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Combined treatment modalities: the need for innovative approaches.

Much of what is accepted as conventional chemical dependence treatment is not supported by rigorous clinical studies. However, the considerable supportive literature and data on methadone treatment has not ensured this treatment modality's acceptance by the medical and/or chemical dependence treatment community. The now obvious connection between AIDS and intravenous drug use demands an objective assessment of and inclusive approach to this problem. The need for effective treatment--both multimodal and acceptable to the addict--is discussed. Data are presented describing the characteristics of a successful methadone program that supports long-term treatment and adequate individual dosing. The disparity between the data and general attitudes toward methadone treatment is discussed. The variable quality among methadone treatment programs is also addressed, urging improved quality of care throughout the modality. It is suggested that quality of life issues are perhaps more important than the drug-free state. Some observations on recovery-oriented methadone treatment are made. A definition of abstinence that provides for appropriate use of licit psychoactive drugs is proposed.