Randomized trial of standard methadone treatment compared to initiating methadone without counseling: 12-month findings.
Schwartz R.P., Kelly S.M., O'Grady K.E. et al. Addiction: 2012, 107(5), p. 943–952.

Up to a year after starting methadone treatment US patients offered virtually no counselling for the first four months were still doing as well as those offered regular counselling. But there is a hint that intensive and high quality counselling enabled more to safely leave treatment.

Summary
The featured article presents the 12-month follow-up results of a study from which Findings has previously analysed the four-month follow-up results. Both articles are drawn on in this account.

At issue in this US study is whether initial regular counselling improves outcomes from methadone maintenance treatment. US regulations require regular counselling except under special authorisation, and even then counselling must start after 120 days – hence the term 'interim' for this stripped-down provision. Previous studies have shown that compared to waiting for a standard methadone treatment slot, rapid access to interim provision substantially reduces opiate use and crime and many more patients eventually start standard methadone treatment. But these studies left open whether offering rapid access to standard programmes would be even more effective than offering rapid access to interim programmes.

To explore this question two Baltimore methadone clinics randomly assigned new patients were to start (usually within three days) an interim programme, or equally rapidly to start standard or enhanced treatment.

As per regulations, the interim programmes could last only up to 120 days, offered crisis counselling only, required patients to take all methadone doses under supervision at the clinics, and featured at least three tests for illegal drug use.

Patients randomised instead to standard programmes were expected to attend weekly group and/or individual counselling sessions (with some room for adjustment to patient needs), permitted ton taker their methadone at home depending on time in treatment and progress, were subject to more frequent drug testing than in the interim programme, and were able to benefit from care planning and other psychosocial inputs.

At one of the clinics patients were also randomly assigned to a third option – the standard programme plus enriched counselling by a highly regarded counsellor with a low caseload, told to see patients as often as they wanted or the counsellor thought appropriate.

The 230 patients recruited to the study and who started one of the three types of programmes were typically unemployed single black men in their early 40s who used heroin daily. All but a few were followed up by researchers four months later when the interim programmes had to have stopped or been replaced by standard provision. As expected, during this time clinic records showed that the interim patients had received virtually no counselling, standard patients about one session a fortnight, and enhanced patients about one a week. Over the next eight months enhanced patients continued to receive individual counselling most frequently – averaging once every two or three weeks – former interim patients about monthly, and standard patients about one session every six weeks.