In this competing continuation we propose to continue and expand our prior aims. First, we will continue our study of computerized treatment. In a prior trial, computer-delivered Community Reinforcement Approach (CRA) with contingency management (CM) was as effective as therapist-delivered CRA with CM. The design of that study, however, did not indicate whether the computer-delivered CRA produced increases in therapeutic outcomes over that produced by the CM procedures alone. Thus, we propose to isolate the contribution of the computerized treatment to therapeutic outcomes. Second, we will examine the efficacy of a component of CRA, therapist-delivered facilitation of treatment goals and outreach services (FOS) that cannot be computerized. The efficacy of FOS has not been previously examined. In the process, we will address the infrequently acknowledged problem of rural opioid dependence.
The aim of this project is to address this serious public health concern by continuing the first and one of only two outpatient clinics providing pharmacotherapies for opioid dependence in the State of Vermont. Opioid-dependent outpatients will receive buprenorphine maintenance across two clinical trials. In the first, patients will be randomized to one of two treatments: (1) computer-delivered CRA along with CM; or (2) CM alone. In the second, patients will be randomized to one of two treatments: (1) therapist-delivered FOS with computer-delivered CRA and CM; or (2) computer-delivered CRA and CM. CM procedures will target both opioid and cocaine abstinence in both trials. Primary outcome measures will include abstinence, HIV-risk behavior, retention and cost-effectiveness. Overall, this research will contribute new empirical information about the efficacy of two approaches of providing CRA with CM. Such information may result in more cost-effective treatment and facilitate dissemination. Moreover, the computerization of substance-abuse treatment may positively impact the treatment field. Finally, this project will contribute positively to this region's public health by providing a substantial portion of all outpatient pharmacotherapy services for opioid dependence in the State of Vermont.
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