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Question 17: Is mandated methadone maintenance treatment as effective as voluntary treatment?

Index

Answer: Yes. Mandated methadone maintenance treatment (being forced to attend treatment by the criminal justice system) is as effective as voluntary treatment.

Research Highlights

A study examined the relationship between length of stay in methadone maintenance treatment and referral by legal and nonlegal sources of 2,200 patients. It was determined that patients who are legally referred to methadone maintenance treatment stay in treatment longer than, and do at least as well as, those who seek treatment voluntarily (Collins and Allison, 1983).

A study of 121 male veterans in a 90-day Veterans Administration drug rehabilitation program compared court-referred and voluntary patients. Objective and subjective measures both indicate that the court-referred patient is potentially as responsive to methadone maintenance treatment as the voluntary patient. Sixty-two percent of the court-referred patients were judged to have a good prognosis compared with 58 percent of the voluntary patients (McLellan and Druley, 1977).

Three samples of methadone maintenance treatment admissions, who were treated during the years of 1971 to 1973, participated in a followup study 7 years later. These groups included (1) a random sample of 100 patients, (2) a sample of 136 patients who had a minimum of 30 months remaining on civil addict parole status at the time of admission, and (3) a matched sample of 136 patients not on parole. The addition of parole supervision with urine testing resulted in only marginal improvements in behavior over that attributable to methadone maintenance treatment alone; however, parole status did significantly reduce the length of intervals of daily heroin use both before and after admission (Anglin, McGlothlin, and Speckart, 1981).

Mandated Methadone Maintenance Treatment and Three Treatment Outcomes–Patients who are legally coerced into methadone maintenance treatment experience treatment success at about the same rate as patients who participate voluntarily in treatment.

A study by 36) had moderate legal pressure to participate in methadone maintenance treatment (medium coercion). A third group had mild legal pressure to participate in methadone maintenance treatment (low coercion).

Figures 34, 35, and 36 compare the behaviors of individuals in the high-coercion group and those in the low-coercion group for three treatment outcomes: time employed (figure 34), daily narcotics use (figure 35), and criminal involvement (figure 36). As the figures illustrate, patients who are coerced in treatment achieve these treatment outcomes at about the same rate as patients who voluntarily participate in methadone maintenance treatment (Anglin et al., 1990). Figure 34 illustrates that for pretreatment the high conversion group was 47% and the low converstion group was 41%. This figure also illustrates that for posttreatment the high conversion group was 55% and the low converstion group was 54%.

Figure 34 compares the behaviors of individuals in the high-coercion group with those of individuals in the low-coercion group for the treatment outcome of time employed. As the figure illustrates, patients who are coerced in treatment achieve this treatment outcome at about the same rate as patients who voluntarily participate in methadone maintenance treatment (Anglin et al., 1990).

Figures 34, 35, and 36 compare the behaviors of individuals in the high-coercion group and those in the low-coercion group for three treatment outcomes: time employed (figure 34), daily narcotics use (figure 35), and criminal involvement (figure 36). As the figures illustrate, patients who are coerced in treatment achieve these treatment outcomes at about the same rate as patients who voluntarily participate in methadone maintenance treatment (Anglin et al., 1990). Figure 36 illustrates that for pretreatment the high conversion group was 67% and the low converstion group was 75%. This figure also illustrates that for posttreatment the high conversion group was 33% and the low converstion group was 31%.

Figure 35 compares the behaviors of individuals in the high-coercion group with those of individuals in the low-coercion group for the treatment outcome of daily narcotics use. As the figure illustrates, patients who are coerced in treatment achieve this treatment outcome at about the same rate as patients who voluntarily participate in methadone maintenance treatment (Anglin et al., 1990).

 
Figures 34, 35, and 36 compare the behaviors of individuals in the high-coercion group and those in the low-coercion group for three treatment outcomes: time employed (figure 34), daily narcotics use (figure 35), and criminal involvement (figure 36). As the figures illustrate, patients who are coerced in treatment achieve these treatment outcomes at about the same rate as patients who voluntarily participate in methadone maintenance treatment (Anglin et al., 1990). Figure 37 illustrates that for pretreatment the high conversion group was 14% and the low converstion group was 31%. This figure also illustrates that for posttreatment the high conversion group was 8% and the low converstion group was 9%.

Figure 36 compares the behaviors of individuals in the high-coercion group with those of individuals in the low-coercion group for the treatment outcome of criminal involvement. As the figure illustrates, patients who are coerced in treatment achieve this treatment outcome at about the same rate as patients who voluntarily participate in methadone maintenance treatment (Anglin et al., 1990).

 

References

Anglin MD, Brecht ML, Maddahian E. Pre-treatment characteristics and treatment performance of legally coerced versus voluntary methadone maintenance admissions. Criminology 1990;27:537-57.

Anglin MD, McGlothlin WH, Speckart GR. The effect of parole on methadone patient behavior. American Journal of Drug and Alcohol Abuse 1981;8:153-70.

Collins JJ, Allison M. Legal coercion and retention in drug abuse treatment. Hospital and Community Psychiatry1983;34(12):1145-49.

McLellan AT, Druley KA. A comparative study of response to treatment in court-referred and voluntary drug patients.Hospital and Community Psychiatry 1977;28:241-45

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