Because of the emerging epidemic of AIDS and the still unchecked problems of opiate abuse, the need for an effective drug abuse treatment is even more important than in years past. For this reasons some have suggested elimination of a minimum counselor- patient ratio requirement (now 1 to 50) and the reduction in the number of urine specimens required by methadone maintenance programs (now 1 per month). With these liberalized criteria it is argued that more potential clients could be treated and in turn, the risks for continued drug use, crime, and AIDS could be reduced. In contrast, others have argued that the expanded use of methadone, particularly under loosely supervised conditions, could even have adverse effects on those in treatment. This project will test these important arguments in a prospective, random assignment evaluation of three different levels of methadone maintenance treatment provided over a six-month period: A) Minimum Methadone Maintenance (MMM) - Blocking doses of methadone, plus emergency counseling and referral services; but no regular counseling, no privilege contingencies based on urine results and no additional services such as family or employment counseling. B) Basic Methadon Maintenance (BMM) - Blocking doses of methadone, plus regular, supervised counseling and referral services using weekly urine screens as the basis for contingency management of the patient; but no extra services such as family or employment counseling. C) Enhanced Methadone Maintenance (EMM) - All the services described under BMM; plus extra medical/psychiatric care, social work assistance, family therapy and employment counseling designed to develop job-seeking and job-holding skills. These three interventions will be tested for efficacy and cost- effectiveness in two different methadone treatment program: 1) a hospital-based, medically managed program, 2) a stand-alone, non- medically managed, community program: and in two treatment samples: 1) newly admitted patients, 2) patients who have been in treatment for six months. Fifty patients from each of the two samples, will be randomly assigned to each of the three treatment interventions, in each of the treatment programs, for a total sample size of 600 patients over the three-year course of the project. All patients will be evaluated using a battery of instruments at the start of treatment, at 3 and 6-months during treatment, and at 6-month follow-up. Major outcome measures will include drug use, employment, crime, health care utilization, AIDS-related behaviors and the costs of care delivered to each patient during treatment.
