In a pilot study from our previous granting period, we demonstrated the efficacy of a relatively low-cost contingency management (CM) procedure for retaining alcohol-dependent patients in treatment and reducing alcohol as well as other drug use. This study will extend use of these procedures to chronic recidivist alcohol-dependent patients and evaluate their efficacy for reducing in-patient detoxification services. Specifically, 116 alcohol-dependent patients who have received 4 or more detoxifications in a calendar year will be randomly assigned to one of two 6-month treatment conditions: standard case management treatment, or standard case management treatment plus CM. In the CM condition, patients earn the chance to win prizes by submitting negative breath samples and by complying with steps toward treatment goals, such as attending outpatient substance abuse treatment services, attending appointments with low income housing programs, or complying with outpatient psychiatric treatment. Treatment services received, alcohol and drug use, psychosocial functioning, and HIV risk behaviors will be measured pretreatment and at months 1, 3, and 6 (post-treatment), and at follow-ups scheduled for 9, 12, and 18 months after intake. Compared to standard case management treatment, we expect that those assigned to the CM condition will decrease alcohol consumption and present for fewer inpatient detoxifications, while showing greater engagement and retention in outpatient treatment. We also anticipate improvements in psychosocial functioning and decreases in HIV risk behaviors in the CM group. Patient characteristics that may be associated with a positive response to treatment will be assessed. We will also evaluate the cost-effectiveness of this CM intervention in relation to standard case management services.
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