Although advances have been made in preventing treatment failure, a large percentage of substance-using individuals drop out of treatment and very few are able to achieve long term abstinence. Cutting-edge work in the field of smoking cessation indicates that one's threshold for tolerating psychological distress (i.e., distress tolerance) is a key factor in treatment dropout and subsequent relapse (e.g. Brandon, Herzog, Juliano, Irvin, Lazev, & Simmons, 2003; Brown, Lejuez, Kahler, & Strong, 2002). Following from this work and in line with PA-99-107 (NIDA Behavioral Therapies Development Program), Brown et al conducted developed a distress tolerance treatment focused treatment for smokers, with this approach consisting of combined behavioral exposure and Acceptance and Commitment Therapy (R01 DA017332, Richard A. Brown, PI; NIDA). Based on recent evidence suggesting the role of low distress tolerance in treatment failure for illicit substance users (Daughters, Lejuez, Kahler, Strong, & Brown, 2005; Daughters et al., in press), the current application seeks to develop a similar distress tolerance-focused treatment for the specific purpose of preventing treatment drop-out in a residential substance use treatment setting. This project will take place in 2 phases. Utilizing therapist and patient treatment manuals based on our prior work (see Appendix), phase 1 will include provision of the novel treatment (Skills for Improving Distress Intolerance, SIDI) to a group of 5 substance users in residential treatment who also have evidence deficits in distress tolerance. Based upon feedback from participants and clinicians, the protocol (including the manuals) will be revised and re-administered to a second group of 5 substance users suffering from low distress tolerance. In the second phase (Stage Ib), 60 individuals receiving residential substance use treatment will be recruited and randomly assigned to receive treatment in the form of either SIDI or the supportive counseling (SC) comparison treatment, with the expectation that the novel treatment will a) improve the participants' low levels of distress tolerance, and b) reduce the rates of treatment attrition. We expect this project to lay the groundwork for a well-specified and novel behavioral distress tolerance treatment for individuals in substance abuse treatment. From a longer term perspective, we expect that this program of research will result in the development of a specialized, efficacious treatment for vulnerable individuals, and therefore will have important clinical and public health significance in decreasing the overall prevalence of treatment failure. Additionally, in line with the goals PA-02-055 (Drug Abuse Dissertation Research), this application allows us to examine gender differences in the basic behavioral mechanisms underlying drug abuse by studying an adequate number of female substance users. Finally, although not a focus of the current application, this research also utilizes a sample of individuals at high risk of HIV infection and therefore may have additional public health significance, as the prevention of dropout and relapse may have beneficial effects in terms of corresponding prevention and reduction in HIV risk behavior (e.g., """"""""dirty"""""""" needle use, exchange of sex for drugs/money). ? ? ?
