Reducing Offenders' HIV Risk: MI Enhanced Case Management With Drug-Free Housing
|Alcohol and Drug Abuse||Behavioral: Motivational interviewing case management Behavioral: Resource referrals|
|Study Design:||Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Treatment
|Official Title:||Reducing Offenders' HIV Risk: MI Enhanced Case Management With Drug-Free Housing|
- Change in criminal justice outcomes [ Time Frame: Baseline, 6-mo, 12-mo ]Measured by number of arrests, convictions, and length of time incarcerated.
- Change in Alcohol and Drug Use (Alcohol Severity Index & Timeline Follow Back) [ Time Frame: Baseline, 6-mo, 12-mo ]Measured by number of days of use for specific drugs in last 30 days and last 6 months.
- Change in needle use and injection, sexual risk behaviors, and HIV status and testing. [ Time Frame: Baseline, 6-mo and 12-mo ]Measured by how often needles were used, shared and cleaned; frequency of high risk sexual behaviors; how recently HIV testing was completed and level of concern about exposure to HIV.
- Change in Alcohol Severity Index (ASI) Scales [ Time Frame: Baseline, 6-mo and 12-mo ]Measured utilizing the standard ASI scales.
- Change in housing stability [ Time Frame: Baseline, 6-mo and 12-mo ]Measured by recent housing situation, how stable the situation is, ability to pay for housing, and how many days living in controlled environments.
- Change in work and income history [ Time Frame: Baseline, 6-mo and 12-mo ]Measured by level of income and how many days worked in the last 30 days and last 6 months.
- Change in social support [ Time Frame: Baseline, 6-mo and 12-mo ]Measured by how frequently the respondent either received or offered support from/to family and friends in the last 12 months.
- Changes in Alcoholics Anonymous (AA)/ Narcotics Anonymous (NA) involvement [ Time Frame: Baseline, 6-mo and 12-mo ]Measured by how many AA/NA meetings were attended in the last 6 months, and measures of identification with AA/NA programs.
- Changes in services received [ Time Frame: Baseline, 6-mo and 12-mo ]Measured by how often common services, such as medical and counseling services, were accessed in the prior 2 months.
- Changes in support and confrontations with family, friends and professionals about drug and alcohol use [ Time Frame: Baseline, 6-mo and 12-mo ]Measured by how often significant people in their lives confronted the respondents about making changes to alcohol and drug use.
- Changes in occurrence and impact from trauma, post-traumatic stress disorder (PTSD), and abuse history [ Time Frame: Baseline, 6-mo and 12-mo ]Measured by how much past traumatic events are causing bothersome feelings and experiences, whether past physical or sexual abuse has occurred and how recently it has happened.
- Changes in motivation to change based on the Alcohol and Drug Consequences Questionnaire (ADCQ) [ Time Frame: Baseline, 6-mo and 12-mo ]Measured by two scales that assess motivation to change substance abuse, based on consequences and benefits significant to the respondents.
- Changes in results from urine screens for drugs [ Time Frame: Baseline, 6-mo and 12-mo ]Measured by positive or negative drug rest results.
|Study Start Date:||January 2014|
|Estimated Study Completion Date:||March 2018|
|Estimated Primary Completion Date:||March 2018 (Final data collection date for primary outcome measure)|
Experimental: Motivational interviewing case management
MICM intervention combines aspects of motivational interviewing along with case management to influence HIV risk and recovery from alcohol and drug problems. Participants assigned to the MICM condition will receive 3 individual sessions within the first 2 weeks of entering the SLH. Thereafter they will have contact with the MICM therapist monthly throughout the duration of their enrollment in the study (12 months).
|Behavioral: Motivational interviewing case management|
Respondents will receive SLH services as usual along with a list of resources that can be used to address a variety of problems.
|Behavioral: Resource referrals|
Hide Detailed Description
This application is based on the premise that probationers and parolees must have access to stable, drug free housing to reduce HIV risk, access needed services and avoid rearrests and reincarceration. Drug free housing at the Sober Living Network (SLN) in California will be studied as a way to provide a positive living environment for probationers and parolees. The houses use a sober living house (SLH) model of recovery that includes a communal recovery environment, abstinence from drugs and alcohol, peer support, and encouragement to attend self-help groups such as Alcoholics Anonymous. Preliminary data based on a sample of 300 individuals entering 20 SLHs in California showed resident improvement in a variety of areas, including drug and alcohol use, employment, psychiatric symptoms, and arrests (Polcin et al., 2010). Although residents referred from parole and probation systems had substance use reductions that were comparable to voluntary residents, they had had far more problems maintaining employment, higher rates of arrest and incarceration, and lower attendance at self- help groups (Polcin, et al., 2010). Thirty seven percent had been rearrested at 6 month follow-up and 0ne reason may be that probationers and parolees received only 35% of the services that they felt they needed to succeed. Although over half met DSM IV criteria for methamphetamine dependence during the last year, a very high risk group for HIV, we did not assess HIV outcomes.
The proposed study will improve SLHs for offenders by adding a Motivational Interviewing Case Management (MICM) intervention specifically targeted to the problems presented by each offender. The list of potential problems that MICM can address is extensive: 1) adapting to the SLH environment, 2) complying with parole and probation, 3) finding and maintain work, 4) successfully accessing and maintaining retention in services, 5) addressing HIV risk, testing and treatment, 6) mobilizing personal and informal resources, and 7) managing setbacks (e.g., relapse, loss of housing, loss of work).
Men and women offenders (N=330) entering SLHs will be assigned to a condition consisting of drug free housing and provision of a resources manual where residents can seek help for a variety of problems (a control group) or drug free housing plus the MICM (intervention).
Aim 1: To assess HIV testing rates, HIV risk behaviors, and utilization for HIV services at baseline, 6, and 12 months.
H1.1 Residents receiving MICM in addition to drug free housing will have higher rates of HIV testing, higher utilization of HIV services, and fewer HIV risk behaviors than the drug free housing and resources condition.
Aim 2: To compare baseline substance use within each study condition with 6- and 12-month substance use.
H2.1 Residents in each study condition will show significant reductions in drug and alcohol use between baseline and follow-up time points as measured by the Time Line Follow Back (TLFB).
H2.2 Residents in each study condition will show significant reductions in drug and alcohol problems between baseline and follow-up time points on the Addiction Severity Index alcohol and drug scales.
Aim 3: To compare outcomes between the two study conditions at baseline, 6, and 12 months.
H3.1 Residents receiving MICM in addition to drug free housing will have less substance use (TLFB) and lower ASI alcohol and drug severity than the drug free housing and resources condition.
H3.2 Residents receiving MICM in addition to drug free housing will have fewer arrests, fewer days incarcerated and lower ASI legal severity than the drug free housing and resources condition.
H3.3 Residents receiving MICM in addition to drug free housing will have fewer work problems (ASI Employment scale) and more days worked than the drug free housing and resources condition.
Aim 4: To assess mediators and moderators of the MICM. H4.1 Service utilization (Hser et al., 1999) will mediate the relationship between drug free housing plus MICM and outcome (TLFB, ASI Alcohol and Drug scales and criminal justice recidivism).
Exploratory Aims: 1) To explore additional outcomes (e.g., ASI Family, Medical, and Psychiatric scales, long-term housing status) and covariates (e.g., social support, supportive confrontation, motivation). (2) To conduct 30 qualitative interviews (15 per condition) to identify general and intervention specific factors affecting outcome.
Please refer to this study by its ClinicalTrials.gov identifier: NCT01977092
|United States, California|
|Alcohol Research Group|
|Emeryville, California, United States, 94608|
|Principal Investigator:||Doug Polcin, Ed.D||Alcohol Research Group / Public Health Institute|