Drug abuse clients who are employed typically do better in their treatment than those who are unemployed. In addition, unemployment is a chronic problem in drug-dependent people. Despite the high rates of unemployment in this population, community treatment programs often do not have the resources to provide vocational services. This study will examine the effectiveness of a 12-hour basic job-training program designed to give patients the skills they need to find and secure a job and set vocational goals and methods for locating employment. The intervention to be evaluated is modeled after the Job Seekers’ Workshop, which was manualized and has been tested in trials.

Women in drug-using communities are one of the fastest growing groups of people with AIDS in the U.S. Female drug users, even if they are in drug treatment, are at especially high risk for heterosexual transmission of HIV. First, they are often in primary sexual relationships with male drug users. Second, like their male peers, some continue to use drugs despite being in treatment. When under the influence of drugs, especially cocaine or crack, they are more likely to engage in unprotected sex. It has been shown that drug abuse treatment can reduce activities related to drug use that increase the risk of HIV transmission. Sexual risk behaviors have received less attention, however, than those directly related to drug use. This study looks at a program for women in drug abuse treatment designed to build safer sexual skills and reduce unprotected sexual risk behavior. The program includes five sessions of group treatment that focus on assessing HIV risk, HIV safer sex problem solving, condom use, negotiation skills, and assertiveness training. This program will be compared to one session of HIV education, which is typically provided as standard care in drug treatment clinics.

Although accrediting organizations, funding sources, and other agencies require community treatment providers to monitor performance, there are no studies showing that this is an effective practice or that it helps addiction treatment patients, clinicians, or managers. This study tests whether one such strategy, feeding back performance data to clinic staff, will improve patient attendance and abstinence. Ratings by patients of their group counseling experience, plus information on patient attendance and retention, will be reported to clinicians and program managers twice a month. Clinicians will receive reports for their caseload; managers will receive clinic-wide reports. Every month managers and clinicians will discuss the clinic-wide reports, identify opportunities for improvement, and make plans to increase the clinic-wide ratings. This study also measures the impact of the system on manager/clinician relations, staff job satisfaction, and whether clinicians and managers will continue to use the system after the study ends.

Post-traumatic stress disorder (PTSD) is common among drug users, particularly among women. Those who suffer from both of these conditions also struggle more with both conditions and have a more difficult time meeting their treatment goals. Estimates also suggest that as many as 80% of women seeking treatment for drug abuse report lifetime histories of sexual and/or physical assault. These facts highlight the importance of finding effective treatments for this high-risk population. Early studies show Seeking Safety, a substance abuse treatment designed specifically for women with trauma, is an option with great potential for this population. This study compares the effectiveness of two manualized interventions for women when added to treatment as usual: Seeking Safety, and Women’s Health Education, a psychoeducational program focused on health topics of special relevance for women.

Adolescent drug abuse continues to be one of the most pressing public health issues in the United States—our nation’s teenagers continue to use illicit drugs at a worrisome rate. Broad reviews of the treatment outcome literature indicate that family interventions in general, and Brief Strategic Family Therapy (BSFT) in particular, are effective with drug using youth. This study was designed to compare BSFT to treatment as usual (TAU). The researchers believed that BSFT would be much more effective than TAU in reducing adolescent drug use.

About 5% of women use illicit substances during pregnancy, and approximately 22% of these also report using tobacco or alcohol. A number of treatment programs have started to offer treatment specifically designed for pregnant substance abusers. While these programs have shown some success, it is still difficult to keep these women in treatment. Brief motivational sessions have been found to improve treatment engagement and outcomes in both alcohol and drug using women. This study compares one such treatment intervention, Motivational Enhancement Therapy (MET), with standard treatment. The three individual MET sessions focus on developing rapport, exploring perceived pros and cons of using substances, reviewing the participant’s feedback on the consequences of substance use and the status of her pregnancy, and developing a change plan or strengthening the commitment to change. Patients assigned to standard treatment receive the treatment normally given in that clinic; this will include at least three individual sessions that are also designed to help them overcome alcohol and drug use.

Substance abuse is associated with a wide spectrum of medical disorders, including infections due to the human immunodeficiency virus (HIV) and the hepatitis C virus (HCV) as well as sexually transmitted infections. Despite the seriousness of this problem, there has not been a systematic investigation of infectious disease services in the substance abuse treatment health care delivery system. This is a study of policies and services in Community Treatment Programs (CTPs) related to these infections. The study surveys CTP administrators and direct care providers and reviews policies related to clinical guidelines and reimbursement policies through a survey of administrators of state substance abuse agencies or health departments. In addition to filling the information gap about available services for infectious disease in substance abuse treatment programs, this study will provide a basis for later studies on the efficiency of these services and of health outcomes

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).