Methadone maintenance and clonidine detoxification in the treatment of opiate addicts in Israel: suggesting evidence for cultural differences in the effectiveness of treatment modalities for opiate addiction.

A 13-month longitudinal study examined two treatment programs in Israel: Methadone Maintenance (MM) with adjunct psychotherapy, and Clonidine Detoxification (CD) with adjunct psychotherapy and antidepressants. A lower 3-month drop-out rate was found in the CD clinic in comparison to the MM clinic. After 13 months of treatment, approximately 50% of the patients in the treatment groups relapsed to heroin and the rest were either drug-free (in the CD clinic) or mainly maintained on methadone (in the MM clinic). No significant differences were observed in employment status, patient attitudes toward their therapists, and patient and therapist attitudes toward their respective treatment modalities. The effectiveness of these two treatment modalities was further compared to results obtained in the United States and other western countries. The results indicate that MM is less effective in Israel than in the United States. No clear-cut conclusion concerning the relative efficacy of CD treatment in Israel in comparison to other western countries can be inferred. The pattern of heroin use among heroin addicts, the popularity of methadone as an illegal drug in Israel, and the application of MM treatment modality in Israel may explain these results.