Ongoing Studies of Treatment for High Risk Drug Users

Inciardi, James

Abstract

This project seeks to combine, continue, and expand upon 2 NlDA Treatment Research Demonstration projects: DA06124 """"""""Assertive Community treatment for High Risk Drug Users;"""""""" and DA06948 """"""""A Therapeutic Community Work Release Center for Inmates."""""""" This includes the continued long term study of the implementation and evaluation of innovative treatment for drug- involved prison releasees in the State of Delaware, comparing groups who received AIDS prevention education and: 1) primary treatment in a prison- based therapeutic community (TC) for males; 2) primary treatment in an intensive, outpatient case management program for male and female releasees; 3) primary treatment in a community-based work release TC for male and female releasees; 4) primary treatment in a prison-based TC for male inmates followed by transitional treatment in the work release TC; and, 5) no-treatment comparison group of both male and female releasees. In addition, the research will examine the effectiveness of two new clinical groups: 1) primary treatment in a newly established prison TC for women followed by transitional treatment in a work release TC; and, 2) """"""""booster"""""""" treatment interventions for male and female graduates of the prison and work release TCs. Finally, the research will investigate the effects on treatment outcome of random vs. purposive client assignment. Longitudinal data are used to address the research questions. The study population is representative of the inmate population, 20% female and 80% male; 65% African-American and 30% White, 4% Hispanic and 1 % other. Over the course of the research, it is anticipated that approximately 800 subjects already in the study will be reassessed with 2 additional interviews, 42 and 54 months beyond baseline. Further, 450 new subjects from the work release TC will be interviewed at 6 and 18 months after release from prison, and 240 of these will complete an additional 42 month followup. All subjects will receive urine and HIV testing at each contact. Analyses will use standard experimental comparison techniques for interventions with success criteria established in terms of self-reports as well as urine and blood test results. Also logistic regression and structural modelling will be used to compare the interventions and evaluate other potential factors leading to significant differences in treatment outcomes and other behavioral changes. The study is unique, in providing long term outcome data on a large group of drug-involved prison releasees and in assessing the impact of drug treatment and AIDS education in a multivariate context. Results of this research will provide important information on treatment alternatives for drug-involved offenders at particularly high risk for relapse, recidivism, and HIV acquisition and transmission.