Drug Reduction Intervention for Needle Exchange Clients

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DESCRIPTION: (Applicant's Abstract) Injection drug users are at risk for a variety of problems such as HIV infection, hepatitis B and C, endocarditis, trauma, legal and work difficulties and family dysfunction. The objective of this research is to investigate ways to effectively reduce drug use among needle exchange program users, whose attendance at such services may signal the beginnings of risk reduction and a desire to escape drug use. In the past two decades brief interventions have proven to be promising in reducing substance abuse in a variety of settings. Recent developments in treatments for substance abuse underscore the primacy of utilizing motivation-based approaches. However, few studies have examined the likelihood that using a brief motivation based intervention with drug users enrolled in needle exchange programs may improve drug use outcomes. Intensifying brief intervention by adding a booster session might further enhance efficacy. The long-term objective of this programmatic body of treatment outcome research is to provide effective brief interventions for adult substance abusers. The specific aims of this proposal are to investigate the extent to which a Motivational Interview with a booster session is effective in reducing drug use among injection drug users enrolled in needle exchange programs as compared to an Attention Placebo Control (AQ condition in a 2-group design. Patients will be followed at 1-and 6 months after the baseline intervention, with self-reports confirmed by urine screens and reports of family or friends. Primary outcome variables include total number of drug use days and number of days in treatment. It is hypothesized that groups receiving MI will show lower levels of drug using days and more days of substance abuse treatment and that 2) the relationship between MI and the outcome variables will vary as a function of the patient's degree of readiness to change. This study will extend previous research by evaluating the use of MI with individuals who are needle exchange participants. The development of effective interventions for a population with poor linkage to primary care, an enormous burden of illness, and high HIV transmission risk should reduce the chronicity of drug use and enhance days in drug treatment.