This is a competing continuation application for the currently funded R18 grant entitled "Neurobehavioral Treatment for Cocaine-Abusing Methadone Patients" (9/90 - 8/95). The current study is implementing and evaluating an innovative treatment that addresses the continuing problem of cocaine use, including cocaine injection and crack use, among the methadone population. Neurobehavioral treatment was modified to take into account the specific psychological vulnerabilities of a disadvantaged inner-city methadone population. Therapeutic techniques designed to improve retention have enabled about two-thirds of study patients to complete six months of what is termed "enhanced cognitive- behavioral treatment." Enhanced treatment patients, as compared with randomly assigned controls, have declined in cocaine use, heroin use, and drug injection; and improved in psychological. The objectives of this competing renewal are (1) To replicate the study's enhanced cognitive-behavioral treatment model at a second inner-city methadone maintenance program; (2) to integrate the innovative treatment model into ongoing methadone clinic practice; (3) to evaluate the effectiveness of the model by conducting a controlled clinical trial of patient outcomes, and (4) to determine the patient characteristics and treatment process variables that may help predict outcomes. Dually- addicted (opiate- and cocaine-dependent) new admissions to methadone maintenance will be randomly assigned to one of three clinics with standard methadone treatment )N=168). Patients will progress from high intensity therapy (provided by one specialist in each clinic) to moderate intensity therapy and maintenance therapy (both provided by regular methadone counselors who will be trained and supervised in using the model). Patient outcomes measured at 4, 8 and 12 months after admission will be cocaine use, heroin use, drug injection, HIV risk behaviors, social productivity, criminality and psychiatric status. Additional analysis will examine the effects of outcomes of treatment process variables such as daily attendance rate, length of treatment, adjunct and supplementary services received; patient/therapist relationship; patient satisfaction; staff attitudes; and critical events during treatment. A Manual for Enhanced Cognitive-Behavioral Treatment will be produced to enable any methadone program to train clinic staff and to implement the model in ongoing clinic practice.