The influence of prison-based methadone maintenance treatment on
continued treatment of former inmates in the community.
Abstract
Roman Geizer
Background
Substance use disorder is a social phenomenon with grave consequences for the health system,
law enforcement, courts and social services. Methadone maintenance treatment (MMT) as a
treatment mode for opiate (heroin) addiction, allows individuals to control their addiction
problems and function normally within society. MMT programs in the community are
available both in Israel and throughout the world and are known to be effective in achieving a
significant reduction in the use of street drugs. In Israel and elsewhere provision is made for
MMT in prisons, but prison-based MMT is characterized by many problems: inconsistent
treatment, limited treatment duration, lack of understanding of treatment objectives by both
inmates and treatment staff. Not the least of these is the psychological impact of incarceration
and the consequential possibility of it affecting treatment outcomes when methadone
maintenance treatment is continued in the community.
Methods
This study examines the hypothesis that the population of patients receiving MMT in prison
and who continue treatment within the community will show poorer treatment outcomes in the
community as measured by retention rates and drug abuse compared to the general population
of MMT patients who did not undergo treatment continuation from prison to community. The
study also assesses the correlates of treatment success in general in the MMT population and
assesses whether these correlations might also be found in the population who received MMT
in prison. Cross-sectional retrospective research design is employed to facilitate comparison
between the former prison population sample and the general sample of patients. The samples
cover 542 patients accepted at the Methadone Community Center in Jerusalem during the years
1991-2007. Data used in relation to randomized urine screening tests for street drugs, two-year
retention rates and demographics were obtained from the Center’s database.
Results
Patients who received continued MMT treatment from prison to community spent on average
fewer days in treatment and used more cocaine during the first year of treatment compared to
the patients that did not receive MMT in prison. No differences between the groups were found
as to the use of opiates, benzodiazepines and the pattern of use of any kind of illicit drugs over
the 2 years period. A small number of demographic factors were found to be correlated to
treatment outcomes, although none of them were distinctive features of the former prison
inmates group.
Conclusions
Prison-based MMT is a risk factor for the continuation of MMT treatment in community. It
can affect negatively treatment tenure in general and abstinence from cocaine during the first
year of treatment. Possible explanations are the long-term implication of deficient and
inadequate methadone treatment in prison along with the psychological impact of incarceration
and institutionalization to the prison environment. The Clinical implication are that MMT
programs should consider the former prison inmates population that received MMT in prison
to be at a high risk for dropping out of treatment. Therefore, increased treatment input and
psychological interventions specifically designed for the needs of this group may reduce
dropout.
The influence of prison-based methadone maintenance treatment
on continued treatment of former inmates in the community.
By: Roman Geizer
Supervised by: Dr. Marc Gelkopf
THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE
REQUIREMENTS FOR THE MASTER DEGREE
University of Haifa
Faculty of Social Welfare and Health Sciences
Department of Community Mental Health
October, 2009
The influence of prison-based methadone maintenance
treatment on continued treatment of former inmates in the
community.
Roman Geizer
THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE
REQUIREMENTS FOR THE MASTER DEGREE
University of Haifa
Faculty of Social Welfare and Health Sciences
Department of Community Mental Health
October, 2009