Methadone treatment has repeatedly been shown to be safe and effective in the treatment of opioid dependence, especially when provided via long-term maintenance treatment. Treatment with methadone has been shown to be most effective when the medication is provided along with science-based psychosocial interventions to address the full array of patients'needs (e.g., patient education, skills training needs). Despite these findings, significant barriers to the adoption of science-based psychosocial treatment exist in methadone programs. Methadone programs offer the lowest level of drug abuse counseling and services and have the highest client to staff ratios relative to other types of drug treatment programs. In this application, we propose to extend our prior research to evaluate the effectiveness and cost-effectiveness of a science-based, computer-delivered psychosocial intervention for patients in methadone treatment. This interactive, self-directed Therapeutic Education System (TES) is theoretically grounded in the evidence-based Community Reinforcement Approach (CRA) to psychosocial treatment. As discussed in the application, this treatment innovation may address the challenges associated with the current delivery of evidence-based psychosocial interventions in methadone treatment by enabling the widespread delivery of science-based psychosocial treatment in a manner that is cost-effective and ensures fidelity. This proposal is being submitted as a Stage II research project (focused on testing a promising therapy in a novel setting) in response to the NIDA's Behavioral Therapies Development Program Announcement (PA #03-126). In the proposed clinical trial, new patients entering methadone treatment (n=180) will be randomly assigned to receive either 1) standard methadone counseling or 2) standard methadone counseling plus TES (such that they will receive the same standard drug counseling as those in the first condition, except that half of each scheduled session will be with the therapist and the other half on the computer using TES). We will evaluate the effectiveness of adding TES to standard methadone maintenance treatment to determine if patient use of the evidence-based TES enhances patient outcomes on the primary outcome of objective drug use (measured via urine toxicology results) and secondary outcomes including treatment retention, self-reported drug use, HIV risk behavior, therapeutic alliance, and psychosocial functioning. We will also conduct exploratory predictors analyses to determine if specific sub-groups of opioid-dependent individuals may differentially benefit from the computer-based TES intervention. Finally, we will perform a comprehensive economic analysis of adding TES to standard methadone treatment to inform a decision regarding adoption of this new therapeutic tool. The proposed research will contribute new empirical information relevant to effectively and cost-effectively increasing the routine delivery of science-based psychosocial treatment with fidelity in methadone treatment programs.
