How methadone research works

Start with the premise that opiate addicts don't get well. (Unless they're doctors.)

Perform a study offering only two variations of your preferred treatment. (Cheap and crime reducing.) One is high dose or long duration and the other low dose or short duration. Do not offer a recovery oriented option at all, or offer a recovery oriented option of inadequate duration and intensity.

Find that, when offering 2 lousy options, the lousy option with the longer duration or higher intensity reduces symptoms better at follow-up.

Run a headline of, "Methadone Detoxification Remains No Match for Methadone Maintenance, Even with Minimal Counseling." In the comments, declare, "Methadone maintenance is the preferred treatment approach for heroin dependence."

Bonus: "No difference between groups was found for cocaine use or depressive symptoms."

Bonus bonus: "Results for MM with standard counseling (2 hours a month) did not differ from those for MM with minimal counseling (15 minutes a month)."

Question: Do you think this will be used to justify offering even less counseling to methadone recipients?

UPDATE: I got some grief on this post. Here's my response:

Five points:

• First, a question. If methadone is a superior treatment option, why don't they use it for opiate addicted health professionals? Health professionals have high rates of opiate addiction and typically receive long term treatment with monitoring that lasts several years. Treatment is stepped up or down as needed. Guess what? They have great treatment outcomes. You might be inclined to chalk it up to a population with lots of recovery capital. To be sure, that plays a role, but surely a real chronic disease management approach plays a role too. 
  
• Second, is it coincidence that this study was done on poor black men? Why aren't studies like this done on young adults from affluent communities?
  
• Third, methadone used to be one component of some comprehensive bio-psycho-social treatment programs. I understand that there are still some programs that fit this description, but every program in my area is a dosing clinic and little more.
  
• Fourth, regarding misery, notice that there was no difference in depressive symptoms. 
  
• Fifth, heroin addicts in our long term programs do just as well as everyone else. It's all about hope and expectations. Beware of the subtle bigotry of low expectations.
  

All I want is a day when addicts are offered recovery oriented treatment of an adequate duration and intensity. I have no problem with drug-assisted treatment being offered. Give the client accurate information and let them choose.

Helping other alcoholics in alcoholics anonymous and drinking outcomes

This isn't a new article, but seemed worth sharing. Researchers demonstrate what mutual aid groups have known for decades. Helping other alcoholics helps the helper stay sober.

OBJECTIVE: Although Alcoholics Anonymous (AA) is the largest mutual-help organization for alcoholics in the world, its specific mechanisms that mobilize and sustain behavior change are poorly understood. The purpose of this study is to examine prospectively the relationship between helping other alcoholics and relapse in the year following treatment for alcohol use disorders. METHOD: Data were derived from Project MATCH, a longitudinal prospective investigation of the efficacy of three behavioral treatments for alcohol abuse and dependence. Kaplan-Meier survival estimates were used to calculate probabilities of time to alcohol relapse. To identify the unique value of helping other alcoholics when controlling for the number of AA meetings attended, proportional hazards regressions were conducted to determine whether the likelihood of relapse was lower for those who were helping other alcoholics. RESULTS: There were no demographic differences that distinguished participants in regard to involvement in helping other alcoholics, with the exception of age; those who were helping other alcoholics were, on average, 3 years older than those who were not helping alcoholics. Those who were helping were significantly less likely to relapse in the year following treatment, independent of the number of AA meetings attended. CONCLUSIONS: These findings provide compelling evidence that recovering alcoholics who help other alcoholics maintain long-term sobriety following formal treatment are themselves better able to maintain their own sobriety. Clinicians who treat persons with substance abuse disorders should encourage their clients to help other recovering alcoholics to stay sober.

It would be interesting to look at two more things:

• If these finding hold up in other mutual aid groups. I suspect they would.
• We know that mutual aid group involvement is a better predictor of recovery than attendance. 12 step work is frequently identified as an indicator of involvement. It would be interesting to see if the benefits of helping are are different or more powerful than other forms of mutual aid group involvement.
  

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