Predicting Community-based Methadone Maintenance Treatment (MMT) Outcome

This was a retrospective study of a community-based methadone maintenance treatment (MMT) program in Toronto. Participants (N = 170) were federally sentenced adult male offenders admitted to this voluntary program between 1997 and 2009 while subject to community supervision following incarceration. The primary investigation examined correlates of treatment responsivity, with principal outcome measures including MMT clients’ rates of: (i) illicit drug use; and (ii) completion of conditional (parole) or statutory release (SR). For a subset (n = 74), recidivism rates were examined after a 9-year interval. Findings included strong convergent evidence from logistic regression and ROC analyses that an empirically and theoretically derived set of five variables was a stable and highly significant (p half of the total variance explained by the five-factor model and increasing the estimated odds of successful release outcome by > 15-fold. Also, when in the MMT program, clients' risk taking behaviour was significantly moderated, with low overall base rates of illicit drug use, yet the rate of parole/SR revocation (71%) was high. The 9-year follow-up showed a high mortality rate (15%) overall. Revocation of release while in the MMT program was associated with a significantly higher rate and more violent recidivism at follow-up. Results are discussed within the context of: (a) Andrews' and Bonta's psychology of criminal conduct; (b) the incompatibility of a harm reduction treatment model with an abstinence-based parole decision-making model; (c) changing drug use profiles among MMT clients; (d) a strength-based approach to correctional intervention focusing on educational and vocational retraining initiatives; and (e) creation of a user friendly case-based screening algorithm for prediction of release outcome for new releases.Ph