There is compelling evidence that treatment factors other than an adequate dose of methadone contribute to improved outcomes. In particular, the quality of the therapeutic relationship between treatment providers and client is important. Where clients are treated respectfully, with regard to their dignity, autonomy and privacy, the outcomes of treatment are likely to be improved. In addition, some formal processes are of value.

Social services

  • Multiple social problems are common among opioid dependent people.

  • A history of physical, sexual and emotional abuse is prevalent among opioid dependent people, particularly for female clients and may have a negative impact on treatment outcome.

  • Providing reinforcement and referral to vocational, financial, housing and family assistance contributes positively to the progress of treatment.

Counselling

  • Counselling should not be mandatory within methadone programs, however, there is evidence that access to counselling as an adjunct to MMT improves the effectiveness of MMT and is associated with greater retention in treatment and reduced use of illicit opioids.

  • Therapeutic tools such as motivational interviewing, relapse prevention and social skills training have been associated with improved outcomes.

  • All ancillary services should be provided on the basis that the patient freely consents to be involved.
NOTE: For further information on counselling strategies see Jarvis T, Tebbutt J & Mattick R (1995) Treatment Approaches for Alcohol and Drug Dependence. Sussex, England: John Wiley and Sons.
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