Intravenous drug users and their sexual partners are a population at major risk for HIV/AIDS because they often share unclean needles and engage in unprotected sex. Since AIDS is lethal, immediate intervention is needed to reduce risk behaviors. The vast majority of opiate addicts use intravenous administration and methadone treatment is the primary mode of treating such addicts. Major goals of this proposal are to expand publicly funded methadone treatment capacity by 180 slots which is a 100 percent increase and to evaluate the impact of various models of supportive services on drug use and HIV/AIDS risk behaviors. The 312 subjects enrolled in this project will be randomly assigned to one of three treatment formats and within each level to one of two modes of managing positive urinalysis results. The three levels of methadone services are: 1)""""""""enhanced"""""""" (mandatory individual counseling, treatment planning and weekly group therapy with psychiatric consultation available); 2)""""""""standard"""""""" (mandatory individual counseling and treatment planning with psychiatric consultation available); 3)""""""""medication only"""""""" (only 15 minute check-in counseling available). Within each level of methadone service two protocols for managing positive urinalysis results will be used. Contingency contracting with a maximum consequence of administrative discharge will be used with half of each group. For the remainder of each group, positive urine tests will result only in additional therapeutic discussion. Data on risk behavior and drug use will be gathered on initial entry into the study and at 6, 12, and 18 months, using structured interviews and physical exams. Optional HIV testing will be available. Changes in risk behavior, drug use patterns and HIV serostatus will be used to assess the effectiveness of the various interventions and to determine if one is superior to the others.

National Institute of Health (NIH)
National Institute on Drug Abuse (NIDA)
Research Demonstration and Dissemination Projects (R18)
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Special Emphasis Panel (SRCD (03))
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Seattle-King County Public Health Department
United States
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Calsyn, D A; Wells, E A; Fleming, C et al. (2000) Changes in Millon Clinical Multiaxial Inventory scores among opiate addicts as a function of retention in methadone maintenance treatment and recent drug use. Am J Drug Alcohol Abuse 26:297-309
Saxon, A J; Wells, E A; Fleming, C et al. (1996) Pre-treatment characteristics, program philosophy and level of ancillary services as predictors of methadone maintenance treatment outcome. Addiction 91:1197-209
Calsyn, D A; Wells, E A; Saxon, A J et al. (1996) Outcome of a second episode of methadone maintenance. Drug Alcohol Depend 43:163-8
Wells, E A; Calsyn, D A; Clark, L L et al. (1996) Retention in methadone maintenance is associated with reductions in different HIV risk behaviors for women and men. Am J Drug Alcohol Abuse 22:509-21
Wells, E A; Clark, L L; Calsyn, D A et al. (1994) Reporting of HIV risk behaviors by injection drug using heterosexual couples in methadone maintenance. Drug Alcohol Depend 36:33-8