The motivation for drug abuse treatment: testing cognitive and 12-step theories

The purpose of this paper is to evaluate two models of behavior change: cognitive theory and 12-step theory. Research subjects were drawn from three separate, but parallel, samples of adults. The first sample consisted of out-of-treatment chronic drug users, the second consisted of drug users who had applied for treatment at a publicly funded multiple-provider drug treatment facility, and the third consisted of drug users who had applied for treatment at an intensive outpatient program for crack cocaine users. Cognitive theory was supported. Study participants applying for drug abuse treatment reported a higher level of perceived problem severity and a higher level of cognitive functioning than out-of-treatment drug users. Two hypotheses drawn from 12-step theory were not supported. Treatment applicants had more positive emotional functioning than out-of-treatment drug users, and one treatment-seeking sample had higher self-esteem.

Effect of drug user treatment on psychosocial change: a comparison of in-treatment and out-of-treatment cocaine users

A panel study of 189 in-treatment and 297 out-of-treatment "heavy" drug users was used to evaluate the hypothesis that drug users who participated in drug user treatment would have a greater degree of psychosocial improvement than those who did not participate in treatment. Although time in treatment was significantly associated with improvements in all three domains, a simple path model suggested that changes in cognitive functioning may have mediated changes in self-esteem and emotional functioning. These results indicate that treatment does produce psychological change, and they hint that the cognitive domain may drive most of this change.

To hang in the 'hood: description and analysis of outreach activities

The unique, influential, and successful characteristics of outreach as a risk behavior reduction intervention among active drug users is examined. The history of outreach is posited as a delineation of roles, and the outreach process as one of communication and role enactment. The premise is that the outreach worker's juxtaposition of multiple communicative roles facilitates success with HIV outreach interventions. The word "outreach" implies a desired object that eludes one's ready grasp. In the attempt to educate the active drug user about HIV risk behavior, it is the addict that often eludes the educator's ready grasp; a small dilemma for the creative outreach worker. An ethnographic description is provided of four different outreach workers' abilities to penetrate social networks, locate and recruit hidden populations, contextualize client behavior, respond to client needs, and build trust necessary to engage them in risk reduction interventions, while still adhering to program recruitment guidelines. Investigative, study, and outreach limitations are discussed.