This is a Stage II study to test a Motivational Enhancement (ME) intervention for cocaine dependent individuals, developed as part of the Stage I project. Although recent advances have been made in developing effective behavioral therapies for cocaine users who seek treatment, there are a number of cocaine dependent people who cycle through treatment programs without success and another large proportion who do not seek treatment. The Transtheoretical Model of Change (TMC)(Prochaska & DiClemente, 1983) provides a framework for working with individuals who are ambivalent about change or not ready to enter treatment. Our Stage I project revised, developed and tested the reliability and validity of measures of TMC constructs with cocaine users recruited through street outreach. In addition, a brief ME intervention for cocaine users at Precontemplation and Contemplation stages of change was developed and pilot tested in a design similar to the one proposed here. Cocaine users receiving the ME intervention showed greater reductions in their cocaine use at 1 month than an Assessment Only control group, and they maintained the changes at 2 month follow-up. The proposed project will evaluate the effectiveness of ME with this population and for different subgroups over a longer follow-up period. ME involves both Assessment and Feedback. To test its effectiveness we propose to separately evaluate the contributions of each of these components to outcome. In a randomized 1 X 3 partial repeated measures design 300 cocaine or crack users will be assigned, 100 to ME, 100 to an Assessment-Only (AO) group, and 100 to an Assessment-at-Follow-up Only (AFO) group. Follow-up interviews will be conducted at 1 and 6 months and will include assessment of drug use, stage of change, and help seeking behavior. It is hypothesized that the ME group will show less cocaine use at follow-up than the other two groups and will indicate greater readiness to change and report more help-seeking activity during the follow-up period than the other two groups.
