The Wheel Project. Women Helping to Empower and Enhance Lives.

The Women Helping to Empower and Enhance Lives (WHEEL) Project focused on female sexual partners of injection drug users (i.d.u.s). It was conducted in five sites, three within and two outside the continental United States. The study's two main intervention goals were to (a) reduce HIV-related sexual risk behaviors and (b) reduce HIV-related drug risk behaviors. The Project also featured needs assessment, planning, and staff training components. Baseline data were collected on 2,794 women, which made this the largest study of noninjecting female sexual partners of i.d.u.s in the United States. Six-month follow-up data were obtained on 1,953 women. The Wheel Project tested two interventions: an individual intervention and a group intervention. The study found significant reductions in drug use and risky sexual behaviors for the 6-month follow-up sample for both interventions. These changes were substantial and point to the viability of both interventions for this population of sexual partners of injection drug users.

Injection drug users, crack-cocaine users, and human services utilization: an exploratory study.

Estimates of the number of people addicted to heroin and cocaine run into the millions. How these drug abusers interact with the social services system is not well understood. To gain insight into the nature and extent of such interactions, an exploratory study was conducted to gather information on the perceptions and utilization of human services by 44 drug abusers not in treatment. Twenty-nine injection drug users and 15 crack-cocaine users participated in focus group sessions and structured interviews. Participants were recruited by indigenous outreach workers in Dayton and Columbus, Ohio. Findings revealed a very high rate of service use by the drug users. The results raise questions about the role and efficacy of the social services system in identifying drug users and addressing their needs. In addition, the findings raise perplexing questions regarding the effectiveness of acquired immune deficiency syndrome risk-reduction efforts among injection drug users and crack-cocaine users.

Case management for substance abusers. More issues than answers.

Although case management has been successfully used in medical settings, its use for the delivery of multiple services for the substance abuser is questioned. An overview of the research suggests that low client-to-worker ratios, frequent and intense contacts, and chronic client relapse often contradict the emphasis on cost-containment, cost-effectiveness, and "successful" outcomes. The implementation of case management programs for substance abusers should proceed with caution. More emphasis should be placed on a community systems advocacy approach.

Implementation issues and techniques in randomized trials of outpatient psychosocial treatments for drug abusers. II. Clinical and administrative issues.

This paper focuses on implementation problems in randomized trials of outpatient psychosocial treatments for drug abusers. The authors examined these problems in nine clinical trial studies and drew on published literature and their own research experiences. Common problems faced by principal investigators include the need for midstream treatment protocol and research design modifications based on the response of both clients and clinical staff, tension between research and clinical requirements, and the need to administer a large, complex organization over a substantial period of time. Solutions include conducting a pilot study, employing advanced research and analysis methods that can incorporate complex design variations, fostering a team spirit between diverse staffs, and employing special management structures.

Implementation issues and techniques in randomized trials of outpatient psychosocial treatments for drug abusers: recruitment of subjects.

We reviewed nine randomized clinical trials of outpatient psychosocial treatments for drug abuse to ascertain implementation problems and solutions that the researchers developed. The most common problem was subject recruitment. Inadequate recruitment can disrupt a project's timetable, preoccupy its staff, reduce the trial's ability to detect treatment differences, and perhaps result in the trial's abandonment. The causes of recruitment problems include the need for large samples and multiple eligibility criteria, subject reluctance to be a "guinea pig," low client treatment motivation, client dislike of research procedures, clinicians' distrust of research, and difficulties collaborating with treatment agencies. Solutions include realistic assessment of the target population's size, use of mass media, statistical adjustments to minimize unnecessary sample exclusions, variable treatment assignment ratios, and prevention of common collaboration difficulties.

Issues in AIDS training for substance abuse workers.

Workers in drug treatment programs need specialized training concerning acquired immune deficiency syndrome (AIDS) to meet the demands of their expanding roles. Initially, the treatment community failed to anticipate training needs fully, but now, comprehensive and systematic AIDS training programs must be developed. This article discusses the five steps in developing and implementing such programs: (a) assessment and information gathering, (b) curriculum development, (c) training of instructors, (d) training delivery, and (e) evaluation.