Predictors of Attrition from a National Sample of Methadone Maintenance Patients

Abstract

Background Methadone substitution therapy is an effective harm reduction treatment method for opioid dependent persons. Ability to retain patients in methadone treatment is an accepted predictor of treatment outcomes. Objectives The current study evaluates the roles of psychiatric comorbidity, medical comorbidity, and sociodemographic characteristics as predictors of retention in methadone treatment utilizing retrospective analysis of data from a nationwide sample of patients in methadone treatment in the VA. Methods Data were gathered using the VA’s national health services use database. A cohort of veterans with a new episode of “opiate substitution” in fiscal year 1999 was identified, and their continuous service use was tracked through fiscal year 2002. The sample included a total of 2,363 patients in 23 VA medical centers. Survival analysis was used to explore factors associated with retention in methadone treatment. Results Younger age, having a serious mental illness, being African American, or having race recorded as unknown were associated with lower rates of retention in methadone treatment programs in this population of veterans (controlling for site). Conclusion Given that extended methadone treatment is associated with improved outcomes while patients remain in treatment, more longitudinal studies using primary data collection are needed to fully explore factors related to retention. For the VA population specifically, further research is necessary to fully understand the relationship between race/ethnicity and treatment retention. Scientific Significance This is the first retention study the authors are aware of that utilizes data from a nationwide, multisite, population of participants in methadone treatment.

Treatment of dissociative disorders and reported changes in inpatient and outpatient cost estimates

“…Furthermore, most trauma treatment studies exclude patients with complex and severe presentations including those with suicidality (Roberts, Roberts, Jones, & Bisson, 2016), although the present study did not exclude any patients based on symptomatology or chronicity (Brand et al, 2009). Attrition is higher in patients who have low incomes, receive government subsidies, and who struggle with substance abuse and/or serious psychiatric illnesses (Mancino et al, 2010), characteristics that were common in this sample (Brand et al, 2009). Although data regarding reasons for attrition were not collected, in cases where patients terminated their treatment with the therapist (and thus the study), therapists indicated reasons such as objective causes (e.g.…”

Patterns of Abstinence or Continued Drug Use Among Methadone Maintenance Patients and Their Relation to Treatment Retention

“…Numerous factors have been found to influence retention in MMT, most prominently higher methadone dose and particular patient characteristics (e.g., older age; Mancino et al 2010;Strike et al 2005). The present study examined the relationship between continued drug use and rates of MMT retention.…”

“…Numerous studies have since confirmed the relationship between duration of MMT and both positive long-term patient outcomes and increased vulnerability for a recurrence of opioid addiction following MMT cessation (Kimber et al 2010;Dole 1994). Studies of first-year attrition in MMT reveal high dropout rates, frequently in the 50%+ range (Bell et al 2006;Deck & Carlson 2005;Simpson et al 1997), with some studies noting one-year attrition at close to 80% (Mancino et al 2010).…”

Psychological Predictors of Retention in a Low-Threshold Methadone Maintenance Treatment for Opioid Addicts: A 1-Year Follow-Up Study

“…Otherwise, there is no clear pattern or association between predictors and treatment retention. For example, Mancino et al (2010), found that age, the presence of a serious mental illness, and race/ethnicity were associated with treatment retention. According to Fischer, Vasdev, Haydon, Baliunas, & Rehm, (2005), study site, housing status, alcohol use, and the use of heroin or injection drugs were related to engagement in treatment, but age and depression were not.…”