Although a number of treatments for cocaine dependence are efficacious, there are several major challenges to the effectiveness of treatment in community settings, including lack of interest in traditional specialty care models, high rates of early dropout, and considerable variability of response in patients who initially engage in treatment. Recent work done by our group and others suggests that adaptive treatment models can ad- Dress many of the problems that interfere with the successful delivery of effective addition treatment. These models are designed to increase participation in treatment by providing flexible care that is tailored over time on the basis of patient response to treatment, and patient choice or preference. The goal of this project is the further development of an adaptive model of care for individuals with cocaine dependence who seek treatment in community-based, specialty care programs. Patients (N=300) who complete an intake at an Intensive Outpatient Program (1OP) will be randomized into two conditions, which use telephone-based Motivational Interviewing (Ml) to increase rates of engagement in either standard IOP (MI-IOP), or in one of three treatment options selected by the patient (MI-PC). Patients are eligible for these interventions if they fail to attend IOP regularly in weeks 1-2 (the """"""""Non-engaged"""""""" group), of if they achieve initial engagement (the """"""""Engaged"""""""" group) but subsequently stop attending IOP at some point during weeks 3-12. The treatment options in MI-PC are IOP, telephone-based stepped care, or the combination of modafinil and medication management in the Non-engaged group; and IOP, telephone-based stepped care, or Cognitive-Behavioral Treatment (CBT) in the Engaged group. The options for the Non-engaged and the Engaged groups differ slightly, because we wanted to offer a non-specialty care alternative (e.g., modafinil) to patients who failed to achieve initial engagement in IOP, whereas limiting options in Engaged patients to lOP-based interventions seemed clinically appropriate. Primary analyses will compare MI-IOP and MI-PC on rates engagement/retention over the first 12 Weeks and cocaine use outcomes over weeks 1-24, and determine whether the predicted advantage of MI-PC over MI-IOP varies as a function of being in the Non-engaged or the Engaged groups. Further analyses will examine secondary outcomes, rates of selection of each treatment option in the MI-PC Nonengaged and Engaged groups, and outcomes within each of these treatment options.
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