In 1998 more than 13 million people had a potentially diagnosable substance abuse disorder (NHSDA, 1998). Substance abuse treatment is considered as an effective response to these disorders. Despite the benefits of substance abuse treatment, only a relatively small proportion of those in need of treatment receive any service. Many of those initiating treatment leave before the therapeutic benefit can be realized (IOM, 1990) Many people needing services face a range of barriers to treatment linkage and engagement. These barriers include internal or psychological ones such as denial of problem, lack of self-efficacy that services could be accessed, embarrassment, and fears of what treatment might entail. External barriers, such as transportation difficulties and childcare needs, may impose limitations to treatment entry and, importantly treatment engagement. While barriers to treatment linkage and engagement have been well documented, few interventions to removing them have been studied. The broad goal of this study is to assess the effectiveness of two interventions to facilitate treatment linkage and treatment engagement. The study's two interventions will be a Motivationally based one and Strengths-Based Case Management. Each has proven effective in either moving substance abusers towards treatment and retaining them once in service. A three-armed controlled clinical trial research design will be used to test the effectiveness of these interventions in the context of a community wide Central Intake Unit (CIU) and several community-based specialty substance abuse providers. Treatment Linkage and Engagement will be the outcome measures. We hypothesize that those receiving either of the interventions will be more likely to Link with treatment than those in the control condition. We further hypothesize that the case management condition will have better outcomes for treatment linkage and engagement than the motivational condition. The study will recruit a sample of 690 treatment seeking people and use a longitudinal design, obtaining data at 3 points. Research goals are to examine the interaction of individual factors, Community Treatment Program factors, and study-delivered interventions on the outcomes of treatment linkage and engagement. The study's parallel qualitative/ethnographic aims will describe how the processes of linkage and engagement occur at the individual level.
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