“It's more than just the act of not using. It's a feeling of finally completing something.”: Person-centered definitions of successful treatment outcomes from patients and staff at a methadone treatment program in Baltimore City

Background

Successful outcomes in substance use disorder (SUD) treatment are traditionally defined by retention in care, substance use cessation, and relapse prevention. However, these metrics may overlook important, person-centered aspects of success, especially for marginalized populations facing significant inequities in care. With overdose-related deaths disproportionately affecting racially minoritized groups, understanding a more inclusive definition of success in opioid use disorder (OUD) treatment is essential for improving clinical treatment, research, and policy. This study explores how patients and staff define successful treatment outcomes and how those definitions align or differ at an outpatient methadone treatment program in Baltimore City.

Methods

We conducted qualitative interviews and focus groups with 32 participants, including patients, clinical staff, and peer recovery specialists (PRSs) at a methadone treatment program serving primarily low-income, racially minoritized individuals with OUD. The sample was 59 % male, average age 48.7, and 66 % Black or African American. Semi-structured interview guides prompted patients (n = 20) and clinical staff/PRSs (n = 12) to describe successful treatment experiences. Data were analyzed using thematic analysis and contextualized within the Health Equity Implementation Framework to propose influences on equitable methadone treatment that optimize treatment outcomes.

Results

Five key themes emerged in defining person-centered successful treatment outcomes: (1) improvements in general health, (2) productivity and accomplishment, (3) social improvements, (4) substance use changes, and (5) treatment engagement. Patients and staff agreed on two-thirds of subthemes but showed notable differences. Patients emphasized experiential and social aspects of recovery, such as increased activities, supporting others, and resisting substance use influences. Staff focused on sustained behavioral change and long-term recovery milestones, including substance use behaviors, self-worth, community involvement, and treatment planning.

Conclusion

Person-centered definitions of success in methadone treatment encompass a range of psychosocial, behavioral, and health-related factors. While patients and staff agreed on overall themes, their perspectives diverged on several subthemes. Incorporating diverse patient perspectives in defining methadone treatment success, particularly from marginalized groups, is essential for improving research, policy, and clinical practices to enhance patient experiences and outcomes in methadone treatment.