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.
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Title: |
Drug Abuse Treatment Clinical
Trials Mid Atlantic Node |
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Principal
Investigator: |
Maxine Stitzer, Ph.D. (Johns
Hopkins School of Medicine) |
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Co-Investigator(s): |
Robert Schwartz,
M.D. |
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Project
Manager: |
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Funded by: |
National Institute on Drug Abuse
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Grant Number: |
U10 DA13034 |
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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.
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Title: |
The Effects of Manualized Treatment in a
Seamless System |
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Principal
Investigator: |
Faye Taxman, Ph.D. |
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Co-Investigator(s): |
Monique Wilson,
Dr.P.H. |
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Project
Manager: |
Meda Barker, M.S. |
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Funded by: |
National Institute on Drug Abuse |
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Grant Number: |
R01 DA017729 |
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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.
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:
The
purpose of this study is to determine whether a monthly injection
of naltrexone is practical and useful in the prevention of
relapse and when compared to treatment as usual. This
collaborative project will take place in five treatment sites
where there is a large population of parolees with a history of
opiate addiction: 1) University of Pennsylvania, Philadelphia,
PA: 2) Rhode Island Hospital, Providence, RI; 3) New York
University/Bellevue, New York, NY; 4) Columbia University, New
York, NY; and 5) Friends Research Institute, Baltimore, MD.
After determining that all volunteers are opiate free by urine
test results and not currently opiate dependent using a naloxone
test, they will be randomized to depot naltrexone or Treatment as
Usual (TAU. Participants in both groups will be given identical
follow up assessments monthly for six months with measures of
opiate use by self-report, urine test and hair analysis. An
additional random urine test will take place each month between
monthly visits. Both groups will be re-evaluated six and 12
months later. The University of Pennsylvania will be the
coordinating site and each site will have a randomization goal of
20 new patients per year over 3.5 to 4 years to accrue a total of
360 to 400 participants. Treatment outcome will be measured by
urine tests, hair analysis, self-report and continuation in
treatment. Both naltrexone and comparison groups will receive
equivalent cash incentives to remain in the program. A
benefit-cost analysis will be conducted to compare the costs of
the treatment with the quantifiable benefits in terms of reduced
crime, re-incarceration and medical services and increased
employment.
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Title: |
Risk Factors for HIV Among Urban African American Youth |
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Principal
Investigator: |
Steven Carswell,
Ph.D. |
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Co-Investigator(s): |
Thomas Hanlon, Ph.D. |
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Funded by: |
National
Center on Minority Health and Health Disparities |
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Grant Number: |
4R00 MD002271 |
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Total Project
Period: |
12/08 –
11/11 |
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
Alternative Education Programs (AEP), have exhibited academic,
school conduct, and behavioral problems. Participants will be
200 male and female students, between the ages of 12 and 16.
Half of the participants will be assessed the first project year
and the remainder assessed in the second year. 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.
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Title: |
Substance Abuse, HIV/AIDS, and Hepatitis Prevention in urban
Native Americans |
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Principal Investigator: |
Diana H. Caldwell,
M.P.A. |
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Project
Manager: |
Jan Gryczynski,
M.A. |
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Funded by: |
Substance
Abuse and Mental Health Services Administration |
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Grant Number: |
SP 133321 |
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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.
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