Demoralization is highly prevalent among new entrants to methadone treatment, persists for months in about 30 percent of patients, and interferes with treatment retention and effectiveness. Based on research on message framing, modeling, cognitive biases, and self-efficacy, we are proposing a Stage I study for manual development and pilot testing of a leading, four-week individual therapy, Brief Engagement in Substance Treatment (BEST), targeting demoralization and drug use. BEST will incorporate principles of motivational interviewing used in Motivational Enhancement Therapy (MET). Sessions will address core issues including 1) fears about treatment; 2) cognitive biases and hopelessness; 3) self-efficacy; and 4) social isolation. Session format will be guided by health behavior psychology research suggesting that appropriate message framing and modeling increases treatment adherence and behavior change. We plan to develop motivational videotapes to be viewed within the sessions, with simulated patients serving as role models to counter patient hopelessness, illustrate therapy issues and stimulate discussion. In Phases 1 and 2 of the proposed study, we will develop a therapy manual and motivational videotapes, pre-pilot BEST in individual therapy, and develop materials for training therapists and for rating manual adherence and performance. Patient and therapist ratings of each session, data about patient response to treatment, reviews of session videotapes, and focus groups conducted with patients will be used to inform development and revisions of the treatment, therapy manual and motivational videotapes. Phase 3 is a randomized, pilot study (N=60) using a dismantling strategy to compare manual-guided BEST to manual-guided MET. Patient outcomes will be assessed during the four-week lead in treatment and for 12 weeks following completion of the lead-in treatment, while patients are participating in standard, weekly group drug counseling. Primary outcome measures include retention in treatment, rates of illicit opioid and other drug use, and reductions of BDI scores. The pilot study will be used to estimate the potential effect size of the difference between the two treatments, evaluate the feasibility of comparing the two treatments in a larger, Stage II study, and to guide additional refinements of the treatment manuals and videotapes. In Phase 4, we plan to develop gender and ethnicity specific videotapes and to pilot BEST in group therapy.
| Chawarski, M C; Zhou, W; Schottenfeld, R S (2011) Behavioral drug and HIV risk reduction counseling (BDRC) in MMT programs in Wuhan, China: a pilot randomized clinical trial. Drug Alcohol Depend 115:237-9 |
