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.

Agency
National Institute of Health (NIH)
Institute
National Institute on Drug Abuse (NIDA)
Type
Research Project (R01)
Project #
5R01DA008754-02
Application #
2121472
Study Section
Special Emphasis Panel (SRCD (43))
Project Start
1993-09-30
Project End
1997-07-31
Budget Start
1994-09-01
Budget End
1995-07-31
Support Year
2
Fiscal Year
1994
Total Cost
Indirect Cost
Name
Apt Foundation, Inc.
Department
Type
DUNS #
City
New Haven
State
CT
Country
United States
Zip Code
06511
Avants, S K; Warburton, L A; Margolin, A (2000) The influence of coping and depression on abstinence from illicit drug use in methadone-maintained patients. Am J Drug Alcohol Abuse 26:399-416
Avants, S K; Margolin, A; Mckee, S (2000) A path analysis of cognitive, affective, and behavioral predictors of treatment response in a methadone maintenance program. J Subst Abuse 11:215-30
Avants, S K; Margolin, A; Sindelar, J L et al. (1999) Day treatment versus enhanced standard methadone services for opioid-dependent patients: a comparison of clinical efficacy and cost. Am J Psychiatry 156:27-33
Avants, S K; Margolin, A; DePhilippis, D et al. (1998) A comprehensive pharmacologic-psychosocial treatment program for HIV-seropositive cocaine- and opioid-dependent patients. Preliminary findings. J Subst Abuse Treat 15:261-5
Avants, S K; Margolin, A; Kosten, T R et al. (1998) When is less treatment better? The role of social anxiety in matching methadone patients to psychosocial treatments. J Consult Clin Psychol 66:924-31
Avants, S K; Margolin, A (1995) ""Self"" and addiction: the role of imagery in self-regulation. J Altern Complement Med 1:339-45