(Applicant?s Abstract) Drug abusers with complex problems have frequent contact with medical emergency departments. Emergency departments can assist patients in accessing drug abuse treatment and linking with less acute care. This randomized trial will test the effects of two linkage strategies: (1) transitional case management; and (2) vouchers for free methadone treatment --- with opioid-dependent injection drug users recruited from the emergency department of a public general hospital. The primary aims are to test the effects of the interventions on: (1) enrolling participants in drug abuse treatment; (2) enrolling participants in medical and social services; (3) improving opioid use outcomes; and (4) changing participants? pattern of utilization of acute health services. Participants will be opioid-dependent injection drug users recruited at a hospital-based emergency department, randomly assigned in a two-by-two factorial design to receive: (1) transitional case management, (2) vouchers for free methadone treatment, (3) case management and vouchers, or (4) usual care (brief contact and referral). Case management will have a cognitive behavioral focus. Assessments will occur before randomization and follow-up assessments at 6, 12 and 18 months. Primary hypotheses will test the effects of: (1) vouchers on enrollment in drug abuse treatment; (2) case management on enrollment in other services; (3) the combination of vouchers and case management in reducing opioid use; and (4) case management on the cost of health care used by the participants. To identify predictors of participation and retention, the study will gather information about the treatment process and prepare treatment manuals that can be used in other settings. The treatment research effort will assess innovative models linking health care with drug abuse treatment. It contributes to cross-component TRC studies, including self-referral versus voucher-referral with Dr. Batki, nicotine dependence with Dr. Hall, and measurement of process variables with Dr. Havassy. It also contributes to collaborative studies described in the TRC core, including drug abuse treatment and statistical analyses, psychiatric and substance abuse comorbidity, and assessing the environments of opioid abusers.
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