The proposed project is formulated in response to a request for service research in drug abuse treatment that includes the goal of """"""""improving the ability of treatment programs to match clients with appropriate treatment and appropriate types and levels of treatment services, to measure the cost-effectiveness of treatment, and to deal with special populations"""""""" (NIDA RFA DA-9-02, January 1993). We propose to meet this goal by conducting a randomized clinical trial of two intensities of ancillary psychosocial treatment services that we will provide to a sample of low SBS, unemployed, methadone maintenance program (MMP) patients, utilizing many of the research methodologies employed in Project MATCH and, additionally, conducting comprehensive cost-effectiveness and cost-benefit analyses. Upon entry into methadone maintenance treatment, 480 unemployed patients, recruited from two MMPs, will be randomly assigned to either a weekly psychoeducational group or an intensive Day Treatment Program, each 12 weeks in duration. Outcomes will be assessed post-treatment and at a six-month follow-up in five domains: illicit drug-use, psychological functioning, vocational/social adjustment, medical status/high risk behaviors, and utilization of services. Five patient-treatment matching characteristics will be investigated: race, sex, cocaine abuse, comorbid depression, and antisocial personality disorder.
The specific aims of the proposed study are fourfold: (1) to conduct a simultaneous replication study investigating the differential impact of two levels of psychosocial treatment intervention at two MMPs -- a small federally-funded VA MMP and a large inner-city State-funded MMP, both located in the same metropolitan area; (2) at the inner-city site, to determine whether the five identified subgroups of MMP patients differentially benefit from the two treatment intensities under investigation; (3) to determine if benefits derived from the two treatments are differentially maintained at a six-month follow-up, and if they are differentially maintained by the five patient subgroups; and (4) to determine which intensity of treatment is most cost-effective and cost-beneficial overall and for each subgroup.
