This project uses a 3 parallel group experimental design to compare efficacy of two behavioral methods, contingency management (CM) and relapse prevention (RP) for reducing methamphetamine (MA) use and enhancing psychosocial functioning among gay and bisexual male MA abusers in Los Angeles. Gay and bisexual men in Los Angeles frequently use MA in highly charged sexual contexts (bath houses and sex clubs) and combine MA use with high-risk sexual behaviors. Thus, the proposed project also evaluates whether behavioral drug treatment outcomes for these men associate with reductions in frequency of highrisk, HIV-related sexual behaviors (i.e., unprotected anal intercourse). Drug use, psychosocial functioning, and sexual behavior outcomes are evaluated at baseline, during treatment, at termination, and at follow-up. A total of 180 treatment-seeking gay and bisexual males who meet DSM-IV criteria for MA abuse or dependence will be randomly assigned to one of three experimental treatment conditions: (1) CM only (n=60); RP only (n=60); or a combined CM+RP condition (n=60). Assessments will measure various dimensions of drug use and sexual behavior: demographic information; drug use history (ASI and urine toxicology); a detailed sexual behavior history (BQA); psychiatric diagnosis (SCID); mood and physical symptoms (SCL-90-R); treatment compliance (TSR) and staff clinical impression (CGI). Behavioral interventions are manualized and an audiotape procedure will monitor and enhance protocol compliance. This proposal provides the unique opportunity to evaluate the utility and efficacy of providing behavioral drug abuse treatment both for reducing MA use and for reducing corresponding HIV-related sexual behaviors in a group at high risk for HIV transmission, i.e., gay and bisexual MA abusers in Los Angeles.
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