Study to Study of Patient-centered Methadone Treatment (PC-MTP)

• Urine cocaine drug test [ Time Frame: 12-months post-baseline ] [ Designated as safety issue: No ]
  Cocaine positive urine drug test
• HIV risk behavior [ Time Frame: 12-months post-baseline ] [ Designated as safety issue: No ]
  Drug use and sexual HIV risk behavior
• Criminal behavior [ Time Frame: 12-months post-baseline ] [ Designated as safety issue: No ]
  Days of criminal behavior
• Quality of Life [ Time Frame: 12-months post-baseline ] [ Designated as safety issue: No ]
  Quality of Life Score
• Opiate dependence [ Time Frame: 12-months post-baseline ] [ Designated as safety issue: No ]
  Diagnostic and Statistical Manual (DSM)-IV criteria for opiate dependence
• Cocaine dependence [ Time Frame: 12-months post-baseline ] [ Designated as safety issue: No ]
  DSM-IV criteria for cocaine dependence

• Urine cocaine drug test [ Time Frame: 12-months post-baseline ] [ Designated as safety issue: No ]
  Cocaine positive urine drug test
• HIV risk behavior [ Time Frame: 12-months post-baseline ] [ Designated as safety issue: No ]
  Drug use and sexual HIV risk behavior
• Criminal behavior [ Time Frame: 12-months post-baseline ] [ Designated as safety issue: No ]
  Days of criminal behavior
• Quality of Life [ Time Frame: 12-months post-baseline ] [ Designated as safety issue: No ]
  Quality of Life Score
• Opiate dependence [ Time Frame: 12-months post-baseline ] [ Designated as safety issue: No ]
  DSM-IV criteria for opiate dependence
• Cocaine dependence [ Time Frame: 12-months post-baseline ] [ Designated as safety issue: No ]
  DSM-IV criteria for cocaine dependence

The purpose of the study is to determine whether a change in the rules and staff roles in methadone treatment programs will result in greater lengths of stay in treatment and lower rates of heroin and cocaine use, crime and HIV-risk behavior as compared to methadone treatment as usual.

Early drop-out and premature discharge from methadone treatment is common in the United States and may be associated with drug use and its associated problems. The purpose of this study is to evaluate the effectiveness of a novel approach to the organization methadone treatment in which the patient rules and staff roles of the clinic will be modified for study participants as compared to patients receiving standard methadone treatment.

• Other: Patient-Centered Methadone Treatment
  Unlike in treatment as usual, counseling will be encouraged but not required and counselors will be responsible for enforcing the clinic's rules. The rules will be enforced by the Clinical Director. Clinic rules will be modified such that involuntary discharge from treatment will be a rare event.
• Other: Methadone Treatment as usual
  Counseling will be required and counselors will enforce the usual clinic rules. Involuntary discharge may occur for ongoing drug use or rule infractions as usually occurs in the clinic.

• Experimental: Patient-Centered Methadone Treatment
  Patient-Centered Methadone Treatment alters the rules and staff roles in methadone treatment as usual in an attempt to increase treatment retention and improve patient outcomes.
  Intervention: Other: Patient-Centered Methadone Treatment
• Active Comparator: Methadone Treatment as Usual
  Methadone treatment provided as usual in the U.S.
  Intervention: Other: Methadone Treatment as usual

Inclusion Criteria:

• opiate dependence
• newly admitted to methadone treatment

Exclusion Criteria:

• pregnancy