Participation in needle exchange programs (NEPs) is associated with increased use of sterile syringes, reduction in high-risk drug injection behaviors, and lower incidence of HIV seroconversion. These settings can also operate as conduits to treatment centers dedicated to reducing drug use and risk of HIV and other infectious diseases. NEP participants have severe opioid dependence, yet many are ambivalent about entering treatment programs that emphasize reductions of drug use, and interest in treatment is hindered further by limited access to immediate treatment in many areas of the country. Our current NIDA grant (Community Based Intervention at Needle Exchange Sites) shows that a single motivational enhancement session increases the treatment seeking of needle exchangers. The proposed 5-year competing continuation study builds logically on our current work and on the research of others by integrating a number of proven interventions to promote the treatment enrollment of needle exchangers. An important new component of the intervention is a procedure for helping participants return to treatment following discharge. New needle exchange participants (n = 635) will be randomly assigned to one of three study conditions: 1) Motivated Referral Condition (MRC), 2) Motivated Referral Condition plus Incentives (MRC + Incentives), or 3) Standard Referral Condition (SRC). Participants assigned to MRC only condition will be referred to 8 motivational enhancement sessions to help encourage treatment interest, and to 16 treatment readiness groups to maintain motivation and provide information on finding treatment. Those referred to the MRC + Incentives condition will receive an identical referral procedure, and will be offered incentives for complying with each aspect of the referral process, and for entering treatment. SRC participants will receive updated lists of treatment programs admitting patients. All participants who leave treatment will be referred back to the BNEP. MRC and MRC + Incentives participants will be referred from the BNEP back to the treatment readiness group, while MRC + Incentives participants will also receive incentives for attending the group and re-entering treatment. SRC participants will not receive access to the treatment readiness group, nor will they receive incentives for treatment re-entry. All participants will be followed monthly for 16 months. The primary dependent measures are rates of drug abuse treatment enrollment and re-entry, speed of enrollment and re-entry, total days in treatment, use of community resources (including the BNEP), and self-reported rates of drug use and risky behavior. This study will continue our work by expanding and strengthening the impressive public health and therapeutic benefits already achieved by many needle exchange programs.
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