Relapse rates are frequently high during the first few months after substance abuse treatment, often reversing many of the positive results of treatment. Virtually all treatment programs strongly recommend that participants get involved in "aftercare" or "continuing care" activities after they are discharged. Treatment programs use a variety of strategies to ensure attendance at continuing care activities. The Betty Ford Center conducted a pilot evaluation of a simple, low-cost, post-treatment continuing care intervention. This strategy consists of telephone calls from Center staff to a selected set of participants. The current study is designed to determine whether it is practical and feasible to conduct a larger, more definitive study testing the value of this post-residential telephone call procedure.

The use of heroin by American adolescents is at its highest level since the 1960s. However, the treatment of young heroin users has not been particularly effective, and some treatment providers are reluctant to use the medications they reserve for their older patients, especially for long-term opioid maintenance. This study compares two 3-month treatments for adolescents/young adults who are addicted to heroin. Both groups receive 3 months of psychosocial treatment (individual and/or group drug counseling). In addition, the experimental group receives 3 months of buprenorphine stabilization, while the control group is detoxified from opiates using buprenorphine over a 7 - 14 day period. The researchers believe the use of a 3-month stabilization with buprenorphine/naloxone in combination with psychosocial therapy will more effectively reduce heroin use, help these young people comply with their treatment, and improve their overall adjustment than brief detoxification with buprenorphine.

The prevalence of cigarette smoking among substance abusers is high, and substance abusers who smoke have more health problems, higher death rates, and more severe drug and alcohol addiction than those who don't. In the past decade, studies have demonstrated that smoking cessation programs and smoke-free policies can be successful in drug and alcohol rehabilitation clinics. Patients stay in treatment longer, they stop smoking for a time, and they do not use more drugs or alcohol than other patients. This study looks at how feasible it is to incorporate a state-of-the-art smoking cessation treatment program into community substance abuse treatment programs and to see if adding such a program will help people quit smoking and stay off of drugs and alcohol better than substance abuse treatment alone. The treatment for quitting smoking consists of group counseling in combination with the nicotine skin patch (NicoDerm CQ).

The "Baseline Study" is designed to help us better understand the community treatment programs participating in the NIDA Clinical Trials Network (CTN). Using a series of surveys, the study will be used to:

To improve treatment outcomes, it is necessary to use interventions that can motivate clients to attend treatment and initiate and sustain abstinence. Extensive research has consistently shown that client motivation for positive behavioral change can be influenced by the use of novel interventions based on established behavioral principles. In numerous controlled experimental studies in both outpatient cocaine treatment and methadone maintenance programs, procedures involving the provision of tangible incentives (prizes, coupons, vouchers, e.g.) to clients for drug-free urines resulted in sustained periods of abstinence and retention in treatment. This study in methadone-based Community Treatment Programs (CTPs) will utilize incentive values that are considerably lower in cost than those typically used in research clinics.

To improve treatment outcomes, it is necessary to use interventions that can motivate clients to attend treatment and initiate and sustain abstinence. Extensive research has consistently shown that client motivation for positive behavioral change can be influenced by the use of novel interventions based on established behavioral principles. In numerous controlled experimental studies in both outpatient cocaine treatment and methadone maintenance programs, procedures involving the provision of tangible incentives to clients for drug-free urines resulted in sustained periods of abstinence and retention in treatment. The initial study in Community Treatment Programs will utilize incentive values considerably lower than those typically used in research clinics.

This study aims to evaluate the efficacy of Motivational Interview (MI) techniques, relative to a standard treatment intake interview at participating CTPs, in enhancing treatment engagement and retention as well as in reducing substance use. It will also evaluate the durability of MI relative to standard treatment at CTPs through a 3 month follow-up. Secondary aims of this study are to explore patient characteristics associated with outcome, to evaluate the ability of clinicians at the CTPs to learn and effectively implement MI techniques, and to conduct process analyses which will assess and evaluate multiple aspects of this treatment approach.

Early dropout, partial attendance, and early relapse are common occurrences in most substance abuse treatment programs. Because the bulk of attrition occurs very early in treatment and retention in treatment has been linked to better outcomes, identifying effective, practical means of enhancing initial treatment engagement and outcome is an important target for the Clinical Trials Network. Motivational Enhancement Treatment (MET) is a systematic intervention approach based on the principles of motivational psychology that utilize motivational strategies to mobilize the client's own change resources. A considerable body of research for more than two decades has shown strong support for the usefulness of motivational interventions in initiating treatment and in reducing use of alcohol, cigarettes, and abused drugs. This protocol will test the therapeutic usefulness of incorporating MET into the standard drug abuse treatment entry process of Community Treatment Programs on improving treatment engagement, retention, and outcome.

For decades clinicians have been frustrated by the inability to successfully detoxify opiate addicted patients because opiate-based detoxification, one of the most effective means to achieving that goal, has been unavailable outside the very restrictive confines of narcotic treatment programs (NTPs). A new medication, buprenorphine, shows promise as an effective aid for opiate detoxification. However, little data have been generated for the shorter-term use of buprenorphine/naloxone for this indication. This protocol will compare the clinical utility of two dosage tapering regimens in buprenorphine/naloxone stabilized subjects for opiate detoxification.

For decades clinicians have been frustrated by the inability to successfully detoxify opiate addicted patients because opiate-based detoxification, one of the most effective means to achieving that goal, has been unavailable outside the very restrictive confines of narcotic treatment programs (NTPs). A new medication, buprenorphine, shows promise as an effective aid for opiate detoxification. However, little data have been generated for the shorter-term use of buprenorphine/naloxone for this indication. Since the diversity of clinics in the CTN provides an unparalleled opportunity to conduct such a clinical endeavor, the utility of buprenorphine/naloxone in short term (13 day) detoxification versus clonidine in an outpatient setting will be tested in the CTN.