Enhancing the effectiveness of methadone using psychotherapeutic interventions.

There is consistent evidence that the efficacy of methadone can be enhanced by psychotherapeutic interventions. For individual psychotherapy, the increased efficacy is most demonstrable among methadone patients also suffering from psychiatric disorders. Patients with severe psychiatric problems generally show little response to drug counseling alone. There is no evidence of a consistent advantage of one type of psychotherapy over another. Contingency contracting using take-home doses of methadone to reinforce drug-free urines has been shown to be effective, at least over the short term. Rewarding clean urines by vouchers exchangeable for retail items is supported by a growing experimental database, although practical issues remain for publicly funded methadone programs. The use of methadone dose as a reinforcer has shown some efficacy, but there are both ethical and conceptual problems. Finally, while there are likely to be some benefits from simply administering methadone alone in the most economical way, the available evidence clearly shows that a relatively minor investment in counseling, individual psychotherapy, or contingency contracting can result in major improvements in the results of this medication.