***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: BACKGROUND Despite its effectiveness , methadone maintenance is rarely provided in American correctional facilities . This study is the first r and omized clinical trial in the US to examine the effectiveness of methadone maintenance treatment provided to prisoners with pre-incarceration heroin addiction . METHODS A three-group r and omized controlled trial was conducted between September 2003 and June 2005 . Two hundred eleven Baltimore pre-release inmates who were heroin dependent during the year prior to incarceration were enrolled in this study . Participants were r and omly assigned to the following : counseling only : counseling in prison , with passive referral to treatment upon release ( n=70 ) ; counseling+transfer : counseling in prison with transfer to methadone maintenance treatment upon release ( n=70 ) ; and counseling+methadone : methadone maintenance and counseling in prison , continued in a community-based methadone maintenance program upon release ( n=71 ) . RESULTS Two hundred participants were located for follow-up interviews and included in the current analysis . The percentages of participants in each condition that entered community-based treatment were , respectively , counseling only 7.8 % , counseling+transfer 50.0 % , and counseling+methadone 68.6 % , p<.05 . All pairwise comparisons were statistically significant ( all ps<.05 ) . The percentage of participants in each condition that tested positive for opioids at 1-month post-release were , respectively , counseling only 62.9 % , counseling+transfer 41.0 % , and counseling+methadone 27.6 % , p<.05 , with the counseling only group significantly more likely to test positive than the counseling+methadone group . CONCLUSIONS Methadone maintenance initiated prior to or immediately after release from prison appears to have beneficial short-term impact on community treatment entry and heroin use . This intervention may be able to fill an urgent treatment need for prisoners with heroin addiction histories OBJECTIVE Both methadone and buprenorphine are effective therapy for heroin dependence .  Efficacy is best documented for methadone maintenance therapy , but safety concerns limit its use . Buprenorphine offers lower overdose risk and improved access , but efficacy may be lower . The authors compared adaptive , buprenorphine-based stepped care to optimal methadone maintenance treatment . METHOD This r and omized controlled trial was undertaken 2004 - 2006 . It consisted of a 24-day uniform double-blind induction phase followed by single-blind flexible dosing based on structured clinical criteria , for a total of 6 months . Ninety-six self-referred subjects with heroin dependence were r and omly assigned to methadone or to stepped treatment initiated with buprenorphine/naloxone and escalated to methadone if needed . All subjects received intensive behavioral treatment . Primary outcome was retention in treatment . Secondary outcomes were completer analyses of problem severity ( Addiction Severity Index ) and proportion of urine sample s free of illicit drugs . RESULTS Overall , 6-month retention was 78 % . Stepped treatment and methadone maintenance therapy outcomes were virtually identical . Among completers of stepped therapy , 46 % remained on buprenorphine/naloxone .  Proportion of urine sample s free of illicit opiates increased over time and ultimately reached approximately 80 % in both arms . Problem severity decreased significantly and uniformly in both arms . CONCLUSIONS A stepped treatment of heroin dependence as described here appears equally efficacious compared to optimally delivered methadone maintenance therapy . Together with prior data on the advantageous safety of buprenorphine , this suggests that broad implementation of strategies using buprenorphine as first-line treatment should be considered OBJECTIVE This study examined whether substance abuse patients self- selecting into one of three aftercare groups ( outpatient treatment only , 12-step groups only , and outpatient treatment and 12-step groups ) and patients who did not participate in aftercare differed on 1-year substance use and psychosocial outcomes . METHOD A total of 3,018 male patients filled out a question naire at intake and 1 year following discharge from treatment . Patients were classified into aftercare groups at follow-up using information from VA data bases and self-reports . RESULTS Patients who participated in both outpatient treatment and 12-step groups fared the best on 1-year outcomes . Patients who did not obtain aftercare had the poorest outcomes . In terms of the amount of intervention received , patients who had more outpatient mental health treatment , who more frequently attended 12-step groups or were more involved in 12-step activities had better 1-year outcomes . In addition , patients who kept regular outpatient appointments over a longer time period fared better than those who did not . CONCLUSIONS Encouraging substance abuse patients to regularly attend both outpatient aftercare and self-help groups may improve long-term outcomes Methadone-maintained cocaine abusers ( N = 78 ) were r and omly assigned to 1 of the following 52-week interventions : ( a ) usual care only ( UC ) , ( b ) take-home methadone doses contingent on cocaine- and opiate-negative results ( THM ) , or ( c ) take-home methadone doses for cocaine- and opiate-negative results and monetary-based vouchers contingent on cocaine-negative urinalysis results ( THM + V ) . Cocaine use was assessed by urinalysis on a thrice-weekly schedule . Frequency and enjoyability of non-drug-related activities were assessed with the Pleasant Events Schedule ( PES ) at baseline , midtreatment , and end of treatment . The THM + V condition achieved the greatest abstinence from cocaine and opiate use , followed by the THM and UC conditions . The THM + V condition had the highest PES frequency ratings at midtreatment and at the end of treatment , followed by the THM and UC conditions . There were significant differences between the THM + V and UC conditions on 10 of 12 PES-derived subscales . Analyses revealed that abstinence mediated the effects of treatment condition on frequency ratings . There were no significant differences in enjoyability ratings . These results suggest that when contingency-management interventions increase abstinence from drug abuse , they also increase engagement in non-drug-related activities in naturalistic setting BACKGROUND Contingency management ( CM ) and significant other involvement ( SO ) were evaluated as strategies to enhance treatment retention , medication compliance , and outcome for naltrexone treatment of opioid dependence . METHODS One hundred twenty-seven recently detoxified opioid-dependent individuals were r and omly assigned to 1 of 3 conditions delivered for 12 weeks : ( 1 ) st and ard naltrexone treatment , given 3 times a week ; ( 2 ) naltrexone treatment plus contingency management ( CM ) , with delivery of vouchers contingent on naltrexone compliance and drug-free urine specimens ; or ( 3 ) naltrexone treatment , CM , plus significant other involvement ( SO ) , where a family member was invited to participate in up to 6 family counseling sessions . Principal outcomes were retention in treatment , compliance with naltrexone therapy , and number of drug-free urine specimens . RESULTS First , CM was associated with significant improvements in treatment retention ( 7.4 vs 5.6 weeks ; P = .05 ) and in reduction in opioid use ( 19 vs 14 opioid-free urine specimens ; P = .04 ) compared with st and ard naltrexone treatment . Second , assignment to SO did not significantly improve retention , compliance , or substance abuse outcomes compared with CM . Significant effects for the SO condition over CM on retention , compliance , and drug use outcomes were seen only for the subgroup who attended at least 1 family counseling session . The SO condition was associated with significant ( P = .02 ) improvements in family functioning . CONCLUSION Behavioral therapies , such as CM , can be targeted to address weaknesses of specific pharmacotherapies , such as noncompliance , and thus can play a substantial role in broadening the utility of available pharmacotherapies We examined the effectiveness of a contingency management program in preventing relapse to  illicit opiate use  and increasing treatment retention during outpatient methadone detoxification treatment . Twenty male opiate addicts were r and omly assigned to an experimental or control group . Following a 3-week methadone stabilization period , men in both groups received identical gradual methadone dose reductions during Weeks 4 through 9 and were maintained on placebo during Weeks 10 through 13 . Beginning in Week 4 , control patients received $ 5.00 for providing a specimen twice weekly . Experimental patients received $ 10.00 and a take home methadone dose for each opiate-free urine specimen but forfeited the incentives and participated in more intensive clinic procedures when specimens were opiate positive . The contingency management procedure slowed the rate of relapse to illicit opiate use . Experimental patients provided significantly more opiate-free urines during the methadone dose reduction in Weeks 4 through 9 than control patients , although the difference between groups was no longer significant during placebo administration in Weeks 10 through 13 . In addition , the contingency management program improved treatment retention and reduced symptom complaints during the detoxification . The usefulness and limitations of contingency management procedures  for outpatient methadone detoxification are discussed The number of drugs targeted may have an important influence on the ability of drug abusers to abstain during motivational incentive procedures . The authors investigated outcomes in  methadone maintenance patients ( n = 58 ) , who had evidence of both opiate and cocaine use , when continuous abstinence from cocaine only ( single target ) or from both cocaine and heroin ( dual target ) was required to earn US dollars 200 in voucher incentives over a 4-day period . Study patients were equally likely to initiate and sustain abstinence from cocaine under the single- versus the dual-drug target . They were more likely to initiate opiate abstinence under the dual-target condition , demonstrating sensitivity to reinforcer effects . Results suggest that adding a second drug target does not impede short-term cocaine abstinence initiation This article presents the outcomes of an innovative vocational rehabilitation model design ed for methadone-maintained patients —the Customized Employment Supports ( CES ) model . CES counselors work intensively with a small caseload of patients to overcome the vocational as well as non-vocational barriers that hinder employment , with the goal of attaining rapid job placement . A r and omized clinical trial was implemented at two methadone treatment programs in New York City and was funded by the National Institute on Drug Abuse The study tested the hypothesis that patients assigned to the  experimental ( CES ) condition would have better employment outcomes than those assigned to a control condition who received st and ard vocational counseling at the programs . The data were collected from May 2001 through April 2005 . The efficacy sample for the analysis consisted of 168 patients who completed follow-up interviews . The sample was 58 % male , 75 % minority group , average age 45 years , and in methadone treatment for an average of five years . The results supported the hypothesis for two measures of employment ; i.e. , the CES group was significantly more likely than the control group to obtain both any paid employment and informal paid employment . However , there were no significant differences for competitive employment or total earnings . The study 's limitations are noted . Implication s of the findings for the improvement of vocational rehabilitation for addiction patients are discussed Abstract The effect of giving  methadone maintenance clients the opportunity to regulate their dosage and of offering take-home doses as an incentive for dose reduction was studied . Subjects ( 116 ) were r and omly assigned to one of three conditions : self-regulation ofdose ( SR-1 ) ; self-regulation of dose with incentive for reduction ( SR-2 ) and st and ard treatment ( control ) . Dependent variables were dosage and use of illicit drugs ( measured by urinalyses ) . Results for the first four months show SR-1 subjects increased dose and maintained themselves at dosages significantly greater than the SR-2 or control groups while having significantly less use of illicit opiates during certain time periods . SR-2 subjects were not different from controls . Findings indicate subjects behaved responsibly under self-regulation and that this regimen is clinical ly feasible . Nevertheless , an increase in take-home privileges was an insufficient incentive to yield major reductions in dosage in SR-2 as a group Abstract Sixty-nine methadone maintenance patients were r and omly assigned to an immediate contingency for take home or the same contingency 2 months later . The contingency required zero rate drug-seeking as measured by r and omly scheduled and monitored urinalyses once per week and full-time production activity , verified every other week . These were examined two months before and after the contingency . Significant decreases in drug-seeking and increases in productivity were associated with the contingency . Control over drug-seeking was evidence d by increased consecutive “ clean urines ” although there was little change in overall percent “ clean urines ” . Although no diversion incidents were observed , experimenters felt unrecorded diversion occurred and discuss implication s of this and other results , concluding take-home methadone can be a powerful reinforcer of rehabilitation behaviors in methadone programs AIMS The aim of this study was to examine the effect of a case management intervention on retention in  opiate agonist therapy among injection drug users ( IDUs ) referred from a needle exchange program ( NEP ) . DESIGN , INTERVENTION , PARTICIPANTS , AND SETTING : A r and omized trial of a strengths-based case management intervention versus passive referral ( control ) was conducted among NEP 
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For the considered outcomes , it seems that adding any psychosocial support to st and ard maintenance treatments do not add additional benefits .
Data do not show differences also for contingency approaches , contrary to all expectations .