Redefining Retention: Recovery from the Methadone Patient’s Perspective

A recent study in the Journal of Psychoactive Drugs examines the process of discharge and treatment reentry for six participants who entered treatment voluntarily but were administratively discharged from methadone treatment programs.

The participants completed semistructured interviews at treatment entry and at four, eight and 12 months post-treatment entry. Grounded theory methodology was used to examine the phenomenon of treatment reentry from the perspective of the patients, who often viewed their recovery as an accumulation of positive changes. Differences in terms of the patients’ goals and motivations for seeking treatment from those of the treatment programs, combined with difficulties encountered during the treatment process eventually led to discharge. However, these patients were then able to navigate their way through the treatment system in different ways in order to remain in treatment.

The authors conclude that failure to abide by treatment clinic rules do not necessary constitute “treatment failure” from the perspective of patients, who often wish to remain in treatment even if it is not progressing optimally from the program’s perspective. As a result, the recovery process can be more fragmented and is often characterized by a series of cyclical treatment episodes rather than continuous time in treatment, thereby impeding their progress towards recovery.

The authors offer the following practical suggestions that may be useful to treatment program staff and administrators:

  • Identify patients’ self-stated needs and goals relevant to drug treatment through good communication and trust building, and help patients better vocalize their needs and expectations.
  • Carefully examine and consider the patients’ prior treatment experiences and meet them where they are in terms of treatment needs and expectations, rather than having a predetermined requirement for treatment for all patients.
  • Tailor treatment to the patients’ work schedule. The patients value and need to earn a living and should not be penalized because of employment requirements. This will help reduce barriers to retention.
  • Work with the patients to try and resolve emerging problems, such as noncompliance issues. Rather than have counseling staff assume conflicting duties (i.e., confidant and reporter of rule infractions), it may be preferable to use an ombudsman to help resolve such conflicts.
  • When necessary, actively facilitate program transfer. Program staff should facilitate seamless and direct transfer of patients to other treatment programs and not administratively detox them without a meaningful referral, so that they may be “retained in treatment” elsewhere. This is an approach that should not be reserved only for select and vulnerable patients (e.g., pregnant women) but rather afforded to all patients, as is routinely done in medical care.

Study Limitations – This study has a number of limitations, including the limited sample size and the fact that the data come from one city and hence may not generalize elsewhere. Despite these limitations, it is clear that some involuntarily discharged methadone patients can and do seek admission elsewhere in order to continue their drug treatment. The available data from clinical and community trials support their efforts, given the increased risk of HIV seroconversion, arrest and incarceration and overdose death borne by out-of-treatment heroin-addicted individuals. Treatment programs should do what they can to retain patients in treatment, either at their facility or by arranging a seamless transfer to be “retained in treatment” and continue their care elsewhere.

The article is available online free-of-charge at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3160714/pdf/nihms310019.pdf

Source: J Psychoactive Drugs. 2011; 43(2): 99–107.

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