The majority of individuals in need of drug abuse treatment remain untreated, and a sizeable proportion of drug abusers who enter treatment exit after a brief tenure. Thus, research that contributes toward an understanding of drug abusers' entry and engagement in drug abuse treatment, and their subsequent outcomes, is critical to efforts to improve treatment. Given the threat of HIV infection, improving treatment entry and engagement is particularly important with regard to opioid addicts, who are at especially high risk for HIV infection, and methadone maintenance treatment, which is widely used for the treatment of opioid dependence. A five-year services research study is proposed to comprehensively examine treatment entry and engagement, using a biopsychosocial theoretical perspective to guide the investigation. Informed by this perspective, the proposed study will examine three domains - namely, personal characteristics, treatment attributes, and environmental influences - that are hypothesized to affect opioid addicts' motivation to change and motivation for treatment, their entry into and subsequent engagement in methadone maintenance treatment, and, ultimately, their recovery. Within each of these domains, the effects of specific, potentially relevant variables, selected on the basis of previous research and theory, will be examined. Two groups of adult opioid addicts will be studied, including addicts who have not recently received nor are interested in seeking treatment (N = 200) and opioid addicts newly admitted to methadone maintenance treatment (N = 400), with both groups involved in the examination of treatment entry, and the admission group alone involved in the examination of treatment engagement. Comprehensive assessments will be conducted at baseline and 3 months (the 3-month assessment involving only the admission group to study their initial engagement in treatment), and 6 and 12 months thereafter. Two separate, but complementary, structural equation models are posited to predict (1) treatment entry and (2) treatment engagement and outcomes. These models, along with hypothesized components of these models, will be tested using structural equation modeling techniques, including the comparison of hypothesized models with plausible alternate models. While the primary study approach is quantitative, a strong qualitative research component will be included to provide for in-depth examination of motivation to change and motivation for treatment, and of other variables that are potentially important to understanding treatment entry and engagement.

Agency
National Institute of Health (NIH)
Institute
National Institute on Drug Abuse (NIDA)
Type
Research Project (R01)
Project #
3R01DA015842-03S1
Application #
7281007
Study Section
Human Development Research Subcommittee (NIDA)
Program Officer
Flanzer, Jerry
Project Start
2004-06-15
Project End
2009-05-31
Budget Start
2006-06-01
Budget End
2007-05-31
Support Year
3
Fiscal Year
2006
Total Cost
$7,018
Indirect Cost
Name
Friends Research Institute, Inc.
Department
Type
DUNS #
010095032
City
Baltimore
State
MD
Country
United States
Zip Code
21201
Mitchell, Shannon Gwin; Monico, Laura B; Lertch, Elizabeth et al. (2018) Counseling Staff's Views of Patient-Centered Methadone Treatment: Changing Program Rules and Staff Roles. J Behav Health Serv Res 45:506-515
Dunlap, Laura J; Zarkin, Gary A; Orme, Stephen et al. (2018) Re-engineering methadone-Cost-effectiveness analysis of a patient-centered approach to methadone treatment. J Subst Abuse Treat 94:81-90
Schwartz, Robert P; Kelly, Sharon M; Mitchell, Shannon Gwinn et al. (2017) When does methadone treatment reduce arrest and severity of arrest charges? An analysis of arrest records. Drug Alcohol Depend 180:385-390
Schwartz, Robert P; Kelly, Sharon M; Mitchell, Shannon G et al. (2017) Patient-centered methadone treatment: a randomized clinical trial. Addiction 112:454-464
Monico, Laura; Schwartz, Robert P; Gryczynski, Jan et al. (2016) Two Models of Integrating Buprenorphine Treatment and Medical Staff within Formerly ""Drug-Free"" Outpatient Programs. J Psychoactive Drugs 48:101-8
Schwartz, Robert P (2016) When Added to Opioid Agonist Treatment, Psychosocial Interventions do not Further Reduce the Use of Illicit Opioids: A Comment on Dugosh et al. J Addict Med 10:283-5
Schwartz, Robert P; Kelly, Sharon M; Gryczynski, Jan et al. (2015) Heroin Use, HIV-Risk, and Criminal Behavior in Baltimore: Findings from Clinical Research. J Addict Dis 34:151-61
Peters, Erica N; Schwartz, Robert P; Wang, Shuai et al. (2014) Psychiatric, psychosocial, and physical health correlates of co-occurring cannabis use disorders and nicotine dependence. Drug Alcohol Depend 134:228-234
Blanco, Carlos; Secades-Villa, Roberto; García-Rodríguez, Olaya et al. (2013) Probability and predictors of remission from life-time prescription drug use disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. J Psychiatr Res 47:42-9
Serpelloni, Giovanni; Gomma, Maurizio; Genetti, Bruno et al. (2013) Italy's electronic health record system for opioid agonist treatment. J Subst Abuse Treat 45:190-5

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