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Cited by 108Opioid Use Disorder TreatmentSubstance Abuse Treatment and OutcomesHIV, Drug Use, Sexual Risk

Day treatment versus enhanced standard methadone services for opioid-dependent patients: A comparison of clinical efficacy and cost

Avants, S. Kelly, Margolin, Arthur, Sindelar, Jody L., Rounsaville, Bruce J., Schottenfeld, Richard, Stine, Susan, Cooney, Ned L., Rosenheck, Robert A. +2 more·1999·American Journal of Psychiatry
DOI 10.1176/ajp.156.1.27
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Abstract

OBJECTIVE: This study examined the differential efficacy and relative costs of two intensities of adjunctive psychosocial services--a day treatment program and enhanced standard care--for the treatment of opioid-dependent patients maintained on methadone hydrochloride. METHOD: A 12-week randomized clinical trial with 6-month follow-up was conducted in a community-based methadone maintenance program. Of the 308 patients who met inclusion criteria, 291 began treatment (day treatment program: N=145; enhanced standard care: N=146), and 237 completed treatment (82% of those assigned to the day treatment program and 81% of those receiving enhanced standard care). Two hundred twenty of the patients participated in the 6-month follow-up (75% of those in the day treatment program and 73% of those in enhanced standard care provided a follow-up urine sample for screening). Both interventions were 12 weeks in duration, manual-guided, and provided by master's-level clinicians. The day treatment was an intensive, 25-hour-per-week program. The enhanced standard care was standard methadone maintenance plus a weekly skills training group and referral to on- and off-site services. Outcome measures included twice weekly urine toxicology screens, severity of addiction-related problems, prevalence of HIV risk behaviors, and program costs. RESULTS: Although the cost of the day treatment program was significantly higher, there was no significant difference in the two groups' use of either opiates or cocaine. Over the course of treatment, drug use, drug-related problems, and HIV risk behaviors decreased significantly for patients assigned to both treatment intensities. Improvements were maintained at follow-up. CONCLUSIONS: Providing an intensive day treatment program to unemployed, inner-city methadone patients was not cost-effective relative to a program of enhanced methadone maintenance services, which produced comparable outcomes at less than half the cost.

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  • The authors identified 13 studies that fit their inclusion criteria.

    “We identified 13 studies that fit our inclusion criteria (SAMHSA, 2003; Zarkin et al., 2004; Avants et al., 1999; Mojtabai and Zivin, 2003; Ettner et al., 2006; Anderson et al., 1998; Weisner et al., 2000; Harwood et al., 2001b; Alterman et al., 1994; Burgdorf et al., 2004; Barnett and Swindle, 1997; Harwood et al., 2001a; and Hartz et al., 1999).”

    From The economic costs of substance abuse treatment: Updated estimates and cost bands for program assessment and reimbursement (2008) · cites this paper as Avants et al., 1999

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Authors
Avants, S. K., Margolin, A., Sindelar, J. L., Rounsaville, B. J., Schottenfeld, R., Stine, S., Cooney, N. L., Rosenheck, R. A., Li, S.-H., & Kosten, T. R.
Affiliations
Yale University (US)
ORCID
Venue
American Journal of Psychiatry
Publisher
American Psychiatric Association Publishing
Published
1999-01-01
Volume
156
Issue
1
Pages
27-33
ISSN
  • 0002-953X (ISSN-L)
  • 1535-7228
DOI
10.1176/ajp.156.1.27
OpenAlex
W2145179206
Cited by
108
References
25
Citations by year
2024: 1 · 2023: 1 · 2022: 1 · 2021: 1 · 2020: 1 · 2018: 1 · 2017: 2 · 2016: 2 · 2015: 3 · 2014: 1 · 2013: 5
FWCI
8.64
Type
journal article
Language
en
Open access
closed
Locations
  • American Journal of Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Institutes of Health (5k21da000277-05, 5r01da008754-08)
  • National Institute on Drug Abuse (DA08754, DA 00277, DA 00112)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
  • Health Sciences › Medicine › Epidemiology › HIV, Drug Use, Sexual Risk
Keywords
opioid use disorder, methadone maintenance treatment, day treatment, treatment intensity, psychosocial services, cost-effectiveness, HIV risk behavior, cocaine use, urine toxicology screening, inner-city patients, unemployed patients
MeSH terms
Adult, Cost-Benefit Analysis, Day Care, Medical, Female, Follow-Up Studies, Humans, Male, Methadone, Opioid-Related Disorders, Risk-Taking, Severity of Illness Index, HIV Infections, Substance Abuse Detection, Substance Abuse Treatment Centers, Treatment Outcome, Health Care Costs, Outcome Assessment, Health Care, Cocaine-Related Disorders

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