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Research Summary

Methadone Detoxification Remains No Match for Methadone Maintenance, Even with Minimal Counseling

No controlled studies have compared short-term methadone maintenance (MM) to methadone detoxification (MD), although it is known that open-ended MM is more effective than MD. Gruber et al. took advantage of a randomized controlled trial (RCT) assessing the effect of 6-month MM on adherence to latent tuberculosis therapy to compare 21-day MD to 6-month MM with either minimal or standard counseling.


In this RCT (n=111), outcomes were substance use and depressive symptoms. Doses of methadone were between 60 and 90 mg per day. Minimal counseling involved a single 15-minute session per month with no contingencies (e.g., take-home medication). Standard counseling involved 2 sessions per month (more, if needed, as determined by the counselor) with the opportunity to earn take-home medications. The majority of subjects were male, nonwhite, poor, and not interested in stopping heroin but rather in cutting down on use.


  • Compared with 6-week MD, 6-month MM resulted in a greater decrease from baseline in self-reported opiate use, opiate positive urines, and days of alcohol use.
  • No difference between groups was found for cocaine use or depressive symptoms.
  • Results for MM with standard counseling did not differ from those for MM with minimal counseling.


These findings show once again that the duration of time on methadone therapy is key to the benefits received, mainly with regard to opiate-related outcomes. As the treatment groups were quite small, few conclusions can be drawn concerning the lack of differences noted between counseling intensity in the 6-month MM groups. Jeffrey H. Samet, MD, MA, MPH


Gruber VA, Delucchi KL, Kielstein A, et al. A randomized trial of 6-month methadone maintenance with standard or minimal counseling versus 21-day methadone detoxification. Drug Alcohol Depend. 2008;94(1–3):199–206.