title: Day treatment versus enhanced standard methadone services for opioid-dependent patients: a comparison of clinical efficacy and cost.
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.
  
  
  METHODS
  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.
authors.affiliation: Yale University School of Medicine, Conn, USA. kelly.avants@yale.edu
authors.forename: S K
authors.initials: SK
authors.lastname: Avants
authors.forename: A
authors.initials: A
authors.lastname: Margolin
authors.forename: J L
authors.initials: JL
authors.lastname: Sindelar
authors.forename: B J
authors.initials: BJ
authors.lastname: Rounsaville
authors.forename: R
authors.initials: R
authors.lastname: Schottenfeld
authors.forename: S
authors.initials: S
authors.lastname: Stine
authors.forename: N L
authors.initials: NL
authors.lastname: Cooney
authors.forename: R A
authors.initials: RA
authors.lastname: Rosenheck
authors.forename: S H
authors.initials: SH
authors.lastname: Li
authors.forename: T R
authors.initials: TR
authors.lastname: Kosten
mesh_terms: D000328:Adult; D019970:Cocaine-Related Disorders / Q000191:economics / Q000453:epidemiology / Q000628:therapy; D003362:Cost-Benefit Analysis; D003631:Day Care, Medical / Q000191:economics; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000453:epidemiology; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008691:Methadone / Q000191:economics / Q000627:therapeutic use*; D009293:Opioid-Related Disorders / Q000191:economics / Q000453:epidemiology / Q000534:rehabilitation*; D017063:Outcome Assessment, Health Care; D012309:Risk-Taking; D012720:Severity of Illness Index; D015813:Substance Abuse Detection; D016320:Substance Abuse Treatment Centers / Q000191:economics; D016896:Treatment Outcome
chemical_list: D008691:Methadone