The International Journal of the Addictions, 14(7), 1009-1013, 1979
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Research Note
Arrest Record and Retention in Methadone Maintenance Treatment Frederick L. McGuire," Ph.D. Department of Psychiatry and Human Behavior California College of Medicine University of California, lrvine Orange, California 92668
Abstract
I t was found that when compared with those who stay in methadone maintenance treatment for less than 18 months, those who remain at least 18 months have a lower pretreatment and a lower in-treatment arrest record. It is questioned, however, if this group entered with a favorable bias and would have responded better to any form of treatment, including simple dispensation of methadone.
INTR0 DUCTI 0 N A primary criterion of a methadone maintenance program is that of attracting into treatment and retention as opposed to nontreatment, *To whom requests for reprints should be addressed at Department of Psychiatry and Human Behavior, University of California, Irvine, Medical Center, 101 City Drive South, Orange, California 92668. 1009 Copyright @ 1979 by Marcel Dekker, Inc. All Rights Reserved. Neither this work nor any part may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, microfilming, and recording, or by any information storage and retrieval system, without permission in writing from the publisher.
McGUIRE
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1010
discharge, or self-termination. This also provides a measure of program effectiveness by comparing the resultant behavior of those who remain in treatment with those who terminate early. (Presumably, those who never enter treatment produce worse records than either the stay-in or dropout groups.) A number of centers have reported a decrease in arrest rate among those patients who have remained in MMPT when compared with those who dropped out (Cleveland et al., 1974; Sechrest and Dunckley, 1973). However, because programs vary widely in their treatment approaches and clientele are so different in background and potential for treatment, outcome measures are likely to also be different for each program. This paper is a report on the arrest records of patients in an MMT Program in Orange County, California as one outcome measure.
PROCEDURE Arrest records maintained by the Orange County Sheriffs Office were searched for 274 subjects given an opportunity to remain in the program 18 months or longer. These constituted approximately 53% of the total number of such patients entered into the program between December 1972 and June 1964. The number of arrests were tallied for each of the five years prior to admission to treatment and for each month during treatment, up to and including the month of termination. For nondropouts, of course, this included a span of 18 months. Group means for the various time frames (per year for pretreatment and per month during treatment) were computed by summing all arrests for those persons completing each time frame and dividing by the number of subjects (Mn). A subject was not included in the calculation for a given month if heishe dropped out of treatment before the month was complete. The “number of arrests per 100 subjects” may be obtained by multiplying the group mean by 100. For the 18-month treatment span these results are reported by quarters; however, the results and conclusions are the same as if they had been reported by each month. For the 5 years of pretreatment the means are reported by year. These results are shown in Tables 1 and 2.
RESULTS AND DISCUSSION As noted, the dropout group has a consistently higher arrest rate than the stay-in group, not only throughout the 18-month treatment span but also during the 5-year pretreatment period. In particular, the difference
ARREST RECORD AND RETENTION IN MMTP
1011
Table 1 Mean Annual Arrests for 5 Years Prior to Entry into MMTP-Patients Completing at Least 78 Months Versus Those Completing Less than 18 Months
Nondropouts Years prior to treatment
Dropouts
N
No. of arrests
Mn"
SD
N
No. of arrests
Mn
SD
r ratio
p
164 164 164 164 164
208 195 170 154 97
1.27 1.19 1.04 0.94 0.59
1.97 1.95 1.63 1.72 1.25
110 110 110 110 110
218 148 127 133 113
1.98 1.35 1.15 1.21 1.03
2.50 1.80 1.94 2.22 1.94
2.61 0.67 0.54 1.13 2.27
.01 .50 59 .26 .02
Subst Use Misuse Downloaded from informahealthcare.com by UB Kiel on 11/07/14 For personal use only.
~~
1 2 3 4 5
~~~
"The rate per 100 subjects may be calculated by moving the decimal two places to the right.
was largest during the year just prior to admission. The fact that there are no reversals (i.e., the dropouts are always higher) during the 5 years also supports the hypothesis of a real difference between the two groups. Among the dropout group, even though their number diminishes during each month of treatment, the arrest rate remains consistently higher than for those remaining in the program. However, it might be asked whether the arrest record was not at least better for those clients who remain in treatment for, say, 1 year. Table 3 notes separately the record for those who remained in the program for up to four quarters (1
Table 2 Mean Arrests by Treatment Quarter' for MMTP Patients Completing at Least 18 Months Versus Those Not Completing 18 Months Nondropouts Treatment quarter completed
N
1 2 3 4 5
164 164 164 164 164
Dropouts
No. of arrests Mnb SD 37 31 25 19 8
0.23 0.19 0.15 0.12 0.05
0.57 0.50 0.46 0.39 0.29
N
No. of arrests
Mn
90 68 55 33 17
47 11 14 12 4
0.52 0.16 0.25 0.36 0.24
SD
t ratio
0.97
3.07 0.39 1.29 2.85 2.27
0.44 0.62 0.70 0.56
p .002 .70 .20 .005 .025
"Includesonly patients completing a full quarter. bThe rate per 100 subjects may be calculated by moving the decimal two places to the right.
McGUIRE
1012
Table 3 Mean Arrests by Treatment Quarterpfor MMTP Patients Completing at Least 78 Months Versus Those Completing 72 Months but Less than 78 Months
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Nondropouts Treatment quarter completed
N
No. of arrests
1 2 3 4 5
164 164 164 164 164
37 31 25 19 8
Dropouts
Mnb SD
N
0.23 0.19 0.15 0.12 0.05
33 33 33 33
0.57 0.50 0.46 0.39 0.29
-
No. of arrests Mn 9 7 8 12 -
0.27 0.21 0.24 0.36
-
SD
t ratio
p
0.57 0.55 0.61 0.70
0.43 0.24 0.96 2.85
.67 .81 .34 .005
-
-
-
“Includes only patients completing a full quarter. bThe rate per 100 subjects may be calculated by moving the decimal two places to the right.
year) but subsequently dropped out during the remaining 6 months. As noted, their arrest record is very like that of the total dropout population and still higher than the arrest record for those who remain in treatment the full 18 months. Therefore, it appears that the dropout population enters the program with a higher level of arrest activity, and when compared with those who remain it stays higher even though it does drop somewhat at entry. It is of interest to note that among the nondropouts the arrest rate during the 1 year just prior to entering treatment was at an annual level of about 127 arrests per 100 subjects, but during the first year of treatment dropped drastically to an annual rate of about 68 arrests per 100 subjects. During the first quarter of treatment the quarterly arrest rate was 23 per 100 and declined steadily to a quarterly rate of 5 per 100. For those 33 subjects who remained in treatment for four quarters but subsequently dropped out, the annual arrest rate during the 1 year prior to treatmznt was 150 per 100, compared with 103 per 100 during the first year of treatment. During their first quarter of treatment their quarterly arrest rate was 27 per 100 but, unlike the stay-ins, it remained comparatively stable throughout the four quarters, ranging from 21 to 36 arrests per 100. Therefore, it appears that while entering treatment accompanies an initial drop for this group, it is not progressive as in the case of the stay-ins. The fact that eventual dropouts have a higher arrest record before and during treatment suggests that they are a “different breed of cat” and that the stay-in group may have entered treatment with a “built-in” bias
ARREST RECORD A N D RETENTION IN MMTP
1013
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toward positive response; it is possible that these people would have improved in any kind of program. It therefore remains to identify what constitutes the most cost-effective approach. For example, simple dispensing of methadone may have produced similar results with this stay-in group at a much lower cost, while the dropouts may have been more successful in a more intensive counseling and supervision format. Future research may therefore be fruitful if directed toward the identification of groups with differing potential for retention and experimenting with different approlzches to each. ACKNOWLEDGMENTS
For assistance in gathering and processing these data, appreciation is expressed to Ronald Kersh, Olivia Mulrain, Kathleen Higgins, Ernest Kuncel, and Patricia Messinger of the Orange County Mental Health Department. Views expressed are not necessarily those of that department nor should endorsement be inferred. REFERENCES CLEVELAND, W., BOWLES, B., and HICKS, W. Outcomes of methadone treatment of 300 inner city addicts. Public Health Rep. 89: 563-568, 1974. SECHREST, D.K., and DUNCKLEY, T.E. A one-year followup of methadone patients on drug use, criminal behavior, and wages earned. Natl. ConJ Methadone Treatment 2: 290-303, 1973.
Subst Use Misuse Downloaded from informahealthcare.com by UB Kiel on 11/07/14 For personal use only.
Research Note
Arrest Record and Retention in Methadone Maintenance Treatment Frederick L. McGuire," Ph.D. Department of Psychiatry and Human Behavior California College of Medicine University of California, lrvine Orange, California 92668
Abstract
I t was found that when compared with those who stay in methadone maintenance treatment for less than 18 months, those who remain at least 18 months have a lower pretreatment and a lower in-treatment arrest record. It is questioned, however, if this group entered with a favorable bias and would have responded better to any form of treatment, including simple dispensation of methadone.
INTR0 DUCTI 0 N A primary criterion of a methadone maintenance program is that of attracting into treatment and retention as opposed to nontreatment, *To whom requests for reprints should be addressed at Department of Psychiatry and Human Behavior, University of California, Irvine, Medical Center, 101 City Drive South, Orange, California 92668. 1009 Copyright @ 1979 by Marcel Dekker, Inc. All Rights Reserved. Neither this work nor any part may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, microfilming, and recording, or by any information storage and retrieval system, without permission in writing from the publisher.
McGUIRE
Subst Use Misuse Downloaded from informahealthcare.com by UB Kiel on 11/07/14 For personal use only.
1010
discharge, or self-termination. This also provides a measure of program effectiveness by comparing the resultant behavior of those who remain in treatment with those who terminate early. (Presumably, those who never enter treatment produce worse records than either the stay-in or dropout groups.) A number of centers have reported a decrease in arrest rate among those patients who have remained in MMPT when compared with those who dropped out (Cleveland et al., 1974; Sechrest and Dunckley, 1973). However, because programs vary widely in their treatment approaches and clientele are so different in background and potential for treatment, outcome measures are likely to also be different for each program. This paper is a report on the arrest records of patients in an MMT Program in Orange County, California as one outcome measure.
PROCEDURE Arrest records maintained by the Orange County Sheriffs Office were searched for 274 subjects given an opportunity to remain in the program 18 months or longer. These constituted approximately 53% of the total number of such patients entered into the program between December 1972 and June 1964. The number of arrests were tallied for each of the five years prior to admission to treatment and for each month during treatment, up to and including the month of termination. For nondropouts, of course, this included a span of 18 months. Group means for the various time frames (per year for pretreatment and per month during treatment) were computed by summing all arrests for those persons completing each time frame and dividing by the number of subjects (Mn). A subject was not included in the calculation for a given month if heishe dropped out of treatment before the month was complete. The “number of arrests per 100 subjects” may be obtained by multiplying the group mean by 100. For the 18-month treatment span these results are reported by quarters; however, the results and conclusions are the same as if they had been reported by each month. For the 5 years of pretreatment the means are reported by year. These results are shown in Tables 1 and 2.
RESULTS AND DISCUSSION As noted, the dropout group has a consistently higher arrest rate than the stay-in group, not only throughout the 18-month treatment span but also during the 5-year pretreatment period. In particular, the difference
ARREST RECORD AND RETENTION IN MMTP
1011
Table 1 Mean Annual Arrests for 5 Years Prior to Entry into MMTP-Patients Completing at Least 78 Months Versus Those Completing Less than 18 Months
Nondropouts Years prior to treatment
Dropouts
N
No. of arrests
Mn"
SD
N
No. of arrests
Mn
SD
r ratio
p
164 164 164 164 164
208 195 170 154 97
1.27 1.19 1.04 0.94 0.59
1.97 1.95 1.63 1.72 1.25
110 110 110 110 110
218 148 127 133 113
1.98 1.35 1.15 1.21 1.03
2.50 1.80 1.94 2.22 1.94
2.61 0.67 0.54 1.13 2.27
.01 .50 59 .26 .02
Subst Use Misuse Downloaded from informahealthcare.com by UB Kiel on 11/07/14 For personal use only.
~~
1 2 3 4 5
~~~
"The rate per 100 subjects may be calculated by moving the decimal two places to the right.
was largest during the year just prior to admission. The fact that there are no reversals (i.e., the dropouts are always higher) during the 5 years also supports the hypothesis of a real difference between the two groups. Among the dropout group, even though their number diminishes during each month of treatment, the arrest rate remains consistently higher than for those remaining in the program. However, it might be asked whether the arrest record was not at least better for those clients who remain in treatment for, say, 1 year. Table 3 notes separately the record for those who remained in the program for up to four quarters (1
Table 2 Mean Arrests by Treatment Quarter' for MMTP Patients Completing at Least 18 Months Versus Those Not Completing 18 Months Nondropouts Treatment quarter completed
N
1 2 3 4 5
164 164 164 164 164
Dropouts
No. of arrests Mnb SD 37 31 25 19 8
0.23 0.19 0.15 0.12 0.05
0.57 0.50 0.46 0.39 0.29
N
No. of arrests
Mn
90 68 55 33 17
47 11 14 12 4
0.52 0.16 0.25 0.36 0.24
SD
t ratio
0.97
3.07 0.39 1.29 2.85 2.27
0.44 0.62 0.70 0.56
p .002 .70 .20 .005 .025
"Includesonly patients completing a full quarter. bThe rate per 100 subjects may be calculated by moving the decimal two places to the right.
McGUIRE
1012
Table 3 Mean Arrests by Treatment Quarterpfor MMTP Patients Completing at Least 78 Months Versus Those Completing 72 Months but Less than 78 Months
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Nondropouts Treatment quarter completed
N
No. of arrests
1 2 3 4 5
164 164 164 164 164
37 31 25 19 8
Dropouts
Mnb SD
N
0.23 0.19 0.15 0.12 0.05
33 33 33 33
0.57 0.50 0.46 0.39 0.29
-
No. of arrests Mn 9 7 8 12 -
0.27 0.21 0.24 0.36
-
SD
t ratio
p
0.57 0.55 0.61 0.70
0.43 0.24 0.96 2.85
.67 .81 .34 .005
-
-
-
“Includes only patients completing a full quarter. bThe rate per 100 subjects may be calculated by moving the decimal two places to the right.
year) but subsequently dropped out during the remaining 6 months. As noted, their arrest record is very like that of the total dropout population and still higher than the arrest record for those who remain in treatment the full 18 months. Therefore, it appears that the dropout population enters the program with a higher level of arrest activity, and when compared with those who remain it stays higher even though it does drop somewhat at entry. It is of interest to note that among the nondropouts the arrest rate during the 1 year just prior to entering treatment was at an annual level of about 127 arrests per 100 subjects, but during the first year of treatment dropped drastically to an annual rate of about 68 arrests per 100 subjects. During the first quarter of treatment the quarterly arrest rate was 23 per 100 and declined steadily to a quarterly rate of 5 per 100. For those 33 subjects who remained in treatment for four quarters but subsequently dropped out, the annual arrest rate during the 1 year prior to treatmznt was 150 per 100, compared with 103 per 100 during the first year of treatment. During their first quarter of treatment their quarterly arrest rate was 27 per 100 but, unlike the stay-ins, it remained comparatively stable throughout the four quarters, ranging from 21 to 36 arrests per 100. Therefore, it appears that while entering treatment accompanies an initial drop for this group, it is not progressive as in the case of the stay-ins. The fact that eventual dropouts have a higher arrest record before and during treatment suggests that they are a “different breed of cat” and that the stay-in group may have entered treatment with a “built-in” bias
ARREST RECORD A N D RETENTION IN MMTP
1013
Subst Use Misuse Downloaded from informahealthcare.com by UB Kiel on 11/07/14 For personal use only.
toward positive response; it is possible that these people would have improved in any kind of program. It therefore remains to identify what constitutes the most cost-effective approach. For example, simple dispensing of methadone may have produced similar results with this stay-in group at a much lower cost, while the dropouts may have been more successful in a more intensive counseling and supervision format. Future research may therefore be fruitful if directed toward the identification of groups with differing potential for retention and experimenting with different approlzches to each. ACKNOWLEDGMENTS
For assistance in gathering and processing these data, appreciation is expressed to Ronald Kersh, Olivia Mulrain, Kathleen Higgins, Ernest Kuncel, and Patricia Messinger of the Orange County Mental Health Department. Views expressed are not necessarily those of that department nor should endorsement be inferred. REFERENCES CLEVELAND, W., BOWLES, B., and HICKS, W. Outcomes of methadone treatment of 300 inner city addicts. Public Health Rep. 89: 563-568, 1974. SECHREST, D.K., and DUNCKLEY, T.E. A one-year followup of methadone patients on drug use, criminal behavior, and wages earned. Natl. ConJ Methadone Treatment 2: 290-303, 1973.
