title: Earning "take-home" privileges and long-term outcome in a methadone maintenance treatment program.
abstract: OBJECTIVE
  This observational prospective study aimed to determine whether duration to the earning of privileges of "take-home" methadone doses (as a part of behavioral enforcement) reflects long-term outcome of patients in methadone maintenance treatment (MMT).
  
  
  METHODS
  All 657 former heroin addicts admitted to our MMT clinic between June 1993 and June 2008 were prospectively studied and followed up. Duration from admission to first take-home dose (until October 2008), to leaving (retention, until June 2009), and to dying (survival, until June 2008) was calculated.
  
  
  RESULTS
  Most patients (n = 435; 66.2%) ever achieved take-home privileges. Retention was longest (10 years, 95% confidence interval [CI]: 8.8 to 11.2) for 110 patients who achieved their first take-home dose after 3 to 6 months, followed by 9 years (95% CI: 7.7 to 10.3) for 98 patients who achieved it after >6 months and ≤1 year, and 8.3 years (95% CI: 7.2 to 9.4) for 127 patients who managed to achieve it only after >1 year. Retention was lower among patients who were given exceptional take-home doses (not respecting policy regulations) <3 months since admission: 5.1 years (95% CI: 3.4 to 7.8) for 30 patients (who got it for medical reasons), 9 years (95% CI: 6.7 to 11.3) for 14 patients admitted from another MMT, and 6.3 years (95% CI: 5 to 7.6) for 56 patients who got it for unjustified (mistakes) reasons. The shortest retention in MMT was 2.2 years (95% CI: 1.8 to 2.7, P < 0.0005) for 222 patients who never managed to achieve any take-home privileges. Survival was longer among patients who ever versus never received take-home privileges (13.2 years [95% CI: 12.8 to 13.6] vs 12.3 years [95% CI: 11.5 to 13.1], respectively; P = 0.04) and longest (14.1 years [95% CI: 13.4 to 14.7]) among those who received take-home privileges after 3 to 6 months.
  
  
  CONCLUSIONS
  The group with the shortest time (3 to 6 months) to the achievement of first take-home dose had the best outcome. Further studies are needed to characterize this group.
authors.affiliation: Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel. einatp@tasmc.health.gov.il
authors.forename: Einat
authors.initials: E
authors.lastname: Peles
authors.forename: Shaul
authors.initials: S
authors.lastname: Schreiber
authors.forename: Anat
authors.initials: A
authors.lastname: Sason
authors.forename: Miriam
authors.initials: M
authors.lastname: Adelson
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D005260:Female; D006556:Heroin Dependence / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008691:Methadone / Q000627:therapeutic use*; D009042:Motivation; D010349:Patient Compliance / Q000523:psychology*; D011446:Prospective Studies; D012055:Reinforcement Schedule; D012201:Reward; D015813:Substance Abuse Detection; D016320:Substance Abuse Treatment Centers / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D008691:Methadone