The authors begin by explaining that today’s patients who are addicted to heroin and other opioids are different than the addicts of the past. Current users are more likely to use other drugs, to have high rates of psychiatric and other health problems, to have high rates of unemployment, and to be isolated from drug-free support networks. As such, a new model of drug treatment for those addicted to opioids is called for. This article explains the use of motivational stepped care (MSC), which is a therapeutic approach that combines the use of methadone with routine and specialized counseling. MSC was developed in 1992 by the Addiction Treatment Services program at Johns Hopkins Bayview Medical Center. Basically, this model matches counseling services to an individual’s clinical progress on methadone treatment. The author explains that the three main principles behind the MSC model are that, first, psychosocial interventions have been found to be an effective means of combating drug dependency; second, using a “step” approach to therapy is an effective means of responding to the individual counseling needs of each patient; and third, contingency management is effective in promoting greater treatment participation. The MSC delivery guideline provides for three distinct intensities of weekly counseling, clear guidelines for movement between the steps of the program, and a process that links the continuation of methadone treatment with attendance at all scheduled counseling sessions. Patients who miss counseling services are removed from methadone treatment, which presents a powerful incentive to continue with counseling. In conclusion, the authors point out that the key to the MSC program is the link between counseling intensity and progression of the clinical methadone treatment section of the program. References