Methadone
Treatment Plans For Methadone Maintenance
Outpatient Methadone Maintenance Treatment Program California
Methadone Maintenance Treatment

J Subst Abuse Treat. Author manuscript; available in PMC 2015 Jan 1.

Published in final edited form as:

Published online 2013 Sep 21. doi: 10.1016/j.jsat.2013.08.012

Many of our clients must continue to meet their work, family and life responsibilities while in treatment. Our outpatient maintenance program uses Medication-Assisted Treatment (MAT), which may include methadone, buprenorphine or naltrexone, to service over 800 clients each week. Yarmouth Comprehensive Treatment Center. In traditional outpatient treatment, individuals live and work according to their normal schedules, but may also benefit from individual therapy, group therapy, and other services that they themselves arrange. Traditional outpatient care is completely self-directed by the person who is seeking treatment. Methadone Maintenance. Methadone Maintenance programs are for people that have a strong support system at home. Drug Rehab, Alcohol Treatment, Inpatient Drug Rehab, OutPatient, Substance Abuse Treatment, and Residential Treatment. Canyon View Sober Living last.

Participants (n=160) were new clients entering methadone maintenance treatment (MMT) at our study site, a large MMT program (of approximately 500 clients) in an urban part of the northeastern U.S. Participants were ≥ 18 years of age and within their first 30 days of MMT treatment entry. A person struggling with methadone use disorder may feel as if they can deal with their addiction through therapy or outpatient therapy, but inpatient care is an essential component of an effective methadone treatment program in most cases.

NIHMSID: NIHMS526704

The publisher's final edited version of this article is available at J Subst Abuse Treat

See other articles in PMC that cite the published article.

Abstract

This study is the first experimental trial to evaluate the effectiveness of a web-based behavioral intervention when deployed in a model where it partially substituted for standard counseling in a community-based specialty addiction treatment program. New opioid-dependent intakes in methadone maintenance treatment (n=160) were randomly assigned for 12 months to either: (1) standard treatment or (2) reduced standard treatment plus a web-based psychosocial intervention, the Therapeutic Education System (TES). Results demonstrated that replacing a portion of standard treatment with TES resulted in significantly greater rates of objectively measured opioid abstinence (48% vs. 37% abstinence across all study weeks; F_(1,158)=5.90, p<.05 and 59% vs. 43% abstinence on weeks participants provided urine samples for testing; F_(1,158)=8.81, p<.01). This result was robust and was evident despite how opioid abstinence was operationally defined and evaluated. The potential implications for service delivery models within substance abuse treatment programs and other healthcare entities are discussed.

1. Introduction

Therapeutic tools that harness existing and emerging technologies (e.g., Internet, mobile devices) offer considerable promise in the assessment, prevention, treatment, and recovery management of substance use disorders. Technology-based assessments can enable greater standardization of data collection and greater accuracy in reporting of sensitive data (e.g., substance use; behavior that may place one at risk for HIV, Hepatitis, or other infectious diseases) (; ). Technology-based interventions may include computer-assisted psychosocial treatment (e.g., behavior therapy, HIV prevention interventions) as well as tools for ongoing recovery support/relapse prevention (; ; ).

Such technologies can expand the self-monitoring of patients and the reach of clinicians through technology-based behavioral monitoring systems and support systems; and can enhance patients’ self-learning and self-management through interactive programs and tools. They can also engage patients, clinicians and an extended support network in shared decision-making through use of electronic decision support systems (Ben-Zeev et al., 2012; ; ).

Harnessing technology in the treatment and recovery management of substance use disorders may increase the quality, reach, and personalization of care in a manner that is cost-effective. These tools can also ensure fidelity in the delivery of interventions, thus assuring delivery of empirically-supported treatment. This is particularly important, as prior work has shown that training clinicians to deliver evidence-based behavioral treatment is time-consuming, clinicians are often not accurate in their assessment of when they are delivering evidence-based treatment, and intensive ongoing training and supervision are needed to ensure interventions are delivered with fidelity (; Moyers et al., 2008; ). Additionally, by having on-demand access to “just in time” therapeutic support via electronic devices, individuals can prevent costly escalation of substance use and related problems and unnecessary healthcare utilization. Technology-based therapeutic tools may be used in conjunction with various systems of care or as stand-alone tools for individuals who are unable (or do not wish) to access care for problematic substance use. Leveraging technology in this way offers great promise for leading to entirely new models for delivery of science-based approaches to addressing substance use disorders.

The promise of this approach is further underscored by the extraordinary rate at which access to the Internet and mobile devices has been growing among a wide array of populations. Over 80% of Americans have Internet access and about 90% subscribe to mobile phone services (Pew Internet & American Life Project, 2013). Worldwide, over 90% of individuals subscribe to mobile phone services, resulting in approximately 6.8 billion mobile phone subscriptions (Sanou, 2013). Growing evidence suggests that increased access to these technologies is also evident in many traditionally underserved and health disparities populations (). Offering behavioral interventions on a wide array of platforms (e.g., desktop computers, mobile devices) offers great promise to reach large numbers of individuals.A large and rapidly expanding scientific literature has demonstrated the promise and clinical utility of a wide array of interactive, technology-based behavioral interventions targeting mental health disorders, including issues of depression, anxiety, post-traumatic stress disorder, eating disorders, as well as severe mental illness, e.g., (Ben-Zeev et al., 2012; ; Marks, Cavanagh, & Gega, 2007; ). Additionally, there is a growing literature focused on how such technology-based tools can be implemented into mental health service delivery models to complement existing services, e.g., (Ben-Zeev et al., 2012; Bennett-Levy et al., 2010) as well as methods and metrics for implementation research, e.g.,(; ).

Although a number of studies have evaluated the role of technology in addressing smoking and alcohol use disorders, e.g.,(; ), only a small (but growing) line of research has demonstrated empirical support for technology-based behavioral interventions targeting chronic illicit substance use disorders. Among these therapeutic tools is a 6-session computerized cognitive behavioral intervention, called the Computer-based Training in Cognitive Behavioral Therapy (or CBT4CBT) program, developed by Carroll and colleagues. This program, which is largely video-based, teaches key cognitive behavioral skills, including coping skills, decision making skills, and understanding patterns of substance use. CBT4CBT has been shown to significantly enhance skills acquisition and substantively reduce substance use when provided as an adjunct to standard outpatient substance abuse treatment with a diverse sample of substance-using individuals (; ).

The Motivational Enhancement System, a single-session intervention, has been shown to be acceptable and easy to use among post-partum women with substance involvement when provided within a health care setting () and was associated with a reduction in illicit substance use among this population (). Additionally, the SHADE program (Self-Help for Alcohol and Other Drug Use and Depression), a motivational intervention targeting comorbid substance use and depressive disorders, was shown to produce equivalent outcomes to a comparable clinician-delivered intervention (; ). Further, a combined motivational and cogn

Outpatient Methadone Maintenance Treatment Program