Outpatient drug-free (non methadone) treatment is the most widely utilized of available drug abuse treatment modalities. Yet it has received disproportionately little attention in research and development efforts. One group particularly in need of outpatient care are recently detoxified i.v. drug abusers. These individuals have already utilized significant treatment resources during their inpatient stay, but remain at risk for HIV infection if they return immediately to drug use upon discharge. Prognosis would be improved by enrollment in continuing care. Yet rates of initiating outpatient treatment after being referred from a detox program are surprising low and retention in outpatient treatment is extremely poor. The purpose of this services research grant project is to investigate l) methods for transitioning iv drug abusers of heroin or heroin and cocaine from detoxification to outpatient aftercare treatment services, 2) methods for retaining these patients in aftercare treatment once they make a program contact and 3) methods for preventing relapse to drug use after the brief inpatient period of abstinence. Study 1 will document naturalistic outcomes over 6-months in a cohort (N = 150) of iv drug abusers discharged from a 3-day medically supervised detoxification program to determine the extent and duration of their post-detox treatment enrollment as well as drug use, social adjustment and HIV risk exposure outcomes. Study 2 will determine the impact of four treatment transition interventions (commitment contracting, contingency contracting, escorted referral and usual care referral) on patients' post-detox contact with and subsequent retention in outpatient drug-free treatment. Study 3 will evaluate separate and combined effects on treatment retention of two practical interventions- transportation service and incentive payment- designed to promote retention in outpatient treatment, which is typically very poor. Finally, Study 4 will a) evaluate effects on treatment retention and drug use of abstinence incentive procedures previously shown effective for outpatient treatment of cocaine abusers, b) evaluate effects of intensive behavioral counseling modeled on the Community Reinforcement Approach previously shown effective for outpatient treatment of alcoholics and cocaine abusers and c) determine the extent to which behavioral counseling enhances the benefits of abstinence incentive procedures designed to directly influence drug abusers toward achieving desired outcome goals. Overall, this grant project will provide valuable new information about the effectiveness of methods to attract and retain iv drug abusers in outpatient drug-free treatment and to achieve relapse prevention goals. The treatment outcome data obtained from patients making the transition from medically supervised detoxification treatment to outpatient aftercare, will have broader application for improving any outpatient drug-free treatment service. The data generated will have implications for policy debates about the most effective way to spend limited resources in order to produce the best results from outpatient drug abuse treatment services.
