An epidemic exists in the nexus of HIV transmission and drug abuse. Houston, (4th largest U.S. city) has the 4th largest number of AIDS cases and HIV is spreading rapidly. Abuse of both cocaine and heroin is rampant. A major treatment prevention effort can be undertaken by implementing effective treatment and increasing treatment availability. The faculty and staff of the Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, propose a series of treatment demonstration studies. We will examine the joint action of pharmacological interventions and behavioral requirements in the treatment of cocaine and heroin abuse. Pharmacological parameters of methadone administration are well understood by optimal combinations are not well defined. Fluoxetine (a new antidepressant with special promise) will be used as an adjunct in cocaine treatment. Behavioral techniques and manipulation of clinic requirements are reported effective, but do not have widespread acceptance. These projects will demonstrate the efficacy of the judicious combination of these interventions. Independent variables will include judicious combination of these interventions. Independent variables will include Therapeutic drug and dose, required attendance regimen, contingencies for reinforcement, and preferred/nonpreferred consequences. Dependent variables will include; psychological/Psychiatric status, sexual behavior, drug craving, addiction severity, medical status, drug urine screens, compliance, and HIV status. Group and Single-Subject Designs will be complementary. this approach will; (1) maximize generality of results while, (2) permitting inclusion of (a) patients not meeting group design requirements, (b) who are difficult to treat but for whom demonstrations of alternative treatments can be achieved, and/or (c) who require (in numbers beyond our resources) continued treatment after completing other projects. There are only two public treatment sources (1 in-,1 outpatient) in Houston, both controlled by our Department. Support of this application will increase our outpatient census from 100 to 250 patients/month. This effort is strongly supported by the houston Health Department, Police Department, Mayors Office, HIV screening clinics, and direct care providers.
