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PhD Thesis - Ward, J

Factors influencing the effectiveness of methadone maintenance treatment: An evaluation of change and innovation in the methadone program in New South Wales, Australia 1985-1995
Ward J (1995)

Abstract:
There is substantial evidence for the effectiveness of methadone maintenance treatment (MMT). However, recent studies suggest that methadone clinics vary in achieving this effectiveness, and there has been considerable debate and speculation about what aspects of treatment are responsible for this variation. Other evidence has raised questions about whether MMT remains effective when treatment is liberalised. This thesis reports three studies which address these issues.

The first study, a cross-sectional study of three public methadone clinics (N=348), examined relationships between treatment components, patient characteristics, patient life circumstances and outcome. Aspects of treatment associated with less heroin use were methadone dose and medical services. A strong association was also observed between higher methadone doses and higher levels of benzodiazepine use. Counselling was not related to any of the outcomes. Women were more troubled than men and, because of their involvement with prostitution, were more likely to use heroin.

Neither stressful life events, nor satisfaction with treatment were related to any outcome.

A second study (N=599) compared the public clinics in the first study with three private clinics in terms of drugs, crime and HIV risk behaviour. There were no clinically meaningful differences across the two sectors. The third study, a randomised controlled trial, was conducted with young, "at-risk" opioid users attending a primary health care centre (N=72). The purpose of the study was to examine whether liberalised treatment would be effective with this more difficult-to-treat group. The results suggest that clinically significant improvements can be achieved, but that the gains are not as great as those seen with an older, less troubled patient group. The results of the three studies suggest that there are important factors that moderate the relationship between exposure to MMT and outcome - higher methadone doses are associated with less heroin use, and the provision of on-site medical services may improve patient functioning. Methadone maintenance is effective regardless of whether it is delivered in the public or private sector. Finally, contrary to previous research, the evidence suggests that MMT can be liberalised and attract patients into treatment earlier on in their addiction careers.

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