Investigating the influence of treatment philosophy on outcome of XXXX maintenance.

@entity4521 @entity284
This study is based on a 'natural experiment' in which a cohort of @entity4521 users was assessed at one unit, then referred on geographic grounds for treatment to one of two clinics--one orientated to long-term maintenance (Clinic 2, with 61 subjects), the other to time-limited treatment aimed at achieving abstinence from all drugs including @entity284 (Clinic 1, 141 subjects). The outcome measure was @entity4521 use as measured by urine testing performed regularly at both clinics. Overall, 25% of urine tests from Clinic 1 were positive for @entity4521 compared to 18% in Clinic 2. This difference reflected in part a high rate of @entity4521 use during the period of mandatory withdrawal from treatment in clinic 1. Statistical models were developed to identify factors associated with @entity4521 use. There was a strong association between @entity284 dose and @entity4521 use; relative to a daily dose of 40 mg, a dose of 80 mg/day of @entity284 was less likely to be associated with a @entity4521 -positive urine (OR 0.55, 95% CI [0.45, 0.68]). Average doses prescribed in Clinic 1 were lower, reflecting the clinic's orientation to abstinence. Adjusting for dose, and for the fact that certain individuals tend to use @entity4521 heavily while others do not, there was no difference between the clinics in risk of @entity4521 use during maintenance treatment. The higher rates of @entity4521 use in the abstinence-orientated clinic were attributable to time-limited treatment and the use of lower doses of @entity284 . This finding confirms that in investigating the effects of treatment factors, the powerful influence of @entity284 dose needs to be taken into account.
