This study was conceived in response to NIDA program announcements #93- 106, Drug Abuse Treatment for Women of Childbearing Age and Their Children, and #94-047, Drug Abuse Health Services Research. Focussing exclusively on women, this five year investigation will test the efficacy of strategies to increase the possibility of a range of post- detoxification outcomes, including treatment entry, self-help participation, and abstinence. The study will develop and test the feasibility and effectiveness of a referral enhancement package comprised of role induction and social support elements. The investigation will also expand understanding of the critical intersection between detoxification and aftercare. Conducted in a hospital in the South Bronx and in the community, the study will include three phases: l) Development--including semi-structured interviews and focus groups with detox patients, staff, and network members; discussions with staff from treatment programs; and a pilot study with referral enhancement and control participants; 2) Outcome study--including assignment of a total of 600 subjects to two study arms; and 3) Data analysis, dissemination, and feedback to and from service providers. In the full scale study, a cohort of new patients entering the unit over a two week period will be assigned to an experimental condition--including group sessions and community sessions involving a therapist, social network member, and the detoxified patient. After the quota is filled, and for the next week, entering patients will not be in the study. Then, for the subsequent two weeks, the next cohort of patients enter the study as controls, who receive the same amount of group and individual intervention, but with differing content. The cycle is repeated over three years, with each condition separated by a """"""""wash-out"""""""" period. Subjects will be measured at baseline, briefly upon exit, and at 4,12 and 40 weeks post- discharge. The study will employ intervention, measurement, and follow-up protocols that build upon existing theory and research, but which also have immediate relevance to the providers of treatment services. The research will be led by scientists from Columbia University, and will be conducted collaboratively with investigators and staff from St. Barnabas Hospital.
