Buprenorphine/Naloxone-Facilitated Rehabilitation
for Heroin Addicted Adolescents/Young Adults (CTN
0010) 
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: buprenorphine/naloxone
combined with psychosocial therapy and “treatment
as usual”— a 7-14 day detoxification with
buprenorphine and three weeks of psychosocial therapy.
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.
Motivational Enhancement Therapy to Improve
Treatment Utilization and Outcome in Pregnant Substance
Users (CTN 0013)
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,
exploration of perceived pros and cons of using substances,
reviewing the participant 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.
Brief Strategic Family Therapy (BSFT) For
Adolescent Drug Abusers (CTN-0014)
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 BSFT in particular, are effective
with drug using youth. This study is designed to compare
BSFT to treatment as usual (TAU). The researchers
believe that BSFT will be much more effective than
TAU in reducing adolescent drug use. They will also
examine which of these treatment approaches does a
better job of engaging adolescents and family members
in treatment, decreasing problem behaviors, decreasing
sexually risky behaviors, increasing pro-social activities
(e.g., school, work), and improving the functioning
of the family.
Women’s Treatment for Trauma and Substance
Use Disorders (CTN 0015)
Posttraumatic 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,
to be an option with great potential for this population.
This study compares the effectiveness of adding Seeking
Safety to standard substance abuse treatment to adding
a control condition: Women’s Health Education
to standard substance abuse treatment. The researchers
will be looking at the effect of these treatment options
on both substance use and the severity of the posttraumatic
stress disorder. In addition, they will look at the
results in relation to demographic and individual
characteristics of those in the study.
HIV and HCV Intervention In Drug Treatment
Settings (CTN 0017)
The connection between AIDS and drug injection is
well established. Through June 2000, injection drug
users accounted for more than a third of all cases
reported among persons aged 13 or older to the Centers
for Disease Control and Prevention. Hepatitis C virus
(HCV), transmitted primarily through sharing drug
preparation and injection equipment, is also a major
public health concern. Sixty percent of HCV transmission
is related to injection drug use and as many as 50-95%
of injection drug users are infected with HCV. This
study tests two strategies to reduce the risk of contracting
HIV or HCV by reducing risk behaviors in patients
undergoing drug detoxification. The first includes
pre-test counseling, testing, post-test counseling,
and the provision of HIV/HCV results. The second strategy,
called therapeutic alliance, provides clients with
information to guide them through the process of role
induction and aims to facilitate transition to continuing
care for drug treatment. Both will be compared to
standard care in drug detoxification settings.
HIV/STD Safer Sex Skills Groups For Men In
Methadone Maintenance Or Drug-Free Outpatient Treatment
Programs (CTN-0018)
Drug treatment, itself, can have a powerful positive
effect on HIV drug use risk behavior, especially needle
use behaviors. However, sexual risk behavior has received
less attention and has been slower to change. Research
suggests, however, that men and women are less likely
to engage in risky sex behavior with a skill-based
HIV risk reduction intervention, peer group discussion,
and the use of separate sex sessions. This study evaluates
a five-session HIV/AIDS group therapy designed specifically
for heterosexual men. This therapy is compared to
standard HIV/AIDS education, which generally consists
of a single session of HIV education. The researchers
hypothesize that men in the gender-specific therapy
group will report less risky sexual behavior than
men in standard therapy. They are also expected to
have a more positive attitude of condom use, be more
likely to have condoms, be more likely to have taken
condoms from clinic supplies, report less drug use
in combination with sex, and hold more egalitarian
attitude toward women.
HIV/STD Safer Sex Skills Groups For Women
In Methadone Maintenance Or Drug-Free Outpatient Treatment
Programs (CTN-0019)
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,
despite treatment, some continue to use drugs. 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 getting or transmitting HIV. These 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/STD education, which
is typically provided as standard in drug treatment
clinics.
Job-Seekers Training for Patients with Drug
Dependence (CTN 0020)
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
don’t 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.
Motivational Enhancement Treatment To Improve
Treatment Engagement and Outcome for Spanish-Speaking
Individuals Seeking Treatment for Substance Abuse
(CTN 0021)
Because Spanish-speaking drug users are often not
included in studies of drug abuse treatment, little
is known about what works with this population. On
the other hand, there is research that shows that
this minority group carries attitudes and beliefs
about substance abuse that may be barriers to participation
in substance abuse treatment. A few studies do indicate,
however, that efforts to motivate substance-abusing
Hispanics can be effective in bringing them into treatment.
One such intervention, Motivational Enhancement Therapy
(MET), is a promising intervention that may increase
Hispanic clients’ commitment to change and reduce
their resistance to entering treatment. This study
compares a three-session Spanish version of MET to
standard treatment to see how well MET engages and
retains Spanish-speaking clients in outpatient substance
abuse treatment. The researchers are also going to
look at the characteristics of the participants to
see if there is a particular type of patient that
is suited for MET and a number of other factors.
Mid-Atlantic
Collaborative Group