The effectiveness of methadone maintenance treatment in reducing opiate use solidly established. However methadone maintenance treatment is being called upon to address a variety of public health issues which were not integrated into its original design or purpose: AIDS prevention, poly drug abuse, indigence and homelessness, severe mental illness. These issues require a comprehensiveness in approach that reaches beyond the administration of methadone and basic psychotherapeutic counseling. Many studies have focused on changing the administration of the modality: changes in dosage schedules, less or more counseling, increased medical care -few have dealt with a fundamental structural change which would address the greater broadbased needs of patients. Some studies have suggested that vocational rehabilitation with a focus on total lifestyle changes would have a broader impact on patients lifestyles and intervene in issues which impact on multiple drug use, AIDS risk behaviors, mental health and socio-economic status. Vocational rehabilitation has been studied as an adjunct to treatment and/or on a short term basis. This project will evaluate vocational rehabilitation as a central feature of treatment on a long term basis utilizing a prospective, random assignment evaluation over a five pear period. Patients will be placed in traditional methadone maintenance or the comprehensive vocational enhanced treatment program (CVEP). The CVEP will utilize the traditional model as a base but provide a client with a seven stage rehabilitation program on an outpatient basis beginning with basic education and lifestyle issues and culminating in job placement and career development. Two hundred clients will be assigned to each of two study groups. The two groups are located in two administratively related treatment program. Patients will be chosen from newly admitted patients as well as patients who have been in treatment. The total sample size is 400 patients. All patients will be evaluated using a battery of instruments at the beginning of the intervention and the completion. In addition patients will be evaluated on select measures appropriate to the level they have achieved throughout the study. Provision has been made to follow those who leave treatment. Major outcomes will be measured in terms of retention, drug use, employment, AIDS risk behaviors and utilization of services.
