This TIP, Matching Treatment to Patient Needs in Opioid Substitution Therapy, offers guidelines to providers who are working to deliver the best treatment possible to opiate-addicted persons. Patients in this population often need a broad range of services in addition to opioid substitution therapy, and research has shown that providing these services as part of the therapy program greatly increases retention in treatment and improves outcomes. The TIP provides a model for matching patients to services that takes into account the changing needs of patients at different phases of treatment. The TIP outlines a comprehensive assessment process for identifying patient needs and describes core treatment elements for addressing those needs. Because evaluation and self-monitoring are important ways to ensure that programs stay responsive to patient needs, the TIP presents step-by-step guidelines to assist programs in designing and implementing evaluation studies.

Contents

• What Is a TIP?
• Consensus Panel
• Foreword
• Chapter 1 -- Patient Matching: Historical Perspective and Overview
  • Managed Care and Opioid Substitution Therapy
  • Patient Matching
  • Historical Perspective
  • Federal Regulations and Public Policy
  • LAAM
  • Treatment Issues
  • HIV/AIDS and Harm Reduction
  • The Need for Resources
  • Examples of Networking
  • Optimizing Methadone Treatment Outcome: The Challenges
  • Organization of This TIP
• Chapter 2—Assessing Patient Needs
  • Opioid Substitution Therapy
  • Definitions
  • The Preliminary Assessment: Determining Eligibility for Opioid Substitution Therapy
  • Admission to Substitution Therapy
  • Matching Patient Needs for An Array of Services: The Comprehensive Assessment
  • Patient Matching: Two Examples
  • Assessing Patient Progress
  • Conclusions and Recommendations
  • Endnote
• Chapter 3—Phases of Treatment
  • Scope of Treatment Phases
  • Acute Phase
  • Rehabilitation Phase
  • Supportive Care Phase
  • Medical Maintenance Phase
  • Tapering and Readjustment Phase
  • Aftercare Phase
  • Transition Between Phases, Discharge, and Readmission
  • Clinical Issues Throughout All Treatment Phases
  • Conclusions
  • Summary of Recommendations
• Chapter 4—Treatment Elements
  • Overview: Elements of Effective Treatment
  • Staff Roles and Responsibilities
  • Establishing a Methadone Dosage Level
  • Provision of Services
  • Treatment Elements
  • Counseling, Behavioral Treatments, and Psychotherapy
  • Special Considerations in Providing Treatment
  • Conclusions and Recommendations
• Chapter 5—Self-Monitoring and Evaluation
  • Self-Monitoring
  • Program Evaluation
  • Why Evaluate?
  • Goals of Evaluation
  • The Role of Program Philosophy in Evaluation
  • Outcomes and Process Evaluation
  • What Can We Learn From Previous Studies?
  • Getting Ready to Evaluate
  • Steps in Conducting an Evaluation
  • A Hypothetical Evaluation
  • Conclusion
  • Endnote
• Chapter 6 -- Cost-Effectiveness of Opioid Substitution Therapy
  • The Effectiveness of Treatment: Recent Reports
  • Review of Cost-Effectiveness Studies
  • Methods of Estimating Treatment Costs
  • Directions for Future Research
  • Allocation of Resources
  • Program Cost Issues for Administrators and Program Planners
  • Conclusions
  • Endnote
• Appendix A -- Bibliography
• Appendix B —Massachusetts Methadone Treatment Criteria
• Appendix C -- Methodological Approaches to Cost-Efficiency and Cost-Effectiveness Analyses
• Appendix D—Federal Resource Panel
• Appendix E—Field Reviewers

This publication is part of the Substance Abuse Prevention and Treatment Block Grant technical assistance program. This publication was written under contract number ADM 270-91-0007 from the Center for Substance Abuse Treatment of the Substance Abuse and Mental Health Services Administration (SAMHSA). Sandra Clunies, MS, served as the CSAT Government project officer. Robert A Lubran, MS, MPA, was the Government content advisor. Writers were Carolyn Davis, Alan Gambrell, Constance Gartner, MA, Linda Harteker, Randi Henderson, and Deborah Shuman.

The opinions expressed herein are the views of the consensus panel members and do not reflect the official position of CSAT or any other part of the U. S. Department of Health and Human Services (DHHS). No official support or endorsement of CSAT or DHHS for these opinions or for particular instruments or software that may be described in this document is intended or should be inferred. The guidelines proffered in this document should not be considered as substitutes for individualized patient care and treatment decisions.