The purpose of this application is to carry on our work in facilitating outpatient drug treatment entry and retention with street-recruited injection drug users (IDUs) in order to reduce risk behaviors associated with HIV and HCV infection. The continued increase in HIV and HCV among IDUs, along with the rise in heroin use, underscores the importance of this effort. From 1995-2000 and from 2000-2005 we have tested a variety of strategies designed to facilitate treatment entry and retention with street-recruited IDUs, including free treatment, motivational interviewing and case management (CM). Of these, free treatment was the most successful, with a 44% entry rate, however, our CM intervention achieved a 42% rate. We feel we can improve upon this figure through enhancing our CM intervention by having case managers work with addiction counselors and clients to facilitate a therapeutic alliance (CM/FTA). Project aims are: 1. To compare the effectiveness of CM vs. CM/FTA on treatment entry and retention and to assess the influence of potential moderators, including therapeutic alliance, baseline motivation to quit using drugs, baseline treatment expectations, gender, ethnicity, and ASPD. 2. To compare the effectiveness of CM vs. CM/FTA on drug injection and HIV/HCV risk behaviors and to evaluate the roles of treatment entry and retention as mediators in this relationship. Over five years, 726 IDUs will be randomly assigned to CM or CM/FTA. Following an initial interview, participants will receive CM or CM/FTA services for five-months, as often as needed based on their case plan and desire for assistance. Participants will be re-interviewed at 6 and 12 months. CM emphasizes reviewing clients'past strengths in nine life areas and building upon these to reduce drug use and risks. CM/FTA includes these components but adds a structured focus on developing and sustaining a positive relationship with counselors. Those who do not to enter will continue to receive CM services and the opportunity to meet again with a counselor to explore treatment as an option. For those who enter, the CM will work with the counselor and client to develop and maintain a positive therapeutic relationship. Outcomes include treatment entry and retention, the quality of the therapeutic alliance and change in sex and drug risks. We hypothesize that clients in CM/FTA will have higher treatment entry and retention rates, a stronger relationship with their counselor and reduce their risks more than CM participants.

R01DA009832

1995-07-15

2013-06-30