Despite the wide observance of religious practice in the United States, the role of spiritual or religious faith as a resource for preventing HIV and other infection in drug users has been the focus of relatively few empirical investigations. In response to RFA-DA-02-009, """"""""New approaches to prevent HIV/other infections in drug users"""""""", we propose to conduct a Stage I behavioral therapy project that will develop and pilot test an innovative motivational intervention -- Spiritual Self-Schema (3-S) Therapy - for reducing behaviors that transmit HIV and other infections among inner-city drug users that taps into patients' spiritual and religious beliefs. 3-S therapy is based on self-schema and self-regulation models of behavior. An activated self-schema establishes selection criteria for regulating attention, provides focus and structure for encoding, storing and retrieving information, and has strong associative links to other components of the system, such as emotions and physiology. The therapeutic goal of 3-S therapy is to facilitate a shift in the client's working self-schema, from the frequently activated """"""""addict"""""""" self-schema to the activation of a patient-defined """"""""spiritual"""""""" self-schema that is compatible with HIV preventive and other pro-social behaviors and that is incompatible with behaviors that lead to contracting or transmitting HIV and other infectious diseases.
The specific aims of this Stage I are threefold: 1) within an overall Information-Behavioral-Motivational (IMB) model of HIV preventive behavior, to develop and refine 3-S therapy, including manual development and codification; 2) to develop and evaluate a 3-S therapy training program; and 3) to conduct a preliminary randomized trial of 3-S therapy that will compare individual and group modality versions of 3-S to enhanced standard care in methadone-maintained patients. Sixty-eight methadone-maintained patients will participate in these studies. Primary outcomes will be retention in treatment and reductions in illicit drug use, sex- and drug-related risk behaviors. In order to explore transportability of the intervention, we will also conduct a feasibility assessment of providing the 3-S group modality in three non-clinical community settings - a local church, a homeless shelter, and an AIDS service organization.
