After 27 years methadone maintenance remains perhaps the most controversial form of available opiate addiction treatment. Recognizing that many patients choose to remain in methadone treatment for extended periods of time the authors have wondered whether such patients might actually be harmed by long-term involvement. A review of the records of 3 patients who had been in continuous treatment for 15 years or more revealed that all of their lives had improved over the course of their treatment involvement. They varied in the length of time required before they showed improvement and all three indicated that they wished to remain on methadone because previously they had resumed drug use when they tried detoxing either alone or in treatment. There were periods during their treatment involvement when these patients were not doing well and could have been regarded as treatment failures. Continuing on in treatment, however, all three had made positive changes in their lives, changes which were of benefit to the society as well as the individual.

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Characteristics of cocaine-addicted individuals who abuse their partners.

The purpose of this study was to determine what proportion of individuals entering treatment for cocaine dependence admitted to battering an intimate partner and to compare the characteristics of those who were not identified as batterers. Of the 77 men in the sample, 38% were characterized as cocaine-dependent batterers. The batterers and nonbatterers were found to differ on a variety of background and assessment variables. Cocaine-dependent batterers more often reported a history of serious conflict with their sexual partner, trouble controlling violent behavior, greater psychiatric disturbance, difficulty relaxing, and being easily annoyed. A summary of the findings as well as implications for future research are discussed.

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Patient-treatment matching in substance abuse. Drug addiction severity.

In this study, a mixed group of 60 substance-dependent patients were randomly assigned to 12 weeks of treatment in either a high-structure, behaviorally oriented (HSB) or a low-structure, facilitative (LSF) individual counseling style. We tested the hypothesis that patients with a more severe pretreatment drug problem will realize greater treatment benefit in HSB counseling, while those with a less severe problem will benefit more in the LSF approach. Six counselors provided the treatments in a counterbalanced design that controlled for possible differences in counselor effectiveness. Treatment benefit comparisons with respect to the counselors' posttreatment ratings, the number of counseling sessions attended, reduction in problem severity, and substance use during treatment were consistently in the hypothesized direction. These findings provide at least partial support for the notion that treatment benefit for substance abuse patients can be improved through appropriate patient-treatment matching on the basis of addiction severity.

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