In response to NIDA's Health Services Research Program Announcement (PA-94- 047), study will be undertaken of """"""""client and program factors that influence ... retention, compliance, effectiveness and relapse ...."""""""" While length of time in treatment has been repeatedly found to be linked to positive outcome, outpatient drug free treatment programs have been found to retain less than half of their clients for three months and less than a quarter of their clients for six months - thereby providing subtherapeutic doses of treatment to the majority of clients seen. Consequently, two early intervention strategies for reducing dropout and increasing treatment effectiveness have been developed for comparison to standard treatment at one outpatient drug free treatment program. Clients admitted to treatment will be randomly assigned to one of three conditions: (a) standard treatment involving post- intake didactic group orientation to the treatment program together with counselor developed treatment plans agreed to by clients and updated at three month intervals; (b) role induction involving post-intake interactive individual orientation to the treatment program with counselor developed treatment plans updated at three month intervals; and (c) behavioral contracting involving role induction plus a negotiated treatment plan with jointly determined short-term goals, strategies and timetables updated frequently. Outcomes will be assessed through a repeated measures design exploring between and within group differences over a 18 month period and examining (a) retention, (b) program compliance, (c) motivation for behavior change and for use of treatment, (d) behavior change (drug and alcohol use, productive activity, illicit activity), (e) psychological functioning, (f) HIV risk taking behaviors, (g) optimism/pessimism, and (h) client and counselor satisfaction with treatment. Measurements will be taken at monthly intervals during the first three months of treatment and thereafter at 6, 12 and 18 months from time of intake. Treatment process variables and client demographic and background characteristics will be related to outcomes.
