Psychological problems and client engagement in methadone treatment.

Client attendance at individual counseling sessions in community-based methadone treatment programs was more frequent among clients with self-reported psychological problems at intake. These problems included anxiety, depression, suicidal ideation, and other symptoms suggesting psychopathology (hallucinations, difficulty controlling violence, etc.). The sample consisted of 462 clients in treatment at least 90 days, divided into two groups of no psychological problems reported at intake (no problems group, N = 341) and two or more problems reported (high problems group, N = 121). The high problems group was twice as likely to attend the treatment program's recommended minimum number of individual counseling sessions (two per month) than was the no problems group, and was more likely to discuss psychological issues in their individual counseling sessions. The high problems group showed significant decreases in drug use and illegal activity in the first 3 months after admission and did not differ significantly from the no problems group on drug-positive urines or illicit activity at month 3. Within the high problems group, clients who attended at least two individual sessions per month reported less cocaine and speedball use during treatment than those who attended fewer sessions.