Candid Descriptions of the Six Programs

Abstract

From the outset of the study, it was recognized that detailed descriptions of how numerous methadone maintenance programs operate were needed. Preliminary visits to dozens of sites revealed not only that program characteristics and treatment procedures varied widely among individual programs but that, for the most part, the black box of treatment included a descriptive void as well as research neglect. Furthermore, it was found that city, state, and federal regulations did not reflect what occurred at the programs. At best, these regulations provided rough guidelines to follow; at worst, they were inappropriate or out-of-date bureaucratic rules. In practice, the regulations were often merely heuristic statements about what should be done. Another reason why accurate descriptions seemed necessary was the almost total dearth of publications about how contemporary methadone treatment clinics function, although a few partial program descriptions are available.^1–3 The black box of treatment remained closed.