SUFFICIENT CONDITIONS FOR EFFECTIVE TREATMENT OF SUBSTANCE-ABUSING HOMELESS PERSONS

Treatment efficacy for homeless substance abusers (primarily crack coc aine) was studied in a randomized control design with subjects (n = 17 6) assigned to usual care (UC) or an enhanced day treatment program pl us abstinent contingent work therapy and housing (EC). Subjects met DS M-III-R criteria for Substance Use Disorder and McKinny Act criteria f or homelessness. UC involved weekly individual and group counseling. E C involved a day treatment program consisting of daily attendance, tra nsportation, lunch, manualized psychoeducational groups, and individua l counseling. A total of 131 (74.4%) subjects (62 UC and 69 EC) were t reated and followed. UC subjects attended 28.5% and EC attended 48.4% of expected treatment during the first 2 months. After 2 months, EC su bjects experienced up to 4 months of abstinent contingent work therapy (44.9% of EC subjects) and housing (37.7% of EC subjects), with day t reatment available two afternoons per week. Longitudinal Wei-Lachin an alyses of medians (reported alcohol use, days homeless and employed) a nd proportions (cocaine toxicologies) were conducted across 2-, 6-, an d 12-month follow-up points. EC had 36% fewer positive cocaine toxicol ogies at 2-months and 18% fewer at 6-months than UC with regression to ward baseline at 12-months. EC had 8 days fewer days of reported alcoh ol use in the past 30 days, 52 fewer days homeless in the past 60 days , and 10 more days employed in the past 30 days from baseline to the 1 2-months. UC showed no changes except a temporary increase in employme nt at 6-months. This is one of the first demonstrations that homeless cocaine abusers can be retained and effectively treated.