This is a Stage II psychosocial development study, combined with medication. It ensues from our Stage I study titled """"""""Development of Network Therapy for Cocaine Abuse"""""""" (PA-92110). Only a minority of heroin addicts are enrolled in addiction treatment, and it is therefore important to develop approaches to care that will attract the larger, unserved population. Network Therapy, a comprehensive intensive, standardized, psychosocial treatment in combination with a pharmacotherapy regimen may offer one such option, and may also be appropriate for certain patients in a private medical office setting. The objective of the present study is to ascertain the relative effectiveness of Network Therapy and a less intensive level of behavioral intervention, when each is paired with an identical regimen of buprenorphine treatment. The treatments are carried out by physicians experienced in the substance abuse field in conventional medical office settings. The subjects are 200 heroin addicts seeking treatment in an outpatient office practice medical setting. The subjects will be randomly assigned to a behavioral treatment condition consisting of (a) a limited regimen of medication management (MM) or (b) network therapy, consisting of sessions that include support from family and friends in a structured program of relapse prevention. All patients will be in treatment for 26 weeks. They will undergo induction onto buprenorphine during the first week and be maintained on a fixed daily dose of 16 mg administered in tablet form for 20 weeks, after which the drug will be discontinued over five weeks. Outcome will be evaluated on the basis of length of time in treatment, use of heroin or secondary drugs, changes in HIV risk behavior, and psychiatric and psychosocial function. In addition, social support for abstinence will be evaluated to determine its predictive effect on treatment outcome.
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