? Substance abuse treatment is effective for clients who remain in treatment for three months or longer. Research indicates that effective programs use linkage services (e.g., referral, case management, child care) as well as core substance abuse counseling supplemented by comprehensive health and social services to improve client functioning The proposed research extends these findings by determining gender differences in specific components of SAT that affect substance abuse, health and social outcomes. The research will document organizational and service components that predict positive substance abuse outcomes for women and men. Although comprehensive services and positive client-provider relationships are important for women, their value for men is unknown. In the proposed research, gender comparisons will reveal how specific program components differentially affect retention and outcome for women and men. The gender comparisons will include race/ethnic, parenting and HIV/AIDS subgroup analyses. The specific relevance of comprehensive services and client-provider relationships will be tested. Thus, the Specific Aims of the study are: 1) To test gender differences in the impact of comprehensive substance abuse services on substance abuse, health and social outcomes and 2) To test gender differences in the impact of client-provider relationship on substance abuse, health and social outcomes. To accomplish these aims, the study will use mixed effects linear modeling in a secondary, multilevel analysis of data from the National Treatment Improvement Evaluation Study (NTIES). NTIES data were collected on organizational, service and client characteristics from a national sample of 78 programs and 6593 clients. We hypothesize that clients in the programs who receive comprehensive health and social services and who have a positive relationship with a provider will be retained in the program and will demonstrate reduced substance use and improved health and social functioning. Further, we hypothesize the magnitude of these effects will be greater for women than men. The research team has substantial prior experience with substance abuse services research, with the NTIES data set and with the methodologies used. The research has significant utility for efforts to reduce gender disparities in the provision of substance abuse services, for efforts to tailor SAT to the specific needs of women and men, and for the development of gender-specific protocols. ? ?
