| [Objectives] To understand the clinical characteristic and drug use related problems in patients in methadone maintenance treatment; to evaluate the effectiveness of cognitive behavioral therapy which added to the methadone maintenance treatment and to explore the predictor factors related to the retention in methadone maintenance treatment.[Methods](1) The self-designed questionnaires, Addiction Severity Index(ASI),Methadone Knowledge Scale(MKS), Self Efficacy Scale(SES), Perceived Stress Scale(PSS) and Beck Depression Inventory(BDI) were used to collected the data of demographic characteristic, drug use related problems and mental health.(2) 240 patients were randomly assigned to either the standard methadone maintenance treatment(control group) or cognitive behavioral therapy plus the standard methadone maintenance treatment(intervention group) for a period of 26 weeks in the prospective, randomized controlled trial. Retention rates, drug use, drug-related problems and patients’ mental health were assessed by standardized measurements at the end of 12 thweek and at the end of 26 thweek after the intervention.(3) Patients were divided into the retention group(n=144) and the drop-out group(n=144)according to their retention status during 26 weeks. Differences of methadone dosage and plasma level of methadone, and other variables were compared between the two groups. Cox regression analysis was used to identify predictors for methadone maintenance treatment retention.[Results](1) Patients in the methadone maintenance treatment had a chronic history of heroine use, and their average period of drug use was 9.45±4.48 years.Employment was most severely impaired area, and the average employment composite score on ASI were 0.57±0.26. Faulse answer rate of methadone treatment were high among MMT patients. They had low level of self-efficacy with average SE scores of 25.76±3.45, had depression with average BDI scores of 19.53±12.41 and had high level of stress with average PSS scores of 18.46±4.59. No differences were found on retention rates at the 26 thweek after intervention between control and intervention group(64.2% vs.55.8%; p>0.05). Compared to control group, the intervention group had higher rate of negative morphine urine test at both the 12 th week(0.69±0.28 vs. 0.59±0.35; p<0.05) and the 26thweek(0.73±0.29 vs.0.63 ±0.37;p<0.05) follow-up point. The composite scores of the ASI decreased at the 26 thweek follow-up point compared to baseline in both groups, with greater decrease on ASI employment composite scores in the intervention group than the control group(0.45±0.27 vs. 0.55±0.24; p<0.05). Knowledge of methadone treatment had been improved at the 26 thweek follow-up point compared to baseline in both groups(p<0.05). Knowledge of methadone treatment length had been improved among patients in the intervention group at the 6th follow-up point compared to the baseline(p<0.05). The scores on PSS and BDI decreased at the 26 thweek follow-up point compared to baseline in both groups. The intervention group had more decrease on PSS total scores than the control group(15.51±5.02 vs. 17.13±5.12; p<0.01).(3)Compared to the drop-out group, the retention group had a higher methadone dosage(51.97±21.32 vs. 43.55±20.80; p<0.05), and higher total trough plasma level(239.16±142.62 vs. 177.93±112.28; p<0.01), free trough plasma level(13.68±8.71 vs.9.37±5.27; p<0.01), total peak plasma level(363.43±212.34 vs. 291.37±157.40;p<0.01) and free peak plasma level(20.84±12.59 vs. 5.46±7.94; p<0.01) of methadone. Compared to the retention group, the drop-out group had higher plasma peak/trough ratio of methadone(1.90±0.84 vs.1.63±0.66; p<0.05). The mean dosages of methadone were negatively correlated with drop-out from MMT(p<0.01). The mean dose and trough plasma level of methadone for effective retention in MMT were45 to 60 mg per day and 150 to 250ng/ml respectively.[Conclusion] MMT patients are all chronic heroin dependent patients, with many drug related psychosocial problems and dysfunctional cognitions towards methadone maintenance treatment. The additional cognitive behavioral therapy to methadone maintenance treatment have efficacy on decreasing heroin use, improving employment functioning and decreasing stress level, enhancing patients’ knowledge about methadone maintenance treatment length. The mean methadone dosage is a predictor for methadone maintenance treatment retention. Better retention in the methadone maintenance treatment can be achieved with higher mean dosages and plasma level of methadone. |
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