PREADMISSION AND POSTADMISSION ATTRITION OF HOMELESS, MENTALLY-ILL CHEMICAL ABUSERS REFERRED TO RESIDENTIAL-TREATMENT PROGRAMS

Aims. To assess the magnitude and psychopathologic predictors of attri tion among homeless, mentally ill chemical abusers (MICAs) referred to residential treatment programs in New York City. Design. Homeless, MI CAs were randomly referred to a therapeutic community (TC) or communit y residence (CR) and monitored with regard to pre-and post-admission a ttrition. Settings, Community based treatment facilities modified to t reat both substance abuse and major mental illness. Participants. Home less individuals with a major mental illness (DSM-III-R) and a history of abusing alcohol or other drugs. Measurements. Attrition rates and selected scales of psychopathology. Findings. From an initial pool of 694 treatment candidates, 147 (22%) were rejected for admission at the ir assigned facility; 247 (36%) failed to show up for treatment,. and 212 (31%) dropped out of treatment at some point during the first 12 m onths. Contrary to expectation, those with severe levels of psychotic ideation, depressive symptoms and hostility were admitted to treatment more frequently and stayed in treatment longer at the TC, a high dema nd approach, than the CR, a low demand approach. Conclusion. Clinician s should consider the TC as a viable treatment option for MICAs.