Counseling Staff’s Views of Patient-Centered Methadone Treatment: Changing Program Rules and Staff Roles

  • Shannon Gwin Mitchell
  • Laura B. Monico
  • Elizabeth Lertch
  • Sharon M. Kelly
  • Jan Gryczynski
  • Jerome H. Jaffe
  • Kevin E. O’Grady
  • Robert P. Schwartz


Conflicts with methadone program counseling staff and violations of program rules can contribute to patients leaving treatment prematurely. This qualitative study was conducted as part of a larger trial of patient-centered methadone treatment (PCM). In-depth, semi-structured interviews at baseline and 12-month follow-up were conducted with five counselors and three clinical supervisors from the programs participating in the PCM parent study. Data were analyzed using Atlas.ti. Counselors reported that, in some cases, PCM allowed them to focus on building a therapeutic alliance with patients because they were not addressing program rule issues. Some reported using more pro-active, innovative strategies for engaging PCM patients and that counseling sessions tended to include a broader range of individually tailored topics, compared to topics normally addressed in typical treatment sessions. Adjusting to the new counselor role was challenging for some counselors and required a shift in tactics to encourage patients’ participation in counseling services. Clinical trial registration: NCT 01442493



The study was supported through National Institute on Drug Abuse (NIDA) Grant No. 2R01DA15842 (PI Schwartz).

Compliance with Ethical Standards

Conflict of Interest

Dr. Schwartz in the past provided a one-time consultation to Reckitt-Benckiser, one of the manufacturers of buprenorphine, on behalf of Friends Research Institute. Dr. O’Grady in the past received reimbursement for his time from Reckitt–Benckiser. No financial disclosures were reported by the other authors.


NIDA or the National Institutes of Health had no role in the design and conduct of the study; data acquisition, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.


  1. 1.
    Ball JC, Ross A. The Effectiveness of Methadone Maintenance Treatment: Patients, Programs, Services, and Outcomes. New York, NY: Springer-Verlag, 1991.CrossRefGoogle Scholar
  2. 2.
    Clausen T, Anchersen K, Waal H. Mortality prior to, during and after Opioid Maintenance Treatment (OMT): A National Prospective Cross-Registry Study. Drug and Alcohol Dependence. 2008;94(1–3):151–157.CrossRefPubMedGoogle Scholar
  3. 3.
    Degenhardt L, Randall D, Hall W, et al. Mortality among Clients of a State-Wide Opioid Pharmacotherapy Program over 20 Years: Risk Factors and Lives Saved. Drug and Alcohol Dependence. 2009;105(1–2):9–15.CrossRefPubMedGoogle Scholar
  4. 4.
    Zanis DA, Woody GE. One-Year Mortality Rates Following Methadone Treatment Discharge. Drug and Alcohol Dependence. 1998;52(3):257–260.CrossRefPubMedGoogle Scholar
  5. 5.
    Mitchell SG, Kelly SM, Brown BS, et al. Incarceration and Opioid Withdrawal: The Experiences of Methadone Patients and Out-of-Treatment Heroin Users. Journal of Psychoactive Drugs. 2009;41(2):145–152.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Peterson JA, Schwartz RP, Mitchell SG, et al. Why don’t Out-of-Treatment Individuals Enter Methadone Treatment Programs? International Journal of Drug Policy. 2010;21:36–42.CrossRefPubMedGoogle Scholar
  7. 7.
    Reisinger HS, Schwartz RP, Mitchell SG, et al. Premature Discharge from Methadone Treatment: Patient Perspectives. Journal of Psychoactive Drugs. 2009;41(3):285–296.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Deck D, Carlson MJ. Retention in Publicly-Funded Methadone Maintenance Treatment in Two Western States. Journal of Behavioral Health Services & Research. 2005;32(1):43–60.CrossRefGoogle Scholar
  9. 9.
    Magura S, Nwakeze PC, Demsky SY. Pre- and In-Treatment Predictors of Retention in Methadone Treatment Using Survival Analysis. Addiction. 1998;93(1):51–60.CrossRefPubMedGoogle Scholar
  10. 10.
    Horvath AO, Luborsky L. The Role of the Therapeutic Alliance in Psychotherapy. Journal of Consulting and Clinical Psychology. 1993;61(4):561–573.CrossRefPubMedGoogle Scholar
  11. 11.
    Luborsky L, McLellan AT, Woody GE, et al. Therapist Success and its Determinants. Archives of General Psychiatry. 1985;42(6):602–611.CrossRefPubMedGoogle Scholar
  12. 12.
    Kelly SM, O'Grady KE, Brown BS, et al. The Role of Patient Satisfaction in Methadone Treatment. The American Journal of Drug and Alcohol Abuse. 2010;36(3):150–154.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Schwartz RP, Kelly SM, Mitchell SG, et al. Patient-Centered Methadone Treatment: A Randomized Clinical Trial. Addiction. 2016;112:454–464.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Friese S. ATLAS.ti 6: User Guide and Reference. Berlin: Scientific Software Development, 2011.Google Scholar
  15. 15.
    Sabate E (Ed). Adherence to Long-Term Therapies: Evidence for Action. World Health Organization: Geneva, 2003.Google Scholar
  16. 16.
    Jackson LA, Buxton JA, Dingwell J, et al. Improving Psychosocial Health and Employment Outcomes for Individuals Receiving Methadone Treatment: A Realist Synthesis of What Makes Interventions Work. BMC Psychology. 2014;2:26.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Schwartz RP, Highfield DA, Jaffe JH, et al. A Randomized Controlled Trial of Interim Methadone Maintenance. Archives of General Psychiatry. 2006;63(1):102–109.CrossRefPubMedGoogle Scholar
  18. 18.
    Brooner RK, Kidorf MS, King VL, et al. Behavioral Contingencies Improve Counseling Attendance in an Adaptive Treatment Model. Journal of Substance Abuse Treatment. 2004;27(3):223–232.CrossRefPubMedGoogle Scholar
  19. 19.
    Novick DM, Salsitz EA, Joseph H, et al. Methadone Medical Maintenance: An Early 21st-Century Perspective. Journal of Addictive Diseases. 2015;34(2–3):226–237.CrossRefPubMedGoogle Scholar
  20. 20.
    Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, D.C.: National Academy Press, 2001.Google Scholar
  21. 21.
    Elwyn G, Dehlendorf C, Epstein RM, et al. Shared Decision-Making and Motivational Interviewing: Achieving Patient-Centered Care across the Spectrum of Health Care Problems. Annals of Family Medicine. 2014;12(3).Google Scholar
  22. 22.
    Wang L, Wei X, Wang X, et al. Long-Term Effects of Methadone Maintenance Treatment with Different Psychosocial Intervention Models. PLoS ONE. 2014;9(2):e87931.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    McLellan AT, Woody GE, Luborsky L, et al. Increased Effectiveness of Substance Abuse Treatment. A Prospective Study of Patient-Treatment “Matching.” Journal of Nervous and Mental Disease. 1983;171:597–605.CrossRefPubMedGoogle Scholar

Copyright information

© National Council for Behavioral Health 2018

Authors and Affiliations

  • Shannon Gwin Mitchell
    • 1
  • Laura B. Monico
    • 1
  • Elizabeth Lertch
    • 1
  • Sharon M. Kelly
    • 1
  • Jan Gryczynski
    • 1
  • Jerome H. Jaffe
    • 1
    • 2
  • Kevin E. O’Grady
    • 3
  • Robert P. Schwartz
    • 1
    • 2
  1. 1.Friends Research Institute, Inc.BaltimoreUSA
  2. 2.Department of PsychiatryUniversity of Maryland School of MedicineBaltimoreUSA
  3. 3.Department of PsychologyUniversity of MarylandCollege ParkUSA

Personalised recommendations