This project seeks to continue and build upon the current NIDA Treatment Research Demonstration project, DA06944, """"""""Enhanced Treatment Through Induction and Case Management"""""""": designated the Enhanced Treatment Project (ETP), it operated at the Dayton, Ohio Veteran's Administration Medical Center (VAMC). Data collected at 6 and 18 months following admission demonstrated that the group receiving the Strengths Perspective case management treatment enhancement stayed longer in treatment, were more likely to complete treatment and were less likely to use drugs during and after treatment. As of 1995, the VAMC will incorporate the Strengths Perspective into their primary treatment regimen for all patients treated in their drug treatment unit. The three basic purposes of this proposed five year project are to: (1) evaluate the long-term impact of the ETP by continuing to follow the original study population; (2) conduct a process analysis of how a treatment enhancement is adopted by a major health services delivery organization like a VAMC; and (3) develop, implement, and evaluate a community-based, Strengths Perspective case management enhanced aftercare treatment component. The study population is comprised of 75% African Americans, 24% whites, and 1% other veterans eligible for treatment at a VAMC. Approximately 77% identify crack cocaine as their primary drug problem. Over the course of the study, the 650 current ETP subjects will be reassessed with 2 additional interviews, 42 and 54 months beyond baseline. The process and efficacy of the community-based case management aftercare program will be examined by random assigning a new sample of 550 subjects into either the VAMC's standard, campus-based aftercare program; or, the new community- based case management enhanced condition. Subjects in both conditions will be interviewed at 1, 2, 6, 12, and 18 months from baseline. All subjects will receive urine testing at each contact. Analysis of relative effectiveness will focus on drug use, self-reports of physical and psychological status, illegal behavior and criminal justice system involvement, drug, mental health treatment, HIV risk behaviors, and employment. Within and between group comparisons will be made controlling for sociodemographic characteristics. For those new aftercare subjects, data on treatment retention and compliance will be obtained. Data analysis will focus on comparisons between the experimental and control groups. Behavioral and sociodemographic variables will be analyzed using logistic regression, structural equation analysis, and survival analysis to examine factors relevant to differences in treatment experiences and outcomes and predicting behavioral changes. The study is unique providing: (1) long term outcome data on a large sample of treated crack-cocaine users; (2) information about technology transfer efforts describing how a major clinical innovation is actually adopted by a large health care organization, and (3) developing and evaluating an aftercare treatment program component.
