This is a revision of 1 R01 DAO9421 -01A1 and is in response to NlDA's Program Announcement PA 94-078 """"""""Behavioral Therapies Development Program."""""""" We propose to develop, refine and test Motivational Training (MT) strategies for patients recently discharged from a psychiatric hospital with a diagnosis of crack/cocaine dependence and comorbid major depression of such severity to warrant pharmacotherapy. These dual disordered (DD) patients are increasingly prevalent in treatment systems and represent a high risk clinical population who are difficult to engage and keep in outpatient treatment following inpatient hospitalization. Our proposed program is based on cognitive and behavioral principles, and adapts Marlatt's model of Relapse Prevention and Miller and Rollnick's model of Motivational Counseling for cocaine dependent patients with depression. We request four years of support to meet the following aims: l) Develop and refine a theoretically based and procedurally specific MT strategy aimed at increasing DD patients' adherence to, and completion of, month 01 of outpatient treatment; 2) Conduct a pilot test comparing DD patients who receive MT against a Treatment-As-Usual (TAU) control group; and 3) Standardize MT protocol, procedures, methods and techniques so that the interventions are delivered with a high degree of competence and adherence. During months 01-06, the MT protocol will be further developed and refined, and staff will be trained to conduct the sessions. At month 07, following successful entry at the initial outpatient assessment and orientation session, study subjects will be randomized to receive one month of MT (N=38) or TAU (N=38) Control condition. The TAU Control Condition will draw upon the Individual Drug Counseling Model and will be operationalized in a treatment manual. Both the MT and TAU protocols include 4 individual, 4 group sessions, and one AIDS Awareness and Prevention session. After month 01, patients will continue in active TAU dual diagnosis treatment for up to an additional five months followed by maintenance treatment. This research is likely to lead to more effective methods of improving outpatient adherence and treatment completion rates of cocaine dependent patients with depressive' illness, and help to fill in deficiencies in existing treatment interventions. This project also involves development of a counseling manual describing MT interventions and a companion patient Recovery Workbook. It builds on our work in an open dual diagnosis treatment clinic and will complement, not conflict with, the aims of our NlDA cocaine collaborative study.
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