Outpatient drug-free (non-methadone) treatment is widely utilized for drug abusers because of its convenience (non special facilities are needed) and relatively low cost. However, it is often characterized by poor retention, and treatment development efforts are needed to improve efficacy. Previous studies indicate that results of outpatient drug-free treatment can be considerably improved by adding some additional financial resources into the system, provided that these resources are appropriately scheduled. We propose to develop a new behavior therapy conceptually based on the Community Reinforcement Approach (CRA), whose primary goal is to facilitate behavioral lifestyle changes that will help clients achieve and maintain abstinence from drugs. The target population, inner city i.v. heroin abusers who either do not want or do not qualify for methadone maintenance treatment, is a difficult and recalcitrant group much in need of improved treatment approaches. During this 2 year-treatment development project we will 1) develop a contingency based monetary incentive program that is women into the therapy process in order to directly support and strengthen CRA interventions; elements of the incentive program include housing, transportation, food and recreational activities; 2) tailor a skills training program to the population that will support goals of CRA therapy and allow behavior changes to generalize beyond the treatment setting and treatment enrollment period; elements of the skills training period include job seeking and job finding, social, recreational and relapse prevention skills; 3) write a treatment manual describing the new tailored CRA therapy; 4) train three bachelor's level therapists to administer the therapy; 5) implement therapist adherence and competency assessments; 6) make interim manual alterations as needed; 7) evaluate the full treatment in a small sample (n=30) random assignment pilot study and 8) revise and finalize the treatment manual. By the end of this Phase I therapy development project, we will have described a practical multi- component contingency-based outpatient therapy tailored to the needs of i.v. heroin abusers residing in a inner city environment. Because of its focus on practical needs, the new treatment should be well accepted by both patients and treatment providers. Should efficacy of the new contingency-based program appear promising in pilot research, a Phase II development project will be undertaken.
