Research Projects
Project Description:
Prisoners with pre-incarceration heroin addiction histories
rarely receive drug abuse treatment while incarcerated, or upon
release. Re-addiction among such individuals typically occurs
within one month of release, placing these individuals at
disproportionately high risk for HIV and hepatitis B and C
infections, overdose death, increased criminal activity, and
re-incarceration. Research is clearly needed to evaluate the
effectiveness of innovative drug treatment interventions spanning
incarceration and the community. Based on substantial evidence
of the effectiveness of opioid agonist treatment in the
community, and the authors' considerable investigative experience
with prison-initiated opioid agonist maintenance treatment of
male inmates, this five-year study will examine the effectiveness
of the administration of buprenorphine to previously-addicted
inmates initiated in the institution and continued on release to
the community. Moreover, this study will be the first to examine
the effectiveness of opioid agonist therapy for female (n=160) as
well as male (n=160) pre-release inmates with pre-addiction
heroin addiction histories. Finally, this research will examine
the extent to which the setting of post-release buprenorphine is
provided [in an opioid agonist treatment program (OTP) vs. a
community health center (CHC)]. Participants will be randomly
assigned, within gender, to one of four treatment conditions: 1) buprenorphine and counseling in prison, with referral for
continued treatment at an OTP upon release; 2) buprenorphine and
counseling in prison, with referral for continued treatment at a
CHC upon release; 3) counseling only in prison, with referral for
buprenorphine and counseling at a OTP upon release; and 4)
counseling only in prison, with referral for buprenorphine and
counseling at a CHC upon release. Participants will be assessed
at study entry and at 1, 3, 6, and 12 months following their
release from prison. Outcome measures include: treatment entry
and retention in the community, heroin use, cocaine use, HIV
infection, HIV-risk behaviors, criminal activity, and employment.
|
Title: |
Drug Abuse Treatment Clinical
Trials Mid Atlantic Node |
|
Principal
Investigator: |
Maxine Stitzer, Ph.D. (Johns
Hopkins School of Medicine) |
|
Co-Investigator(s): |
Robert Schwartz,
M.D. |
|
Project
Manager: |
|
|
Funded by: |
National Institute on Drug Abuse
|
|
Grant Number: |
U10 DA13034 |
|
Total Project
Period: |
10/99 – 9/09 |
Project
Description:
The drug abuse treatment
Clinical Trials Network (CTN) was founded in 1999
with six participating groups; it now has 16
participating groups, called Nodes, distributed
throughout the US. Each node is comprised of a
consortium of university-based researchers and
directors of community-based drug abuse treatment
clinics. The Mid Atlantic Node is led by Dr. Maxine Stitzer at the Johns Hopkins University and includes
collaborations with Virginia Commonwealth University
and Friends Research Institute, as well as a group
of community treatment providers in Baltimore and
Virginia. This configuration is designed to promote
and advance the three missions of the CTN: 1) to
promote bi-directional communication between
researchers and community treatment providers; 2) to
conduct research on evidence-based interventions at
community-based clinical sites to identify
interventions with effectiveness in real world
settings; and, 3) to promote dissemination and
adoption of new evidence-based practices in order
ultimately to improve treatment services nationwide. The CTN has now successfully conducted over 20
studies. Some have examined new medications such as buprenorphine for the treatment of opioid
dependence; others have examined behavior therapies
including motivational interviewing, contingency
management and family-based therapy for adolescents. The results of completed studies can be found at:
http://ctndisseminationlibrary.org. Further, to
address the dissemination agenda, CTN and the
national network of ATTC’s jointly sponsor a
Blending Initiative to develop dissemination
training packages for use of buprenorphine,
motivational interviewing and contingency management
(also called Motivational Incentives). These
packages can be found on the ATTC website,
www. nattc.org.
|
Title: |
The Effects of Manualized Treatment in a
Seamless System |
|
Principal
Investigator: |
Faye Taxman, Ph.D. |
|
Co-Investigator(s): |
Monique Wilson,
Dr.P.H. |
|
Project
Manager: |
Meda Barker, M.S. |
|
Funded by: |
National Institute on Drug Abuse |
|
Grant Number: |
R01 DA017729 |
|
Total Project Period: |
8/05 – 7/10 |
Project
Description:
The overarching purpose of
this study is to assist offenders in adopting a crime-free,
drug-free lifestyle, and to increase the probability that they
will successfully complete supervision. The intervention
involves three complementary components: 1) an initial
collaborative goal-setting session between the drug-involved
offender, the Probation Agent (PO), and the Addiction Treatment
Counselor or Clinician; 2) 18 weeks of group counseling,
involving the drug-involved offenders, the Clinician, and the PO;
and 3) 6 sessions designed to help the offender improve
communications with significant others and strengthen informal
social control networks in the community that can support the
offender’s efforts at desistance.
Project
Description:
Developing effective strategies for engaging clients in
treatment is a first responsibility of drug abuse programming. Despite concerns about the inability of detoxification alone to
promote sustained abstinence, little work has been done to
develop strategies for engaging opiate users into long-term
treatment following detoxification. During the first grant
period, drug-free treatment entrants receiving a single Role
Induction (RI) session were found to be significantly more likely
than those receiving Standard orientation to achieve three month
retention and report greater treatment satisfaction (Katz et al.,
2001; In Press). RI was not, however, similarly effective with
clients admitted to a three-day buprenorphine detoxification
program at the same site (Katz et al., 2002). The current grant
is designed to assess the effectiveness of two strategies
adapting the RI model, found effective with drug-free outpatient
clients, to the special circumstances of detoxification.
Intensive Role Induction (IRI) will involve an initial RI session
augmented by additional RI sessions to permit initial preparation
for detoxification, and later preparation for transition to
long-term treatment. IRI + Case Management will involve IRI in
conjunction with efforts to access community resources that are
significant to the client's well-being and retention in
treatment. The two experimental interventions will be compared to
routine treatment provided detoxification clients at the
outpatient program. Participants will be recruited from
applicants to a 30-day buprenorphine detoxification program.
Baseline measures will be administered prior to random
assignment. Follow-up will occur at one and three months with a
primary emphasis on measures of consecutive days retained and
retention to 90 days as criteria of treatment engagement, and at
six and twelve months with a primary emphasis on drug use, crime,
and employment as measures of treatment outcome. We will also be
concerned with session attendance, program satisfaction,
counselor ratings, motivation for treatment and behavior change,
and hopelessness in addition to the primary measures of treatment
engagement; and measures of HIV/AIDS risk behaviors and
psychological functioning in addition to primary measures of
treatment outcome. It is expected that the experimental
interventions will be more effective than the Standard Treatment
for measures of treatment engagement during the first three
months of follow-up, and more effective than the Standard
Treatment for measures reflecting behavior change administered at
six- and 12-month follow-up. Findings from this study are seen
as having relevance for strategies to engage and retain
detoxification clients in long-term treatment regardless of the
pharmacological agent employed.
Project Description:
The majority of individuals in need of drug abuse treatment
remain untreated, and a sizeable proportion of drug abusers who
enter treatment exit after a brief tenure. Thus, research that
contributes toward an understanding of drug abusers’ entry and
engagement in drug abuse treatment, and their subsequent
outcomes, is critical to efforts to improve treatment. Given the
threat of HIV infection, improving treatment entry and engagement
is particularly important with regard to opioid addicts, who are
at especially high risk for HIV infection, and methadone
maintenance treatment, which is widely used for the treatment of
opioid dependence. This five-year services research study
comprehensively examines treatment entry and engagement, using a
biopsychosocial theoretical perspective to guide the
investigation. Informed by this perspective, the proposed study
will examine three domains - namely, personal characteristics,
treatment attributes, and environmental influences - that are
hypothesized to affect opioid addicts’ motivation to change and
motivation for treatment, their entry into and subsequent
engagement in methadone maintenance treatment, and, ultimately,
their recovery. Within each of these domains, the effects of
specific, potentially relevant variables, selected on the basis
of previous research and theory, will be examined. Two groups of
adult opioid addicts will be studied, including addicts who are
not currently in nor interested in seeking treatment (N = 200)
and opioid addicts newly admitted to methadone maintenance
treatment (N = 400), with both groups involved in the examination
of treatment entry, and the admission group alone involved in the
examination of treatment engagement.comprehensive assessments
will be conducted at baseline and 3 months (the 3-month
assessment involving only the admission group to study their
initial engagement in treatment), and 6 and 12 months
thereafter. Two separate, but complementary, structural equation
models are posited to predict (1) treatment entry and (2)
treatment engagement and outcomes. These models, along with
hypothesized components of these models, will be tested using
structural equation modeling techniques, including the comparison
of hypothesized models with plausible alternate models. While
the primary study approach is quantitative, a strong qualitative
research component will be included to provide for in-depth
examination of motivation to change and motivation for treatment,
and of other variables that emerge in the quantitative research
as being important for understanding treatment entry and
engagement.
|
Title: |
Entry into Comprehensive Methadone Treatment via Interim
Maintenance |
|
Principal
Investigator: |
Robert Schwartz,
M.D. |
|
Co-Investigator(s): |
Jerome H.
Jaffe, M.D., Sharon Kelly, Ph.D. |
|
Project
Manager: |
Sharon
Kelly, Ph.D. |
|
Funded by: |
National
Institute on Drug Abuse |
|
Grant Number: |
R01
DA13636 |
|
Total Project
Period: |
04/07 –
12/10 |
Project
Description:
As a result of inadequate funding for treatment, waiting
lists for opioid treatment programs (OTPs) persist, and new and
more effective approaches for expanding treatment access and
improving outcomes are needed. This competing renewal
application seeks to build on our parent R01 study, which was the
first randomized clinical trial of interim methadone treatment
conducted under existing federal regulations. Research resulting
from the parent study has demonstrated that interim treatment
(methadone with only crisis counseling) in comparison to wait
list control, was associated with greater entry into
comprehensive OTPs, lower self-reported heroin and cocaine use,
lower rates of opioid-positive drug tests, and lower rates of
self-reported crime at both 4- and 10- month follow-up (Schwartz
et al., 2006 and in press). A parallel two-group randomized
study is proposed, in which adult heroin-dependent subjects (N =
300) who meet federal criteria for OTP entry and for whom no
treatment slot is available, will be randomly assigned at three
community-based OTPs to either interim methadone treatment or
prompt admission to comprehensive methadone treatment. Following
federal guidelines, all interim treatment subjects who have not
gained entry into a comprehensive OTP by 120 days (4 months) from
study entry will be admitted to comprehensive treatment. Outcome
will be assessed by measuring enrollment in comprehensive
treatment at 4 and 12 months from baseline, as well as
participants' illicit drug use, HIV-risk behavior, and criminal
activity at baseline and at 2, 4, and 12 months post-baseline.
We hypothesize that prompt entry to comprehensive treatment will
have outcomes superior to interim treatment. Furthermore,
participants with lower motivation for treatment are hypothesized
to respond more positively to interim maintenance than to
comprehensive treatment, because of potentially aversive features
of comprehensive treatment, particularly confrontation in
counseling. Finally, a cost benefit analysis will be conducted
to determine the related costs and benefits of interim treatment v.comprehensive treatment. The results of this study will
provide important information to researchers, clinicians, and
public health policymakers regarding the relative effectiveness
and benefits of these two approaches to OTP treatment.
Project
Description:
This twelve-month study will examine the feasibility of enrolling
5 probationers with a recent history of heroin dependence
attending an outpatient drug abuse treatment program in Baltimore
City on subcutaneous injectable (depot) naltrexone provided by
the University of Pennsylvania under its IND. We are conducting
a feasibility study to assess our ability to recruit, treat, and
retain opioid-dependent parolees in this pilot study of depot
naltrexone. We will use data from this study to apply for grant
funding for a larger randomized trial examining the effectiveness
of depot naltrexone.
Project
Description:
Most prisoners with histories of pre-incarceration heroin
addiction do not receive treatment while incarcerated and seldom
enter treatment upon release. Effective treatment for such
prisoners is urgently needed because rapid readdiction typically
follows release, placing these individuals at risk of HIV
infection and other negative consequences of addiction. Additional research to develop effective treatments that begin
during incarceration and continue in the community is clearly
needed. Based on evidence of methadone maintenance
treatment effectiveness in community settings, it appears an
especially promising approach for inmates with heroin addiction
histories. A five-year study is proposed to examine the
benefits of a methadone maintenance treatment program for prison
inmates who have been incarcerated for some time and are not
currently addicted, initiating maintenance treatment prior to
release from prison and continuing treatment in the community. Other than three studies of methadone maintenance with short-term
jail inmates, the only study of longer-term inmates was a
locally-conducted pilot study involving prison inmates in
pre-release status. Based on this pilot research, which
found that initiating maintenance treatment in prison is feasible
and facilitates entry into community-based treatment after
release, we are proposing a more rigorous examination of this
unique treatment approach. In the proposed study, prisoners
with pre-incarceration histories of heroin addiction having 3-6
months left to serve before release (N=360) will be randomly
assigned to one of three conditions: (1) initiation
of methadone maintenance in prison, with transfer to
community-based methadone maintenance with the same provider
immediately upon release; (2) immediate access to methadone
maintenance treatment upon release from prison, but no
maintenance treatment in prison; and (3) no experimental
intervention. This study design will permit disentanglement
of the effects of two distinct program components, namely (a) the
provision of methadone maintenance treatment prior to release,
and (b) the availability of immediate entry into maintenance
treatment in the community upon release. Participants in
all three conditions will receive drug abuse counseling in
prison, along with information on how to access treatment
resources in the community. Participants will be assessed
at baseline (study entry) and at 1, 3, 6, and 12 months following
their release from prison. Outcome measures include:
treatment entry and retention in the community; heroin use;
cocaine use; HIV-risk behaviors; criminal activity; and
employment. The proposed research will also examine the
relationship of initial motivation for treatment, early criminal
involvement, and cocaine abuse history to treatment outcome.
Project
Description:
The primary aim of this cross-sectional study is to examine the
extent to which specific risk and protective factors predict both
perceptions of HIV risk and participation in risky sexual
behavior among high-risk African American youth. These youth,
currently attending Baltimore City Alternative Learning Centers (BCALC),
have been expelled from traditional public schools for committing
violent acts or for engaging in other serious infractions, with
many engaging in risky sexual behavior. Half of the participants
will be assessed the first project year and the remainder
assessed in the second year. Participants will be 200 male and
female students, between the ages of 11 and 17 randomly selected
from two BCALC school sites. Assessment data will be collected
from January through May during each of the two data collection
years. This research study has the potential to provide a
greater understanding of issues related to perceptions of HIV
risk and participation in risky sexual behaviors among high-risk
urban African American youth. Findings from the study will
be of significance to the field of public health by filling
important knowledge gaps in terms of risk for HIV infection among
such youth.
|
Title: |
Substance Abuse, HIV/AIDS, and Hepatitis Prevention in urban
Native Americans |
|
Principal Investigator: |
Jeannette Johnson, Ph.D. |
|
Project
Manager: |
Jan Gryczynski,
M.A. |
|
Funded by: |
Substance
Abuse and Mental Health Services Administration |
|
Grant Number: |
SP 133321 |
|
Total Project
Period: |
10/05 –
9/10 |
Project
Description:
Now, and for many decades, drug and alcohol use and abuse
problems have continued to occur in Native American communities.
More recently, HIV/AIDS and hepatitis have appeared in all but a
few of these communities. Along with the frustration, pain, and
senseless deaths that result from these problems, Native
Americans must struggle with treating and preventing a problem
that doesn't seem to fit within their own traditional healing
systems. This study seeks to build a foundation for delivering
and sustaining effective and culturally relevant services to
prevent and reduce the onset of substance abuse (SA), and
transmission of HIV/AIDS and hepatitis among urban Native
Americans and Native American reentry populations in Baltimore,
MD. The overall purpose of this project is to implement a
culturally responsive SA/HIV/AIDS/Hepatitis program that will
increase and sustain service capacity to Native Americans in
order to address SA, HIV, and hepatitis problems. The increases
in service capacity are designed to: (1) build skills and
knowledge; (2) promote new peer group norms of preventive
communications and behaviors; and (3) help sustain new health
promoting habits. Using the Strategic Prevention Framework as a
model to develop culturally relevant service capacity
specifically for urban Native Americans, the five goals of the
project are to: (1) Conduct a community needs assessment; (2)
Mobilize and build capacity to address SA/HIV and hepatitis
prevention needs; (3) Develop a comprehensive strategic plan; (4)
Implement evidence based prevention programs and infrastructure
development activities; and, (5) Assess program effectiveness.
Service capacity will be enhanced through partnership with an
urban Native American program, LifeLines Foundation that serves
substance abusing Native Americans in Maryland. Through this
partnership, we will develop workgroups that provide syntheses of
state and local indicator data specifically on Native Americans;
select culturally appropriate evidence based programs; and,
utilize culturally appropriate evaluations.
Culturally competent Native American
evaluations will work in partnership with the local community
utilizing both quantitative and qualitative methodology that will
serve the purposes of on-going monitoring and evaluation in order
to assess program effectiveness, ensure service delivery quality,
identify successes, encourage needed improvement, and promote
sustainability of effective policies, programs, and practices.
Project
Description:
This research examines the application of a multifaceted
after-school approach, within an alternative learning setting,
designed to prevent both the initiation and escalation of
alcohol, tobacco, and other drug use (ATOD), risky sexual
behaviors, and violence among high-risk inner-city
African-American youth who have been expelled from traditional
public schools because of violence or other serious rule
infractions. Evolving from our earlier preventive interventions
implemented in both clinic and school settings in Baltimore City,
the intervention, The Village Model of Care, involves structured
group mentoring, parental empowerment and support services, and
community outreach services. The prevention program is being
implemented with students and their primary care giver(s) over a
seven-month period during the school year, from November through
May, and involves four days per week of after-school programming,
together with scheduled gatherings of students with their
families and community volunteers, organized field trips, and
community participation in planning and activities. Over
the four-year implementation phase, 280 youth will be enrolled in
the study, including 112 boys and 28 girls who will participate
in the after-school program, and an additional 112 boys and 28
girls who will serve as comparison participants for program
evaluation purposes. Using a counterbalanced design, one of
two participating alternative learning schools will be randomly
selected to receive the experimental intervention in the first
project year and to serve as a no-intervention control school in
the second year, while the second school will serve as a control
school the first year and will receive the experimental
intervention in the second year. This selection procedure
will be repeated in the third and fourth years of the project. Baseline measures, including the collection of information
regarding students’ risk and protective factors, will be
administered prior to program implementation and outcome measures
will be administered at baseline, post-intervention and
nine-months following the conclusion of intervention. A
process evaluation will examine the fidelity to the planning
process, the integrity of the intervention and the relationship
between degree of youth/family participation and outcome. Outcome assessment will focus not only on the effectiveness of
the Village Model of Care in comparison to no after-school care,
but also on the extent to which risk and protective factors
differentially predict success in the Village Model of Care
program. To facilitate replication elsewhere, manuals will
be developed, with the input of school officials and other
community members, documenting both training and implementation
procedures. Results of the project will be disseminated in
written reports,
scientific articles, and through presentations.
|