Below are the six dimensions used by MaineCare and opioid treatment programs to determine whether patients can continue on methadone beyond the two-year limit, referred to in Alcoholism & Drug Abuse Weekly, January 14, 2013.
Dimension 1. Acute intoxication and/or withdrawal potential
- The patient requires continued methadone maintenance therapy to prevent his or her return to illicit opiate use; or
- The patient evidences current use (or increased risk of use) of drugs other than opiates; or
- The patient has a history of inability to abstain from opiate use, despite multiple attempts at detoxification.
Dimension 2. Biomedical conditions and complications
- Biomedical conditions, if any, continue to be sufficiently stable to permit the patient’s continued participation in outpatient treatment; or
- The patient evidences, or is at risk of, a serious or chronic biomedical condition (such as HIV/AIDS, tuberculosis, etc.) that may be exacerbated by a return to illicit opiate use.
Dimension 3. Emotional, behavioral or cognitive conditions and complications
- The patient has achieved stable emotional, behavioral or emotional functioning, which may be jeopardized by discontinuation of methadone maintenance treatment; or
- The patient demonstrates the potential for making use of methadone maintenance treatment (by participating in the program, attending counseling sessions, decreasing illicit activity, etc.) but has not yet made necessary life changes; or
- An emotional, behavioral or cognitive disorder, which is being concurrently managed, continues to distract the patient from focusing on treatment goals; however, the patient is responding to treatment and, with further intervention, is expected to achieve treatment objectives; or
- The patient continues to manifest behaviors that pose a risk to self or others (e.g., periodic needle sharing, unprotected sexual contact, outside drug use, etc.), but the condition is improving; or
- Emotional, behavioral, or cognitive complications of addiction are still present and are manageable in a structured outpatient environment but require continued therapeutic interventions. These behaviors may include illicit drug use/criminal activity, involvement in domestic violence as a victim or perpetrator, or inability to keep a job or maintain a stable household (e.g., provide for food, consistent shelter, supervision of children and healthcare).
Dimension 4. Readiness to change
- The patient recognizes the severity of his or her drug problem but demonstrates minimal understanding of the self-defeating nature of his/her substance abuse; however, the patient is progressing in treatment; or
- The patient recognizes the severity of his or her drug problem and demonstrates an understanding of the self-defeating nature of such drug involvement; however, the patient does not demonstrate behaviors that indicate the level of responsibility necessary to cope with the problem; or
- The patient is beginning to accept responsibility for addressing his or her drug problem but still requires this level of intensity of motivational strategies to sustain progress in treatment; or
- The patient has accepted responsibility for his or her drug problems and has determined that ongoing treatment with methadone maintenance treatment is the most effective means of preventing relapse.
Dimension 5. Relapse/continued use potential
- The patient continues to require structured therapy, pharmacotherapy and a programmatic milieu to promote treatment progress because the patient attributes continued relapse to physiologic craving/need for opiates; or medical conditions, if any, continue to be sufficiently stable to permit the patient’s continued participation in methadone maintenance treatment; or
- The patient recognizes relapse triggers but has not developed sufficient coping skills to interrupt or postpone gratification or to change inadequate impulse control behaviors; or
- The patient's addiction symptoms, while stabilized, have not been reduced sufficiently to support functioning outside a structured milieu; or
- Pharmacotherapy has been a part of an effective treatment process that has alleviated addiction symptoms and prevented relapse, and the withdrawal of methadone is likely to lead to a recurrence of addiction symptoms.
Dimension 6. Recovery environment
- The patient has not yet developed sufficient coping skills to withstand stressors in the work environment so as to prevent return to illicit opiate use and has not developed vocational alternatives; or
- The patient has not yet developed sufficient coping skills to deal with a non-supportive family/social environment to prevent return to illicit opiate use and has not developed alternative support systems; or
- The patient has not yet integrated the socialization skills necessary to establish a supportive social network; or
- Problem aspects of the patient's social and interpersonal life are responding to treatment but are not sufficiently supportive of recovery to allow transfer to a less intensive level of care; or
- The patient's social and interpersonal life has not improved or has deteriorated and the patient needs additional treatment to learn to cope with the current situation or to take steps to secure an alternative environment; or
- The patient's social and interpersonal life has stabilized while he/she has been in treatment and indicates the need for continued methadone maintenance treatment.