Increased availability and the high purity of heroin in the New York area have greatly increased demands for methadone services by former as well as new patients, at the same time that serious problems confront the effective delivery of services. Not only do patients enter and leave treatment in """"""""revolving door"""""""" fashion, but also diversion of medication, loitering, and polydrug abuse among patients is widespread. This treatment research proposal is based on a three-state study of methadone programs and their problems (TRISEP); and tests three experimental treatment models based on a factorial design. Models vary on dimensions of patient governance and treatment contracting in relation to treatment options. These two independent variables were identified as intimately related to problems in effective delivery of methadone services. Treatment issues (our dependent variables or outcome measures) include recruitment to and length of stay in treatment, loitering, diversion of medication, polydrug-abuse, among others. We vary dimensions of governance and treatment contracting among four clinics matched according to clinic size, staff, patient composition, etc. These clinics are based on: community governance only (1); individual treatment contracting only (2); both governance and contracting (3); neither governance nor contracting but with treatment options (4, a traditional clinic). Clinics are monitored at three-month intervals over an eighteen month period on eighteen different outcome measures. Progessional staff and indigenous fieldworkers observe and record behavioral interactions which complement data analysis based on data collection utilizing survey instruments, statistical files, and other quantitative information. Models are evaluated and compared as to therapeutic efficacy based on outcome measures. Officials of state agencies are provided study results for possible implementation.
