DESCRIPTION: (Applicant's Abstract) Practical methods to facilitate detection of drug abuse and referral to treatment must be investigated. Brief intentions based on negotiation, decisional balance, and readiness to change are effective with alcohol abusers, but have not been adequately tested among crack/cocaine and heroin drug users. This study utilizes a randomized controlled trial to test the effectiveness of a brief negotiated interview and active referral process for linking crack/cocaine and heroin abusing patients from the general medical setting to the drug treatment system. Outreach workers from the same minority communities as the patients (the indigenous leader model) will be used to increase the effectiveness of intervention. 17,600 patients will be screened in the Urgent Care and Women's Health clinics at Boston Medical Center, using DAST and frequency of use questions embedded in a Health Needs History. We expect to detect 10% or 1760 patients with heroin and/or crack/cocaine use in the last three months and a DAST score > 3, and offer them enrollment. All enrollees will be assessed at baseline by researchers blinded to intervention or control status with biochemical analysis of hair for crack/cocaine and heroin, the Addiction Severity Instrument (ASI) and the Readiness to Change Ruler. After random allocation, a control group of 800 will receive the standard of care only (written advice/referral to treatment) and an intervention group of 800 will receive the same advice/referral materials plus a brief negotiated interview to encourage them to seek treatment. Follow up of control and intervention groups will occur at 3 and 6 months, and will consist of biochemical analysis, a structured interview, and repeat of the ASI Questionnaires. Treatment contact records obtained from subjects and from the State MIS Treatment database, and comprehensive charge and health care utilization data obtained from subjects and from Boston Medical Center for an 18 month preperiod and 18 month post-period will be analyzed to permit comparison of control and intervention groups. Subjects will also be compared for self-reported behaviors (improvement in DAST and ASI scores) and by biochemical test results. We hypothesize that the use of the brief negotiated interview and active referral process by outreach workers will facilitate access to treatment for patients in the general medical setting, (1) result in a 3:1 ratio of treatment contact compared to controls, (2) improve DAST and ASI scores, (3) reduce the number of hair samples positive for crack/cocaine and heroin, and (4) reduce Emergency Department and inpatient utilization, and substance abuse-related hospital admissions, visits and costs.