Although advances in pharmacotherapy have enabled people living with HIV/AIDS to live longer, fuller lives, some leave medical care, resulting in sub-optimal treatment and increased health risk to themselves and others. Forty-one patients who dropped out of an urban, publically funded primary care HIV clinic were contacted and encouraged by outreach staff to return. Participants were interviewed within two weeks of returning, and themes associated with dropping out and returning were elicited and content analyzed. Dropping out was associated with drug/alcohol use, unstable housing/homelessness, psychiatric disorders, incarceration, problems with HIV medications, inability to accept the diagnosis, relocation, stigma, problems with the clinic, and forgetfulness. Returning was associated with health concerns, substance abuse treatment/recovery, stable housing, incarceration/release, positive feelings about the clinic, spirituality, and assistance from family/relocation. Because a large number of patients reported substance abuse, depression, and past suicide attempts. Clinic staff should assess substance use, depression, and suicidal ideation at each primary care visit and encourage patients to obtain substance abuse treatment and mental health care. Future interventions could include providing SBIRT and/or onsite mental health and substance abuse treatment, all of which may boost retention.

Contingency management (CM) for drug abstinence has been applied to individuals independently even when delivered in groups. We developed a group CM intervention in which the behavior of a single, randomly selected, anonymous individual determined reinforcement delivery for the entire group. We also compared contingencies placed only on cocaine abstinence (CA) versus one of four behaviors (CA, treatment attendance, group CM attendance, and methadone compliance) selected randomly at each drawing. Two groups were formed with 22 cocaine-dependent community-based methadone patients and exposed to both CA and multiple behavior (MB) conditions in a reversal design counterbalanced across groups for exposure order. The group CM intervention proved feasible and safe. The MB condition improved group CM meeting attendance relative to the CA condition.

Among the numerous treatments available for helping to educate people with autism, applied behavior analysis (ABA) is the best empirically evaluated, as many articles in this dual-volume special issue document. Unfortunately, the best supported treatments are not always the best disseminated or accepted. Recently, however, ABA has emerged with widespread recognition beyond the limited community of academic and behavioral psychologists and special educators. In fact, ABA has been recognized by the surgeon general of the United States as the treatment of choice for autism in his mental health report for children: "Thirty years of research demonstrated the efficacy of applied behavioral methods in reducing inappropriate behavior and in increasing communication, learning, and appropriate social behavior" (U.S. Department of Health and Human Services, 1999). Corroborating the surgeon general's recommendation are state governments in New York (Department of Health, 1999) and California (Collaborative Work Group on Autistic Spectrum Disorders, 1997), as well as a collaborative group in Maine (MADSEC Autism Taskforce, 1999). New York and Maine reference the unparalleled quantity of outcome research supporting behavior analytic instruction and its best-practice features (see Jacobson, 2000). Beyond governmental organizations, the popular media has begun to recognize and educate the public about ABA treatment for autism. For example, ABC broadcast a Nightline episode endorsing ABA early intervention for children with autism 671

Background This is the first study to systematically manipulate duration of Voucher-Based Reinforcement Therapy (VBRT) to see if extending the duration increases abstinence during and following VBRT. Methods We randomized cocaine-dependent methadone-maintained adults to Standard (12 weeks; n=62) or Extended (36 weeks; n=68) VBRT and provided escalating voucher amounts contingent upon urinalysis verification of cocaine abstinence. Urinalysis was scheduled at least every two weeks during the 48-week study and more frequently during VBRT (3/week) and 12 weeks of Aftercare (2/week). Results Extended VBRT produced longer durations of continuous cocaine abstinence during weeks 1–24 (5.7 vs 2.7 weeks; p=0.003) and proportionally more abstinence during weeks 24–36 (X2 =4.57, p=.03, OR=2.18) compared to Standard VBRT. Duration of VBRT did not directly predict after-VBRT abstinence; but longer continuous abstinence during VBRT predicted abstinence during Aftercare (p=0.001) and during the last 12 weeks of the study (p < 0.001). Extended VBRT averaged higher monthly voucher costs compared to Standard VBRT ($96 vs $43, p < .001); however, the average cost per week of abstinence attained was higher in the Standard group ($8.06 vs $5.88, p < .001). Participants in the Extended group with voucher costs exceeding $25 monthly averaged 20 weeks of continuous abstinence. Conclusions Greater abstinence occurred during Extended VBRT, but providing a longer duration was not by itself sufficient to maintain abstinence after VBRT. However, if abstinence can be captured and sustained during VBRT, then providing longer durations may help increase the continuous abstinence that predicts better long-term outcomes.