Our recently completed randomized clinical trial of two intensities of psychosocial intervention in methadone-maintained programs (MMPs) suggested that standard methadone maintenance enhanced by the addition of a weekly coping skills training group together with as-needed referral to other services was comparable to a 25-hour per week Day Treatment Program in reducing illicit drug use, and was provided at one- third the cost. However, in the absence of a standard methadone maintenance comparison group, no definitive policy recommendation could be made concerning the need for MMPs to enhance standard care. Other findings suggested that methadone-maintained patients may have social and cognitive deficits that may influence HIV risk reduction efforts, and that both standard and enhanced MMPs would benefit from the inclusion of an HIV risk reduction intervention. Based on these findings, we developed: (a) a single-session HIV risk reduction intervention based on NADR Project recommendations that could be included in standard methadone maintenance and repeated as a post- treatment """"""""booster"""""""" session to reduce the risk of relapse; (b) a manual- guided weekly coping skills training group that could be included in enhanced methadone services using cognitive remediation and motivational enhancement strategies to teach HIV risk reduction skills; and (c) a comprehensive risk assessment battery which includes assessment of risky behaviors, and the processes underlying these behaviors, such as HIV/AIDS knowledge, motivation, and objective measures of behavioral skills. This competing renewal requests four years' additional support to continue our research to identify the most cost-effective level of ancillary psychosocial treatment for reducing illicit drug use and other HIV risk behaviors in MMPs by conducting a 12-week randomized clinical trial in which 224 methadone-maintained patients will be randomized to one of four cells in a 2 (standard/enhanced MMP) x 2 (booster/no booster) factorial design. Both clinical efficacy and cost will be determined, and objective measures will be employed to assess change in illicit drug use and other HIV risk behavior at post-treatment, and at a 6-month follow-up.
