title: Using enhanced and integrated services to improve response to standard methadone treatment: changing the clinical infrastructure of treatment networks.
abstract: Outcomes are presented from opioid-dependent outpatients (N = 81) participating in a new community-based initiative designed to improve access to enhanced substance abuse and psychiatric services in a publicly supported methadone maintenance treatment network in Baltimore, MD. The initiative, entitled Community Access to Specialized Treatment (CAST), is located at the Addiction Treatment Services, a program within this network. Network programs referred patients engaged in unremitting drug use who are at risk for discharge to CAST, where they received methadone substitution, individual and group counseling within an adaptive platform, behavioral contingencies to reinforce adherence, and on-site psychiatric evaluation and care. Patients returned to their referring program after producing at least two consecutive weeks of drug-negative urine samples and full counseling adherence. CAST was well utilized by the community. Patients had high rates of adherence to scheduled individual and group counseling services (93% and 73%, respectively); 43% of referrals successfully completed the program in an average of 101 days. This community-wide service delivery approach is a novel alternative to integrating intensive substance abuse and psychiatric care at each program within a treatment network.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA. kneufel2@jhmi.edu
authors.forename: Karin
authors.initials: K
authors.lastname: Neufeld
authors.forename: Michael
authors.initials: M
authors.lastname: Kidorf
authors.forename: Van
authors.initials: V
authors.lastname: King
authors.forename: Ken
authors.initials: K
authors.lastname: Stoller
authors.forename: Michael
authors.initials: M
authors.lastname: Clark
authors.forename: Jessica
authors.initials: J
authors.lastname: Peirce
authors.forename: Robert K
authors.initials: RK
authors.lastname: Brooner
mesh_terms: D015142:Baltimore; D001521:Behavior Therapy / Q000379:methods / Q000458:organization & administration; D003156:Community Mental Health Services / Q000379:methods / Q000458:organization & administration*; D003376:Counseling / Q000379:methods / Q000458:organization & administration*; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008297:Male; D008691:Methadone / Q000008:administration & dosage*; D009294:Narcotics / Q000008:administration & dosage; D009293:Opioid-Related Disorders / Q000628:therapy* / Q000652:urine; D010349:Patient Compliance; D011615:Psychotherapy, Group / Q000379:methods / Q000458:organization & administration; D015813:Substance Abuse Detection / Q000379:methods; D016320:Substance Abuse Treatment Centers / Q000379:methods / Q000458:organization & administration*; D016896:Treatment Outcome; D014505:Urban Population
chemical_list: D009294:Narcotics; D008691:Methadone