Subsidization of Substance Use Treatment: Comparison of Methadone Maintenance Treatment and Abstinence-Based Residential Treatment in Iran

Background: Subsidization is a policy to encourage the purchase and use of goods and services and to promote their a ordability for the poor. The Welfare Organization of Iran subsidizes substance use treatment in order to increase coverage and adherence to treatment. Objectives: This study aimed to answer the following questions: is the model eÿcient? Has the policy resulted in increased coverage and higher adherence to substance use treatment? How could the model be improved? Methods: We compared two types of substance use treatments of abstinence-based residential program and outpatient methadone maintenance. Based on their severity of addiction and retention in treatment clients who benefited from subsidization were com-pared with other clients. Therefore, 109 clients, 78 from methadone maintenance and 31 from residential abstinence-based programs were interviewed. Results: Subsidization had an encouraging e ect on clients to enter substance use treatment in both treatment programs (P = 0.001). However, we were unable to find evidence that subsidization helped retention in the treatment (P = 0.389), or that concomi-tant use of illegal substances in clients on methadone maintenance was lower (P = 0.500). Based on economic status of clients (P = 0.05) their criminal record (P = 0.001), length of use of substances (P = 0.05), and comorbid psychiatric conditions (P = 0.05), it was evident that assignment to subsidization in methadone maintenance services was significantly more reasonable, while it was almost random in abstinence-based residential facilities assignment. Conclusions: The current model of substance use treatment subsidization is not eÿcient. Addiction severity subscales and socioe-conomic status of clients could be considered appropriate factors for assignment to the subsidization program.