Behavioral interventions based on reinforcement principles have been among the most effective treatments for initiating cocaine abstinence and producing long-term improvements in outcomes. These interventions have combined voucher-based contingency management and community reinforcement (CRA) procedures derived from an extensive body of laboratory and clinical research. Unfortunately, many treatment providers perceive these procedures as too costly, complex, politically unpopular, difficult, and philosophically inconsistent to integrate with usual care. Most of the objections to using these behavioral interventions relate to the use of financial incentives to reinforce drug abstinence. This Stage I research will develop an intervention for cocaine abusing African American women that implements CRA through religious communities and avoids or at least minimizes financial reinforcers. In addition, we will make the intervention more acceptable to treatment providers by making it an adjunct to usual care so that it does not require counselors to adapt an entirely new treatment approach, implementing it in a group intervention so that it is more cost-efficient, and making it less complex to administer by using existing religious communities rather than having counselors identify and develop a support community for each client. Specifically, we will: (1) develop a manual that will provide an overview of the intervention, detail methods for training and monitoring staff and church volunteers, and specify weekly group activities; (2) refine procedures that have already been developed in residential settings to implement the intervention in outpatient settings; (3) conduct a pilot study of the outpatient intervention to assess the adequacy of the treatment manual and make revisions as needed; and (4) gather preliminary data that will allow power estimations for a randomized clinical trial. Overall, this research could provide a cost-effective, community friendly means of adapting an efficacious behavioral treatment (CRA) for wider use in community treatment settings.
