This study of adaptations to residential treatment to accommodate residents on methadone found that methadone participants generally used methadone support groups as recommended. Additionally, over half of all methadone participants used acupuncture services. There are no published studies reporting the rate of acupuncture service use among methadone patients, thus it is difficult to evaluate whether this is a high or low rate of use. There are several reports, however, of the use of acupuncture services in methadone treatment, showing mixed results (13
). Methadone patients may have used acupuncture services to alleviate the symptoms of methadone withdrawal or to better cope with psychiatric symptoms. However, an analysis of the prevalence of current psychiatric disorders among methadone patients revealed that 52% of those who used acupuncture services were not more likely to have a current psychiatric diagnosis than the 38% who did not use acupuncture services (p = .09).
With regard to psychiatric services, we found that non-methadone participants were more likely to receive psychiatric treatment than methadone participants. This finding was somewhat surprising, as methadone participants could have potentially benefited from being prescribed medications to ameliorate withdrawal symptoms from methadone tapering. However, it is possible that methadone patients with serious psychiatric conditions may have benefited from the mood stabilizing properties of methadone (18
), thus attenuating the severity of psychiatric symptoms.
This sample had high rates of lifetime and current psychiatric disorders and substance dependence. Most notably, 48% of the sample had a lifetime diagnosis of major depressive disorder and 24% of participants had a current diagnosis of posttraumatic disorder. Additionally, 32% of the entire sample met diagnostic criteria for at least one current psychiatric disorder. These findings are consistent with studies demonstrating unusually high rates of other coexisting psychiatric disorders among people in treatment for substance use disorders (21). However, 22% of participants received onsite psychiatric services suggesting that some who needed these services did not receive them while in the TC. Moreover, the finding of no significant differences in onsite psychiatric services received between those with and without a current psychiatric disorder supports the notion that some who needed psychiatric treatment did not receive it while residing in the TC.
The study has limitations that should be taken into consideration in interpreting findings. Participants may differ from TC residents receiving services in other TC settings in unknown ways. We also did not systematically assess how much psychiatric care participants received outside the TC setting, which could have accounted for between group differences. Additionally, 9% of attendance logs were not made available to study staff. Future research with larger samples may also explore the differential response of subgroups, such as TC residents with opiate dependence versus dependence on other substances of abuse.
Co-occurring psychiatric disorders are highly prevalent in the substance abusing client population (19
); however, most substance abuse treatment programs are not well equipped to treat these patients. Although the best practice for clients with co-occurring disorders is integrated care, many barriers exist that prevent substance abuse treatment programs from adopting this best practice approach. Indeed, in order to implement the “no wrong door” policy of the Center for Substance Abuse Treatment (2005), that clients with co-occurring disorders receive efficacious treatment regardless of point of treatment entry, facilitators and barriers to this treatment approach warrant further exploration (20
). Nonetheless, with adequate resources for program development and trained staff, TCs may be able to enhance their programs to accommodate such patients.