title: Premature discharge from methadone treatment: patient perspectives.
abstract: Longer retention in drug abuse treatment is associated with better patient outcomes, and research indicates the first 12 months of methadone treatment are critical to patient success. Nevertheless, large-scale multisite longitudinal studies over the past three decades indicate that the majority of patients drop out during the first year of methadone treatment. Through an examination of 42 qualitative interviews with patients prematurely discharged from six methadone treatment programs in Baltimore, this study highlights factors patients describe as contributing to their reasons for being discharged within the first 12 months of the treatment. The two most consistent themes are program-related factors and incarceration. The former factors are richly described through patients' words and underscore the ways in which patients' perceptions of control exerted by the program and by the medication and misunderstandings of program structure can lead to premature discharge. Patients' reasons for discharge were compared to counselors' reasons as indicated in discharge summary forms. An analysis of the patterns of agreement and disagreement are presented. Patient-centered program and policy implications are discussed.
authors.affiliation: Iowa City VA Medical Center, 601 Hwy 6 West, Iowa City, IA 52246, USA. heather.reisinger@va.gov
authors.forename: Heather Schacht
authors.initials: HS
authors.lastname: Reisinger
authors.forename: Robert P
authors.initials: RP
authors.lastname: Schwartz
authors.forename: Shannon Gwin
authors.initials: SG
authors.lastname: Mitchell
authors.forename: James A
authors.initials: JA
authors.lastname: Peterson
authors.forename: Sharon M
authors.initials: SM
authors.lastname: Kelly
authors.forename: Kevin E
authors.initials: KE
authors.lastname: O'Grady
authors.forename: Erica A
authors.initials: EA
authors.lastname: Marrari
authors.forename: Barry S
authors.initials: BS
authors.lastname: Brown
authors.forename: Michael H
authors.initials: MH
authors.lastname: Agar
mesh_terms: D000328:Adult; D001071:Appointments and Schedules; D003376:Counseling; D003415:Crime / Q000706:statistics & numerical data; D005006:Ethnicity; D005260:Female; D006556:Heroin Dependence / Q000534:rehabilitation; D006801:Humans; D008016:Life Change Events; D008137:Longitudinal Studies; D008297:Male; D008396:Maryland / Q000453:epidemiology; D008691:Methadone / Q000191:economics / Q000627:therapeutic use*; D009294:Narcotics / Q000191:economics / Q000627:therapeutic use*; D009293:Opioid-Related Disorders / Q000191:economics / Q000534:rehabilitation*; D010351:Patient Discharge / Q000191:economics / Q000706:statistics & numerical data*; D017060:Patient Satisfaction; D011306:Prescription Fees; D012008:Recurrence; D012959:Socioeconomic Factors; D016320:Substance Abuse Treatment Centers / Q000191:economics / Q000706:statistics & numerical data*; D000078329:Workforce
chemical_list: D009294:Narcotics; D008691:Methadone