Are there minimum conditions necessary for methadone maintenance to reduce intravenous drug use and AIDS risk behaviors?

Although methadone maintenance is a treatment modality with the demonstrated ability to reduce IV drug use and subsequent AIDS risk, methadone maintenance programs vary widely in their effectiveness: Demographically similar patient samples show profound improvements in some programs and little change in others. This suggests that programmatic factors rather than patient variables or sheer availability of methadone may be important active ingredients in effective methadone maintenance. The AIDS epidemic has led to the demand for increased availability of methadone, with suggested elimination of counseling, urine contingencies, and other rehabilitative services in an effort to fund additional "methadone-only" treatment slots. The data reviewed here, including preliminary results from a study examining the effectiveness of "minimal" methadone services, suggest that merely increasing the availability of methadone in the absence of administrative counseling, and rehabilitative services may not adequately protect the majority of patients from continued drug use and the risk of AIDS.