Changes in methadone treatment practices: results from a panel study, 1988-1995.

Results from several studies conducted in the late 1980s and early 1990s showed that the majority of the nation's methadone treatment units did not use effective treatment practices. Since then, however, many efforts have been made to improve critical treatment practices. This paper examines the extent to which key methadone treatment practices (dose levels, treatment duration, client influence in dose decisions) changed from 1988 to 1995 in a panel sample of methadone maintenance units. We also examine factors that may account for variation in methadone treatment practices. We use panel data from a national random sample of 172 units in 1988 (82% response rate), 140 units in 1990 (87% response rate), and 116 units in 1995 (89% response rate). Unit directors and clinical supervisors provided phone survey data on clients influence on doses, upper limits on doses, average dose levels, unit emphasis on decreasing doses, time when clients are encouraged to detoxify, and average length of treatment. Results from random effects regression analyses indicate that treatment practices concerning methadone dose levels, client influence in dose decisions, and treatment duration improved significantly between 1988 and 1995. Several characteristics of clients (race, age) and treatment units (staff, ownership, geographic location) are associated with the use of less-effective treatment practices. Efforts to improve treatment practices appear to be making progress and certainly need to be continued.