Drug Abuse Treatment: The Implementation of Innovative Approaches

Drug Abuse Treatment: The Implementation of Innovative Approaches

Drug Abuse Treatment: The Implementation of Innovative Approaches

Drug Abuse Treatment: The Implementation of Innovative Approaches

Synopsis

This collection reports on the progress of the intervention programs first described in Innovative Approaches in the Treatment of Drug Abuse: Program Models and Strategies (Inciardi and Fletcher, 1993). By examining the implementation of treatment initiatives, this study focuses on an area often neglected in the research literature: the context in which research is conducted. Applied researchers, particularly those who study users of illicit drugs, face many obstacles that investigators working in more controlled settings, or with more predictable and compliant subjects, often do not encounter. These accounts demonstrate the challenges in producing rapid improvement in treatment for the vulnerable and underserved population of drug abusers. A close study of these efforts will be useful to other researchers in planning for and solving implementation problems that can be anticipated, and in providing guidelines and strategies to overcome those that cannot.

Excerpt

In the mid-1980s, two public health problems grew into epidemics that threatened to overwhelm the drug abuse treatment system. The first of these was the spread of the Human Immunodeficiency Virus (HIV), the virus that causes AIDS, among injection drug users and their sexual partners. HIV is transmitted through the shared use of contaminated syringes and other injection equipment, and through unprotected sexual behavior with infected individuals. By 1989, more than a fourth of reported AIDS cases were among injection drug users. At the same time, heterosexual transmission accounted for 5 percent of cases (Miller,Turner, and Moses, 1990:44). More than 67 percent of heterosexually acquired AIDS cases in women, who are at more risk of heterosexual transmission than men, are attributed to unprotected intercourse with an infected male injection drug user (Miller,Turner, and Moses, 1990:49). The second public health problem was a rapid increase in the use of "crack," a smokeable and highly addictive form of cocaine that is notorious for the remarkably short time in which it can dominate and devastate the lives of its users. After years of neglect, the drug abuse treatment system was ill-prepared to deal with either of these crises.

In 1989, as part of a larger AIDS prevention effort to reduce risk behaviors that spread HIV infection, the National Institute on Drug Abuse (NIDA) developed a program of research demonstration grants to improve and expand treatment. Client populations for these studies were defined as those at risk of HIV infection or transmission, either through injection drug use or through drug use linked to sexual risk behaviors (e.g., prostitution or exchange of sex for drugs). The following year, the initiative was broadened to include all individuals in . . .

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