Developing effective strategies for engaging clients in treatment is a first responsibility of drug abuse programming. Despite concerns about the inability of detoxification alone to promote sustained abstinence, little work has been done to develop strategies for engaging opiate users into long-term treatment following detoxification. During the first grant period, drug-free treatment entrants receiving a single Role Induction (RI) session were found to be significantly more likely than those receiving Standard orientation to achieve three month retention and report greater treatment satisfaction. RI was not however, similar effective with clients admitted to a three-day buprenorphine detoxification program at the same site. The current grant is designed to assess the effectiveness of two strategies adapting the RI model, found effective with drug-free outpatient clients, to the special circumstances of detoxification. Intensive Role Induction (IRI) will involve an initial RI session augmented by additional RI sessions to permit initial preparation for detoxification, and later preparation for transition to long-term treatment. IRI + Case Management, will involve IRI in conjunction with efforts to access community resources that are significant to the client's well-being and retention in treatment. The two experimental interventions will be compared to routine treatment provided detoxification clients at the outpatient program. Participants will be recruited from applicants to a 30-day buprenorphine detoxification program. Baseline measures will be administered prior to random assignment. Follow-up will occur at one and three months with a primary emphasis on measures of consecutive days retained and retention to 90 days as criteria of treatment engagement, and at six and twelve months with a primary emphasis on drug use, crime, and employment as measures of treatment outcome. We will also be concerned with session attendance, program satisfaction, counselor ratings, motivation for treatment and behavior change, and hopelessness in addition to the primary measures of treatment engagement; and measures of HIV AIDS risk behaviors and psychological functioning in addition to primary, measures of treatment outcome. It is expected that the experimental interventions will be more effective than the Standard Treatment for measures of treatment engagement during the first three months of follow--up, and more effective than the Standard Treatment for measures reflecting behavior change administered at six and 12-month follow-up. Findings from this study are seen as having relevance for strategies to engage and retain detoxification clients in long-term treatment regardless of the pharmacological agent employed.
