This research will conduct an effectiveness study in a therapeutic community (TC) that treats, among its other residents, opiate dependent patients receiving opioid replacement therapy (methadone, LAAM, or buprenorphine). The study is an early step in development of linkages between TCs and programs providing opioid replacement therapy (ORT). The project will test primary hypotheses that both retention in the TC and opiate use will be statistically equivalent between TC clients receiving ORT compared to a similar group of TC clients not receiving ORT, and that at a 24-month follow-up the clients receiving ORT will demonstrate less utilization of health services. Research has confirmed that TC treatment significantly reduces drug use and increases prosocial behavior of drug users. Yet most TCs will not treat patients on any form of ORT. ORT is poised to expand in coming years through the use of buprenorphine, methadone in medical maintenance, and possibly through new treatment models such as office-based treatment by physicians and mobile treatment programs. The proposal builds on much preliminary work and a strong history of collaboration between the researchers and practitioners. In an evaluation of effectiveness, the study will follow two groups of residents entering a TC, comparing the equivalence of residents receiving ORT versus a group with heroin use history who are not receiving ORT and are balanced on variables that predict retention in the TC. Procedures will involve recruitment after admission to the TC and following the research participants for 24 months. The outcomes will include retention in the TC, substance use, HIV risk and criminal behaviors, and utilization of health and substance abuse services. A process evaluation will gather quantitative and qualitative information about the TC treatment experience. The project will occur at a time when drug abuse policy is changing in California, and the research will study outcomes for those participants who enter the TC under the Substance Abuse Crime Prevention Act of 2000 (Proposition 36). The products of this research will include a treatment manual that can be used by other TCs. In addition we will pilot-test the refinement of procedures to incorporate patients receiving buprenorphine, as this medication becomes more available. The research is an important part of the effort to further link the TC and opioid replacement treatment modalities.

Agency
National Institute of Health (NIH)
Institute
National Institute on Drug Abuse (NIDA)
Type
Research Project (R01)
Project #
5R01DA014922-03
Application #
6664986
Study Section
Special Emphasis Panel (ZDA1-KXN-G (09))
Program Officer
Hilton, Thomas
Project Start
2001-09-30
Project End
2006-05-31
Budget Start
2003-06-01
Budget End
2004-05-31
Support Year
3
Fiscal Year
2003
Total Cost
$483,627
Indirect Cost
Name
University of California San Francisco
Department
Type
Schools of Medicine
DUNS #
094878337
City
San Francisco
State
CA
Country
United States
Zip Code
94143
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Chun, JongSerl; Haug, Nancy A; Guydish, Joseph R et al. (2009) Cigarette smoking among opioid-dependent clients in a therapeutic community. Am J Addict 18:316-20
Chen, TeChieh; Masson, Carmen L; Sorensen, James L et al. (2009) Residential treatment modifications: adjunctive services to accommodate clients on methadone. Am J Drug Alcohol Abuse 35:91-4
McCarty, Dennis; Roman, Paul M; Sorensen, James et al. (2009) Health Services Research for Drug and Alcohol Treatment and Prevention. J Drug Issues 39:197-208
Greenberg, Brian; Hall, Danny H; Sorensen, James L (2007) Methadone maintenance therapy in residential therapeutic community settings: challenges and promise. J Psychoactive Drugs 39:203-10
Barnett, Paul G; Masson, Carmen L; Sorensen, James L et al. (2006) Linking opioid-dependent hospital patients to drug treatment: Health care use and costs 6 months after randomization. Addiction 101:1797-804
Sorensen, James L; Masson, Carmen L; Delucchi, Kevin et al. (2005) Randomized trial of drug abuse treatment-linkage strategies. J Consult Clin Psychol 73:1026-35