaluate the relationship of patient characteristics to retention and other outcomes (reported from 1971 to 1983), it was noted that patient characteristics probably accounted for only 25 to 45 percent of the variance in retention (McLellan, 1983).
• For methadone maintenance treatment patients in the Drug Abuse Reporting Program (DARP) studies, the most important predictors of posttreatment outcomes were (1) preadmission criminality and (2) measurements of crime, drug use, and employment during treatment. Of all the patient characteristics, chronic criminality is the strongest predictor of unfavorable posttreatment outcomes (Simpson and Sells, 1982).
• Ball and Ross’s work (1991) supports the finding that a younger age at the onset of heroin use is associated with poorer treatment outcomes. Overall, however, this study noted that patient characteristics had less impact on outcomes than program variables.
• Anglin and Hser (1990) note that better psychosocial adjustment predicts superior treatment outcomes. Psychosocial adjustment was described as an intact marriage, a job, a shorter history of drug abuse, lower levels of psychiatric dysfunction, and minimal or no criminal history.
• Rounsaville, Glazer, Wilber, et al. (1983) assessed 123 opioid addicts who were followed for 6 months after admission and found that outcome was predicted by the behavior examined: greater pretreatment criminality predicts criminal activity following discharge. Conversely, pretreatment employment predicts posttreatment employment. This study found that patients who abuse alcohol, are unemployed, are dually diagnosed, manifest psychopathology, and engage in criminality have poor outcomes.

Figure 29 illustrates that, overall, patients who demonstrate emotional, psychological, and social well-being generally experience greater treatment success than patients who have emotional, psychological, and social problems. Several studies have noted that certain patient characteristics, which are listed in Figure 29, are associated with success in methadone maintenance treatment (Anglin and Hser, 1990).

References

Anglin MD, Hser IY. Treatment of drug abuse. In: Tonry M, Wilson JQ (eds.). Drugs and Crime. Chicago: University of Chicago, 1990.

Ball JC, Ross A. The Effectiveness of Methadone Maintenance Treatment: Patients, Programs, Services, and Outcomes. New York: Springer-Verlag, 1991.

McLellan AT. Patient characteristics associated with outcome. In: Cooper JR, Altman F, Brown BS, Czechowicz D (eds.). Research in the Treatment of Narcotic Addiction. NIDA Treatment Research Monograph Series. Rockville, MD: National Institute on Drug Abuse, 1983.

Rounsaville BJ, Glazer W, Wilber CH, Weissman MM, Kleber HD. Short-term interpersonal psychotherapy in methadone maintained opiate addicts. Archives of General Psychiatry 1983;40:629-36.

Simpson DD, Sells SB. Effectiveness of treatment for drug abuse: an overview of the DARP research program.Advances in Alcohol and Substance Abuse 1982;2(1):7-29.

Ward J, Mattick RP, Hall W. Duration of methadone maintenance treatment. In: Ward J, Mattick RP, Hall W (eds.).Methadone Maintenance Treatment and Other Opioid Replacement Therapies. Amsterdam: Harwood Academic Publishers, 1998, p. 571