International Journal of the Addictions
ISSN: 0020-773X (Print) (Online) Journal homepage: http://www.tandfonline.com/loi/isum19
Attitudes of Community Members toward Methadone Maintenance Treatment Anthony C. Pugliese, Leslie R. Cohen & Susan B. Greenberg To cite this article: Anthony C. Pugliese, Leslie R. Cohen & Susan B. Greenberg (1975) Attitudes of Community Members toward Methadone Maintenance Treatment, International Journal of the Addictions, 10:3, 373-385, DOI: 10.3109/10826087509026721 To link to this article: http://dx.doi.org/10.3109/10826087509026721
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The International Journal of the Addictions, 10(3), 373-385, 1975
Attitudes of Community Members toward Methadone Maintenance Treatment Anthony C. Pugliese, Ed.D. Leslie R. Cohen, B.S. Susan B. Greenberg, B.S. Methadone Clinic Middlesex County Drug Abuse Clinic Roosevelt Hospital Metuchen. New Jersey
This study was designed to investigate individual attitudes of community members toward the issues of methadone maintenance treatment. It is also an attempt to provide evidence for the need of public drug education programs concerning methadone maintenance, not only for schools and children, but for parents and family. 373 Copyright 0 1975 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.
314
PUGLIESE, COHEN, AND GREENBERG
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INT R 0DUCTI 0N Methadone maintenance is still relatively controversial both to the professional and the layman. The authors wanted to assess the public’s knowledge of methadone treatment and to investigate the inherent misconceptions that the public might hold about the ex-addicts being maintained on methadone, and what leads to acceptance. Methadone maintenance, as a treatment for heroin addiction, is aimed at rehabilitatingJhe addict; enabling him to become a responsible member of society, capable of holding a steady job, and living as a productive citizen in the community. This must be accompanied with community acceptance of the treatment process, and specifically the methadone maintenance patient. One of the most important forms of acceptance for the ex-addicts’ rehabilitative needs is the availability of employment, where the ex-addict, when given the opportunity, may reintegrate into society with his own skills. However, with the current ambivalance of negative attitudes toward the addict, it is difficult for this process of reintegration to occur. Of course, this acceptance cannot occur instantaneously, but with increased drug education and understanding, negative attitudes can be mitigated. Despite the huge sums of money allocated for drug education programs, individual negative attitudes toward the drug abuser are dramatically increasing each year, and while rehabilitation occurs, the misconceptions still prevail. For this reason it is essential that the public begins to understand and perhaps accept the methadone treatment process and learn more about its goals. The authors assumed that the more knowledgeable people are about the methadone program, the more positive would be their attitudes toward the ex-addict. The public taxpayer would tend to consider these programs as worthwhile tax expenditures, refer more addicts for treatment, extend greater employment opportunities, and view methadone maintenance as a method to reduce crime. It is our contention that this greater understanding can only come through the process of education.
REVIEW OF LITERATURE Research of methadone maintenance has found that the majority of methadone patients are capable of holding jobs and doing manual labor (Dole, 1970).Further research has provided evidence that a high percentage of patients receiving treatment stop their use of illicit drugs (Jaffe, 1970). Methadone maintenance treatment for heroin addiction has facilitated
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ATTITUDES TOWARD METHADONE MAINTENANCE TREATMENT
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the rehabilitation of thousands of patients (Cushman and Dole, 1973). The treatment programs offering free medication can eliminate the need and desire for illicit drugs and in turn alter drug traffic. Thus, by removing the addict from the drug subculture, patients can strive to overcome the liabilities of their addiction experience, return to complete their education, increase their skills, establish families, and become productive and law-abiding citizens. Methadone maintenance should, perhaps, more properly be considered an effective palliative measure against heroin addiction and, quite obviously, not a curative one, not only because the drug itself is addictive, but because it does not produce total sustained abstinence from heroin in all patients. Methadone maintenance is not enough. Medically it has been proven to relieve the addicts’ drug hunger and enable him to function normally. Socially, however, the addict must depend upon the community’s acceptance of him and his treatment. The program demands that the individual surrender his past addictive lifestyle and function in a “socially productive manner” in the community (Dole et al., 1968).
RESEARCH PR 0 POSAL The problem to which this study has been directed is toward the question: Will the individual increase his/her acceptance of methadone patients back into society if his/her understanding of the methadone treatment program is increased? With this question in mind, we have hypothesized that : 1. The greater one’s understanding, the more positive one’s attitudes will be toward the program and the ex-addict. 2. The greater one’s understanding, the higher one’s level of acceptance will be. 3. The more positive one’s attitudes are, the more likely an increase in acceptance will occur.
The variables we have decided to test with regard to their influence on attitudes, understanding, and acceptance are age, education levels, understanding, attitude, and acceptance. Some of these variables (concepts) may not be clear as to meaning with regard to their use in this study. According to this study, “understanding” is defined as the variable referring to the amount of knowledge an individual says he/she has about the
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PUGLIESE, COHEN, AND GREENBERG
methadone maintenance treatment program. The variable “acceptance” pertains to a positive or negative attitude or an affirmative action that the individual (interviewee) has toward the methadone patient and the program’s efforts. “Attitude(s)” is defined to mean either positive or negative beliefs (responses). “Level of education,” as a variable, has been broken up into three categories (50 and over, 49 to 31, and 30 and under), and is used as a factor related to the amount of one’s understanding. Many of the variables are interrelated. The relationships between the variables can best be seen in the following model; these are hypothesized directional relationships. EDUCATION,
, , , , , ,
AGE
\
UNDERSTANDING
\
1/ ATTITUDE
ACCEPTANCE
This model assumes an interrelationship between the variables of education, age, understanding, attitudes, and acceptance. For example, we have predicted that understanding would influence attitude, which would influence acceptance. It was also predicted that: 1. Education will influence understanding. 2 . Age will influence understanding and attitudes. 3. Attitudes will influence acceptance.
RESEARCH DESIGN The 34 demographic and attitude items on the questionnaire were constructed through a review of sociological research literature dealing with drug use and abuse. Two hundred interviews were collected by the authors from community members randomly chosen in parks, shopping centers, waiting rooms, employment lines, and corporations throughout Middlesex County, New Jersey. The interviewees were told that the survey was both voluntary and confidential, and that they were free to refrain from answering any questions they wished. The interviewers stressed that the study could help lead to improvements in the treatment of drug addiction. The refusal rate was
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less than 1%, and most of the respondents answered all of the questions. The variables in this study are measured by several of the questions on the interview ; all were either yes-no or multiple-choice questions. There were no open questions for these variables. Education level was determined by asking the person to designate his/her level according to the various levels of education listed on the questionnaire. Age was determined in the same fashion. Understanding was determined on the basis of answers to the following question:
Do you consider your understanding of the treatment of heroin addiction with methadone maintenance as good, fair, or poor? To test this understanding, we had asked a true/false question : Methadone maintenance programs are connected with the rehabilitation of heroin addicts. Positive or negative attitudes toward the program and ex-addict were determined on the basis of answers to the following questions : 1. Do you feel that methadone programs are a waste of tax dollars ? Yes/No 2. Do you feel that methadone programs will reduce crime rates? YesINo
Acceptance was determined in the same fashion, except that two other questions were asked:
1. Would you hire a methadone treated patient? 2. Would you refer a heroin addict to a methadone clinic? There were several questions geared to finding out opinions on drug abuse, including the following: 1.
Who or what do you believe initiates youth into the drug culture ? a. b. c. d.
curiosity peer group pressure parents pushers
PUGLIESE, COHEN, A N D GREENBERG
318
e. mass media f. other 2. In your opinion, heroin addiction should be treated as:
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a. medical b. social c. criminal problem
3. What do you feel is the most effective measure to solve drug problems ?
a. increase legal penalties b. improve drug education c. wage war on illicit drug traffic
FINDINGS The results for the questions geared to find out opinions on drug abuse (Questions 1, 2, and 3 above) were as follows: 1. Curiosity and peer group pressure were the two major initiators introducing youth into the drug culture (Table 1). 2. The overall response to this question was that most of the sample felt that heroin addiction should be treated as a medical problem (Table 2). 3. The most effective measure sought was to improve drug education, followed by waging war on illicit drug traffic (Table 3). The results to the true/false question (intended to show a general understanding or knowledge of the methadone program) show an overwhelming response of 92.8% of the total sample, indicating that methadone programs are connected with the rehabilitation of heroin addicts. The frequencies for the variables used in this study are given in Table 4. Table 1 Initiators of Youth into the Drug Culture
Curiosity Peer group pressure Parents Pushers Mass media Other
36.7 % 36.7 2.2 11.2 10.4 2.8 100.0%
ATTITUDES TOWARD METHADONE MAINTENANCE TREATMENT
379
Table 2 Treatment of Heroin Addiction
64.2 % 30.0 5.8
Medical problem Social problem Criminal problem
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100.0%
Table 3 Measures to Solve Drug Problems ~~
Increase legal penalties Improve drug education Wage war on illicit drug traffic Total responses
16 94 90 200
Table 4 Frequencies
Variables
Measures
Total number
_____________
Good, 22 %
Understanding
Fair, 41 %
Poor, 37 %
200
Attitudes 1. Waste taxes 2. Reduce crime
Yes 20 % 62%
No 38 %
200 200
Acceptance 1. Refer 2. Hire
79 % 75 %
21 % 25 %
200 200
Age Education
50 and over, 52
80 %
49 to 31, 68 30 and under, 80
Graduate, 23 College, 59 High School, 108 Grade, 10
200 200
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380
Initially it had been hypothesized that there would be a relationship between an individual’s education level and the amount of knowledge one had about the treatment program. The hypothesis states that education is related to or influences one’s understanding (Table 5). The findings seem to indicate that their relationship is not significant, and for this variable we must therefore conclude that education does not influence one’s understanding. It had been hypothesized that there would be a relationship between age and understanding, and a relationship between age and attitudes (Table 6 ) . But what was in fact found was that these relationships are not significant at the .05 level either (Table 7). Two of the hypotheses have been proven false as evidenced by Tables 5-7. It appears that age and education do not significantly influence understanding and that age does not influence attitude. We were now interested in seeing if understanding influenced attitudes. Table 5 Cross Tabulation of Education Level by Understandinga
Gradyate,
a
A
A
17 43 40
34 42 24
42 42 16
60 30 10
75 83 42
23
59
108
10
200
A
Poor Fair Good Total number =
Total number
%
Understanding
Chi square
Education level College, HighoSchool, Grfde,
10.2, 6 df. Table 6 Cross Tabulation of Age by Understanding’
Understanding
a
50+, %
49 to 31, %
30 and under, %
Total number
Poor Fair Good
40 42 18
37 45 18
36 38 26
74 83 26
Total number
52
68
80
200
Chi square
=
2.306, 4 df.
ATTITUDES TOWARD METHADONE MAINTENANCE TREATMENT
38 1
Table 7 Cross Tabulation of Age by Attitude (Waste Taxes)”
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Attitude (Waste Taxes)
a
Age
%
50+,
49 to 31,
%
30 and under,
% Total number
Yes No
20 80
21 79
16 84
31 159
Total number
50
68
78
196
Chi square
=
0.4261, 2 df.
It was hypothesized that the greater one’s understanding, the more positive one’s attitudes will be toward methadone (Table 8). Both of these measures seem to indicate that our hypothesis is true. (The relationships for both measures are very significant.) Since this relationship was found to be true, we then went on to test the hypothesis that the greater one’s understanding, the higher one’s level of acceptance will be (Table 9). Both of these measures were found related but not significant, Only the relationship between understanding and referring was found to be significantly greater than .05. (We still maintain our original hypothesis that understanding influences acceptance.) We next wanted to test our hypothesis that the more positive one’s attitudes are, the more likely an increase in acceptance will occur (Tables 10 and 11). Tables 8-1 1 indicate that attitudes do in fact influence acceptance, and all are found to be significantly greater than .01 and .001. Table 8 Cross Tabulation of Understanding by AttitudeQ
Understanding Poor, %
Attitude
a
Fair, %
Good, %
Waste taxes
Yes No
68 32
87 13
93 7
Reduce crime
Yes No
55 45
32 68
20 80
Chi square
=
13.792, 2 df. Chi square = 14.78,2 df.
PUGLIESE, COHEN, AND GREENBERG
382
Table 9 Cross Tabulation of Understanding by Acceptancea
Understanding Poor, %
Fair, %
No Yes
30 70
17 83
90
No Yes
32 68
26 74
14 86
Acceptance Refer
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Hire Chi square
= 7.6903,
2 df. Chi square
=
Good, % 10
4.531, 2 df.
Table 10 Cross Tabulation of Attitudes by Acceptance"
Attitudes (reduce crime)
a
Refer
No Yes
7 93
41 59
Hire
No Yes
33 67
22 86
Chi square = 21.409, 1 df. Chi square
=
35.398, 1 alf.
Table 11 Cross Tabulation of Attitudes by Acceptancea
Attitudes (waste taxes) Acceptance
No, %
Yes, %
Refer
No YeS
14 86
43 51
Hire
No Yes
21 79
44 56
"Chi square = 15.03, 1 df. Chi square
=
8.1333, 1 df.
ATTITUDES TOWARD METHADONE MAINTENANCE TREATMENT
383
SUMMARY
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Of the variables studied and the relationships tested, only several were found to be not significant. Education level showed no significant relationship to understanding, nor does age affect understanding and attitude. Understanding significantly influenced attitude, although its relationship to acceptance is marginal. Attitude was also shown to affect acceptance. These relationships can be clearly seen by the following model :
.
\ .9,,,,,,,,
UNDERSTANDING \
ATTITUDE The general findings uncover a positive reaction toward methadone maintenance treatment aimed at the rehabilitation of addicts. An important factor in the study dealt with the individual’s response to the question of his/her understanding of methadone programs and its interrelationships between the positive attitudes toward the treatment. We predicted that those with a high level of understanding would have a more positive attitude toward the treatment. It was found that of those who stated they had a good understanding of methadone maintenance, 90% thought it was a useful measure and worth an expenditure of tax dollars. Seventy-six percent of those with good understanding felt the methadone programs reduced crime, and 90% of them stated they would refer addicts to the methadone clinics. They were also the group with the most positive attitude toward employing the ex-addict, with 86% stating they would hire a methadone patient. These figures were significantly different than those obtained from the group that stated their understanding of methadone treatment was poor. One might then speculate that the increase in knowledge of the programs caused a decrease in misconceptions, and thus a more realistic, while less stigmatic, view of the ex-addict. This would entertain a more positive approach toward reintegration into society and the opportunity to live “a normal life.” It is significant to note that the questions, without testing for relationships between two variables, gave an indication of the populace opinion. The response was favorable; 81% felt that the programs are not wasting tax dollars. A majority (62%) concur that these programs can
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PUGLIESE, COHEN, AND GREENBERG
reduce crime, and 79% stated that they would refer people to the methadone clinics. “If that can help, I’ll send them,” they responded. A surprising factor was the hiring question, which in this study was very significant. The data reveals that 75% of the sample would hire a methadone patient (a hopeful outlook for the addict who needs a job). This, however, was in comparison to only 28% of employers (in the same geographic area sent an anonymous questionnaire) who stated they would hire methadone patients (Pugliese, 1974). In looking at the results from a sociocultural problem rather than an employment problem, our sample was more apt to hire the ex-addict, whereas if the sample had been drawn from a greater number of employers, the responses may have been different. (It should be noted that an anonymous questionnaire could provide a n easier method for giving a negative response, which can be more difficult to do in a face-to-face interview.) Pugliese also found that of the employees interviewed at Roosevelt Hospital, New Jersey, 68% would hire a methadone patient, coinciding with our findings. An interesting factor was the finding that the understanding of methadone programs by the sample was mostly rated as fair or poor, in accord with the fact that more education was desired and needed as an effective measure against drug abuse. The general findings have uncovered a favorable climate toward the methadone program efforts and give an affirmative hope for the reintegration of ex-addicts back into society. However, the results also reveal an indispensible need for further drug education efforts for increased understanding of the drug abuse problem and the methadone maintenance treatment. The federal government spends thousands of dollars per drug arrest for rehabilitation and to maintain a drug addict on methadone, but this program can only be effective when the addicts are removed from their old life patterns and given a chance. It is our contention that this can only occur by educating the public (increasing their understanding) to the facts about drug addiction and methadone maintenance treatment.
R ECOM M EN DATl0 NS The methadone treatment program must successfully establish open lines of communication with other community agencies, with influential community leaders, and with the mass media. The most potent weapon in the community education program is the
ATTITUDES TOWARD METHADONE MAINTENANCE TREATMENT
385
individual patient or client served by the agency. A consultant skilled in community relations working with this paraprofessional can be a vital part of a team in a community education program.
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REFERENCES CUSHMAN, P., and DOLE, V. Detoxification of rehabilitated methadone maintained patients. J. Amer. Med. Assoc. 226(7): 262-269, November 12, 1973. DOLE, P. Research on methadone maintenance treatment. Intern. J . Addictions 5(1): 359-379, 1970. DOLE, P., NYSWANDER, M., and WARNER, A. Successful treatment of 750 criminal addicts. J . Amer. Med. Assoc. 206: 2708-271 1, 1968. JAFFE, J. H. Further experience with methadone in the treatment of narcotics users. Intern. J . Addictions 5(1): 375-389, 1970. PUGLIESE, A. A Sttidy of Ex-Heroin Addicts in a Methadone Treatment Program and Their Employability. Unpublished Doctoral Dissertation, Rutgers Univ., 1971.
ISSN: 0020-773X (Print) (Online) Journal homepage: http://www.tandfonline.com/loi/isum19
Attitudes of Community Members toward Methadone Maintenance Treatment Anthony C. Pugliese, Leslie R. Cohen & Susan B. Greenberg To cite this article: Anthony C. Pugliese, Leslie R. Cohen & Susan B. Greenberg (1975) Attitudes of Community Members toward Methadone Maintenance Treatment, International Journal of the Addictions, 10:3, 373-385, DOI: 10.3109/10826087509026721 To link to this article: http://dx.doi.org/10.3109/10826087509026721
Published online: 03 Jul 2009.
Submit your article to this journal
Article views: 1
View related articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=isum19 Download by: [McMaster University]
Date: 06 April 2016, At: 23:59
Downloaded by [McMaster University] at 23:59 06 April 2016
The International Journal of the Addictions, 10(3), 373-385, 1975
Attitudes of Community Members toward Methadone Maintenance Treatment Anthony C. Pugliese, Ed.D. Leslie R. Cohen, B.S. Susan B. Greenberg, B.S. Methadone Clinic Middlesex County Drug Abuse Clinic Roosevelt Hospital Metuchen. New Jersey
This study was designed to investigate individual attitudes of community members toward the issues of methadone maintenance treatment. It is also an attempt to provide evidence for the need of public drug education programs concerning methadone maintenance, not only for schools and children, but for parents and family. 373 Copyright 0 1975 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.
314
PUGLIESE, COHEN, AND GREENBERG
Downloaded by [McMaster University] at 23:59 06 April 2016
INT R 0DUCTI 0N Methadone maintenance is still relatively controversial both to the professional and the layman. The authors wanted to assess the public’s knowledge of methadone treatment and to investigate the inherent misconceptions that the public might hold about the ex-addicts being maintained on methadone, and what leads to acceptance. Methadone maintenance, as a treatment for heroin addiction, is aimed at rehabilitatingJhe addict; enabling him to become a responsible member of society, capable of holding a steady job, and living as a productive citizen in the community. This must be accompanied with community acceptance of the treatment process, and specifically the methadone maintenance patient. One of the most important forms of acceptance for the ex-addicts’ rehabilitative needs is the availability of employment, where the ex-addict, when given the opportunity, may reintegrate into society with his own skills. However, with the current ambivalance of negative attitudes toward the addict, it is difficult for this process of reintegration to occur. Of course, this acceptance cannot occur instantaneously, but with increased drug education and understanding, negative attitudes can be mitigated. Despite the huge sums of money allocated for drug education programs, individual negative attitudes toward the drug abuser are dramatically increasing each year, and while rehabilitation occurs, the misconceptions still prevail. For this reason it is essential that the public begins to understand and perhaps accept the methadone treatment process and learn more about its goals. The authors assumed that the more knowledgeable people are about the methadone program, the more positive would be their attitudes toward the ex-addict. The public taxpayer would tend to consider these programs as worthwhile tax expenditures, refer more addicts for treatment, extend greater employment opportunities, and view methadone maintenance as a method to reduce crime. It is our contention that this greater understanding can only come through the process of education.
REVIEW OF LITERATURE Research of methadone maintenance has found that the majority of methadone patients are capable of holding jobs and doing manual labor (Dole, 1970).Further research has provided evidence that a high percentage of patients receiving treatment stop their use of illicit drugs (Jaffe, 1970). Methadone maintenance treatment for heroin addiction has facilitated
Downloaded by [McMaster University] at 23:59 06 April 2016
ATTITUDES TOWARD METHADONE MAINTENANCE TREATMENT
375
the rehabilitation of thousands of patients (Cushman and Dole, 1973). The treatment programs offering free medication can eliminate the need and desire for illicit drugs and in turn alter drug traffic. Thus, by removing the addict from the drug subculture, patients can strive to overcome the liabilities of their addiction experience, return to complete their education, increase their skills, establish families, and become productive and law-abiding citizens. Methadone maintenance should, perhaps, more properly be considered an effective palliative measure against heroin addiction and, quite obviously, not a curative one, not only because the drug itself is addictive, but because it does not produce total sustained abstinence from heroin in all patients. Methadone maintenance is not enough. Medically it has been proven to relieve the addicts’ drug hunger and enable him to function normally. Socially, however, the addict must depend upon the community’s acceptance of him and his treatment. The program demands that the individual surrender his past addictive lifestyle and function in a “socially productive manner” in the community (Dole et al., 1968).
RESEARCH PR 0 POSAL The problem to which this study has been directed is toward the question: Will the individual increase his/her acceptance of methadone patients back into society if his/her understanding of the methadone treatment program is increased? With this question in mind, we have hypothesized that : 1. The greater one’s understanding, the more positive one’s attitudes will be toward the program and the ex-addict. 2. The greater one’s understanding, the higher one’s level of acceptance will be. 3. The more positive one’s attitudes are, the more likely an increase in acceptance will occur.
The variables we have decided to test with regard to their influence on attitudes, understanding, and acceptance are age, education levels, understanding, attitude, and acceptance. Some of these variables (concepts) may not be clear as to meaning with regard to their use in this study. According to this study, “understanding” is defined as the variable referring to the amount of knowledge an individual says he/she has about the
Downloaded by [McMaster University] at 23:59 06 April 2016
376
PUGLIESE, COHEN, AND GREENBERG
methadone maintenance treatment program. The variable “acceptance” pertains to a positive or negative attitude or an affirmative action that the individual (interviewee) has toward the methadone patient and the program’s efforts. “Attitude(s)” is defined to mean either positive or negative beliefs (responses). “Level of education,” as a variable, has been broken up into three categories (50 and over, 49 to 31, and 30 and under), and is used as a factor related to the amount of one’s understanding. Many of the variables are interrelated. The relationships between the variables can best be seen in the following model; these are hypothesized directional relationships. EDUCATION,
, , , , , ,
AGE
\
UNDERSTANDING
\
1/ ATTITUDE
ACCEPTANCE
This model assumes an interrelationship between the variables of education, age, understanding, attitudes, and acceptance. For example, we have predicted that understanding would influence attitude, which would influence acceptance. It was also predicted that: 1. Education will influence understanding. 2 . Age will influence understanding and attitudes. 3. Attitudes will influence acceptance.
RESEARCH DESIGN The 34 demographic and attitude items on the questionnaire were constructed through a review of sociological research literature dealing with drug use and abuse. Two hundred interviews were collected by the authors from community members randomly chosen in parks, shopping centers, waiting rooms, employment lines, and corporations throughout Middlesex County, New Jersey. The interviewees were told that the survey was both voluntary and confidential, and that they were free to refrain from answering any questions they wished. The interviewers stressed that the study could help lead to improvements in the treatment of drug addiction. The refusal rate was
ATTITUDES TOWARD METHADONE MAINTENANCE TREATMENT
377
Downloaded by [McMaster University] at 23:59 06 April 2016
less than 1%, and most of the respondents answered all of the questions. The variables in this study are measured by several of the questions on the interview ; all were either yes-no or multiple-choice questions. There were no open questions for these variables. Education level was determined by asking the person to designate his/her level according to the various levels of education listed on the questionnaire. Age was determined in the same fashion. Understanding was determined on the basis of answers to the following question:
Do you consider your understanding of the treatment of heroin addiction with methadone maintenance as good, fair, or poor? To test this understanding, we had asked a true/false question : Methadone maintenance programs are connected with the rehabilitation of heroin addicts. Positive or negative attitudes toward the program and ex-addict were determined on the basis of answers to the following questions : 1. Do you feel that methadone programs are a waste of tax dollars ? Yes/No 2. Do you feel that methadone programs will reduce crime rates? YesINo
Acceptance was determined in the same fashion, except that two other questions were asked:
1. Would you hire a methadone treated patient? 2. Would you refer a heroin addict to a methadone clinic? There were several questions geared to finding out opinions on drug abuse, including the following: 1.
Who or what do you believe initiates youth into the drug culture ? a. b. c. d.
curiosity peer group pressure parents pushers
PUGLIESE, COHEN, A N D GREENBERG
318
e. mass media f. other 2. In your opinion, heroin addiction should be treated as:
Downloaded by [McMaster University] at 23:59 06 April 2016
a. medical b. social c. criminal problem
3. What do you feel is the most effective measure to solve drug problems ?
a. increase legal penalties b. improve drug education c. wage war on illicit drug traffic
FINDINGS The results for the questions geared to find out opinions on drug abuse (Questions 1, 2, and 3 above) were as follows: 1. Curiosity and peer group pressure were the two major initiators introducing youth into the drug culture (Table 1). 2. The overall response to this question was that most of the sample felt that heroin addiction should be treated as a medical problem (Table 2). 3. The most effective measure sought was to improve drug education, followed by waging war on illicit drug traffic (Table 3). The results to the true/false question (intended to show a general understanding or knowledge of the methadone program) show an overwhelming response of 92.8% of the total sample, indicating that methadone programs are connected with the rehabilitation of heroin addicts. The frequencies for the variables used in this study are given in Table 4. Table 1 Initiators of Youth into the Drug Culture
Curiosity Peer group pressure Parents Pushers Mass media Other
36.7 % 36.7 2.2 11.2 10.4 2.8 100.0%
ATTITUDES TOWARD METHADONE MAINTENANCE TREATMENT
379
Table 2 Treatment of Heroin Addiction
64.2 % 30.0 5.8
Medical problem Social problem Criminal problem
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100.0%
Table 3 Measures to Solve Drug Problems ~~
Increase legal penalties Improve drug education Wage war on illicit drug traffic Total responses
16 94 90 200
Table 4 Frequencies
Variables
Measures
Total number
_____________
Good, 22 %
Understanding
Fair, 41 %
Poor, 37 %
200
Attitudes 1. Waste taxes 2. Reduce crime
Yes 20 % 62%
No 38 %
200 200
Acceptance 1. Refer 2. Hire
79 % 75 %
21 % 25 %
200 200
Age Education
50 and over, 52
80 %
49 to 31, 68 30 and under, 80
Graduate, 23 College, 59 High School, 108 Grade, 10
200 200
PUGLIESE, COHEN, AND GREENBERG
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380
Initially it had been hypothesized that there would be a relationship between an individual’s education level and the amount of knowledge one had about the treatment program. The hypothesis states that education is related to or influences one’s understanding (Table 5). The findings seem to indicate that their relationship is not significant, and for this variable we must therefore conclude that education does not influence one’s understanding. It had been hypothesized that there would be a relationship between age and understanding, and a relationship between age and attitudes (Table 6 ) . But what was in fact found was that these relationships are not significant at the .05 level either (Table 7). Two of the hypotheses have been proven false as evidenced by Tables 5-7. It appears that age and education do not significantly influence understanding and that age does not influence attitude. We were now interested in seeing if understanding influenced attitudes. Table 5 Cross Tabulation of Education Level by Understandinga
Gradyate,
a
A
A
17 43 40
34 42 24
42 42 16
60 30 10
75 83 42
23
59
108
10
200
A
Poor Fair Good Total number =
Total number
%
Understanding
Chi square
Education level College, HighoSchool, Grfde,
10.2, 6 df. Table 6 Cross Tabulation of Age by Understanding’
Understanding
a
50+, %
49 to 31, %
30 and under, %
Total number
Poor Fair Good
40 42 18
37 45 18
36 38 26
74 83 26
Total number
52
68
80
200
Chi square
=
2.306, 4 df.
ATTITUDES TOWARD METHADONE MAINTENANCE TREATMENT
38 1
Table 7 Cross Tabulation of Age by Attitude (Waste Taxes)”
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Attitude (Waste Taxes)
a
Age
%
50+,
49 to 31,
%
30 and under,
% Total number
Yes No
20 80
21 79
16 84
31 159
Total number
50
68
78
196
Chi square
=
0.4261, 2 df.
It was hypothesized that the greater one’s understanding, the more positive one’s attitudes will be toward methadone (Table 8). Both of these measures seem to indicate that our hypothesis is true. (The relationships for both measures are very significant.) Since this relationship was found to be true, we then went on to test the hypothesis that the greater one’s understanding, the higher one’s level of acceptance will be (Table 9). Both of these measures were found related but not significant, Only the relationship between understanding and referring was found to be significantly greater than .05. (We still maintain our original hypothesis that understanding influences acceptance.) We next wanted to test our hypothesis that the more positive one’s attitudes are, the more likely an increase in acceptance will occur (Tables 10 and 11). Tables 8-1 1 indicate that attitudes do in fact influence acceptance, and all are found to be significantly greater than .01 and .001. Table 8 Cross Tabulation of Understanding by AttitudeQ
Understanding Poor, %
Attitude
a
Fair, %
Good, %
Waste taxes
Yes No
68 32
87 13
93 7
Reduce crime
Yes No
55 45
32 68
20 80
Chi square
=
13.792, 2 df. Chi square = 14.78,2 df.
PUGLIESE, COHEN, AND GREENBERG
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Table 9 Cross Tabulation of Understanding by Acceptancea
Understanding Poor, %
Fair, %
No Yes
30 70
17 83
90
No Yes
32 68
26 74
14 86
Acceptance Refer
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Hire Chi square
= 7.6903,
2 df. Chi square
=
Good, % 10
4.531, 2 df.
Table 10 Cross Tabulation of Attitudes by Acceptance"
Attitudes (reduce crime)
a
Refer
No Yes
7 93
41 59
Hire
No Yes
33 67
22 86
Chi square = 21.409, 1 df. Chi square
=
35.398, 1 alf.
Table 11 Cross Tabulation of Attitudes by Acceptancea
Attitudes (waste taxes) Acceptance
No, %
Yes, %
Refer
No YeS
14 86
43 51
Hire
No Yes
21 79
44 56
"Chi square = 15.03, 1 df. Chi square
=
8.1333, 1 df.
ATTITUDES TOWARD METHADONE MAINTENANCE TREATMENT
383
SUMMARY
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Of the variables studied and the relationships tested, only several were found to be not significant. Education level showed no significant relationship to understanding, nor does age affect understanding and attitude. Understanding significantly influenced attitude, although its relationship to acceptance is marginal. Attitude was also shown to affect acceptance. These relationships can be clearly seen by the following model :
.
\ .9,,,,,,,,
UNDERSTANDING \
ATTITUDE The general findings uncover a positive reaction toward methadone maintenance treatment aimed at the rehabilitation of addicts. An important factor in the study dealt with the individual’s response to the question of his/her understanding of methadone programs and its interrelationships between the positive attitudes toward the treatment. We predicted that those with a high level of understanding would have a more positive attitude toward the treatment. It was found that of those who stated they had a good understanding of methadone maintenance, 90% thought it was a useful measure and worth an expenditure of tax dollars. Seventy-six percent of those with good understanding felt the methadone programs reduced crime, and 90% of them stated they would refer addicts to the methadone clinics. They were also the group with the most positive attitude toward employing the ex-addict, with 86% stating they would hire a methadone patient. These figures were significantly different than those obtained from the group that stated their understanding of methadone treatment was poor. One might then speculate that the increase in knowledge of the programs caused a decrease in misconceptions, and thus a more realistic, while less stigmatic, view of the ex-addict. This would entertain a more positive approach toward reintegration into society and the opportunity to live “a normal life.” It is significant to note that the questions, without testing for relationships between two variables, gave an indication of the populace opinion. The response was favorable; 81% felt that the programs are not wasting tax dollars. A majority (62%) concur that these programs can
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PUGLIESE, COHEN, AND GREENBERG
reduce crime, and 79% stated that they would refer people to the methadone clinics. “If that can help, I’ll send them,” they responded. A surprising factor was the hiring question, which in this study was very significant. The data reveals that 75% of the sample would hire a methadone patient (a hopeful outlook for the addict who needs a job). This, however, was in comparison to only 28% of employers (in the same geographic area sent an anonymous questionnaire) who stated they would hire methadone patients (Pugliese, 1974). In looking at the results from a sociocultural problem rather than an employment problem, our sample was more apt to hire the ex-addict, whereas if the sample had been drawn from a greater number of employers, the responses may have been different. (It should be noted that an anonymous questionnaire could provide a n easier method for giving a negative response, which can be more difficult to do in a face-to-face interview.) Pugliese also found that of the employees interviewed at Roosevelt Hospital, New Jersey, 68% would hire a methadone patient, coinciding with our findings. An interesting factor was the finding that the understanding of methadone programs by the sample was mostly rated as fair or poor, in accord with the fact that more education was desired and needed as an effective measure against drug abuse. The general findings have uncovered a favorable climate toward the methadone program efforts and give an affirmative hope for the reintegration of ex-addicts back into society. However, the results also reveal an indispensible need for further drug education efforts for increased understanding of the drug abuse problem and the methadone maintenance treatment. The federal government spends thousands of dollars per drug arrest for rehabilitation and to maintain a drug addict on methadone, but this program can only be effective when the addicts are removed from their old life patterns and given a chance. It is our contention that this can only occur by educating the public (increasing their understanding) to the facts about drug addiction and methadone maintenance treatment.
R ECOM M EN DATl0 NS The methadone treatment program must successfully establish open lines of communication with other community agencies, with influential community leaders, and with the mass media. The most potent weapon in the community education program is the
ATTITUDES TOWARD METHADONE MAINTENANCE TREATMENT
385
individual patient or client served by the agency. A consultant skilled in community relations working with this paraprofessional can be a vital part of a team in a community education program.
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REFERENCES CUSHMAN, P., and DOLE, V. Detoxification of rehabilitated methadone maintained patients. J. Amer. Med. Assoc. 226(7): 262-269, November 12, 1973. DOLE, P. Research on methadone maintenance treatment. Intern. J . Addictions 5(1): 359-379, 1970. DOLE, P., NYSWANDER, M., and WARNER, A. Successful treatment of 750 criminal addicts. J . Amer. Med. Assoc. 206: 2708-271 1, 1968. JAFFE, J. H. Further experience with methadone in the treatment of narcotics users. Intern. J . Addictions 5(1): 375-389, 1970. PUGLIESE, A. A Sttidy of Ex-Heroin Addicts in a Methadone Treatment Program and Their Employability. Unpublished Doctoral Dissertation, Rutgers Univ., 1971.
