The index of choice: indications of methadone patients' selection of naltrexone treatment

Abstract

Self-report inventories from 35 male methadone patients were examined for possible indicators of intent to choose naltrexone treatment. The index of choice, a composite score derived from the analysis, was developed for each patient and compared to naltrexone treatment status at 6-month follow-up. There was a highly significant relationship between scores on the index of choice and the actual process of naltrexone selection. Patients who elected to detoxify from methadone, who were less confident of their ability to remain opiate-free, and who also expressed greater fear of losing the security that maintenance had helped them attain, intended to choose, exhibited greater interest in, and actually selected naltrexone treatment more often. A significant number of maintenance patients who had been prescribed methadone at higher doses and for longer periods of time rejected naltrexone. Failure is the factor that seems to motivate methadone patients to respond to the selection process. Although perceptions of "failure to remain free of illicit opiates" may have enhanced interest in naltrexone, perceptions of "failure to detoxify from methadone" diminished naltrexone's appeal, and actual "failure to remain free of illicit opiates" following methadone detoxification precluded patient participation. Thus, dilemmas appeared to exist. The index of choice may prove to be effective in the evaluation of these dilemmas encountered by patients throughout the selection process, and recommendations for intervention are made. Cautious application of the index of choice is advised until the relationships with retention and success in naltrexone treatment are more clearly demonstrated in future research.