Residential treatment for dually diagnosed homeless veterans: A comparisonof program types

This study compared two types of residential programs that treat dually dia gnosed homeless veterans. Programs specializing in the treatment of substan ce abuse disorders (SA) and those programs addressing both psychiatric diso rders and substance abuse problems within the same setting (DDX) were compa red on (1) program characteristics, (2) clients' perceived environment, and (3) outcomes of treatment. The study was based on surveys and discharge re ports from residential treatment facilities that were under contract to the Department of Veterans Affairs Health Care for Homeless Veterans program a national outreach and case management program operating at 71 sites across the nation. Program characteristics surveys were completed by veterans in treatment, and discharge reports were completed by Va case managers. DDX pr ograms were characterized by lower expectations for functioning, more accep tance of problem behavior, and more accommodation for choice and privacy, r elative to SA programs after adjusting for baseline differences. Dually dia gnosed veterans in DDX programs perceived these programs as less controllin g than SA programs, but also as having lower involvement and less practical and personal problem orientations. At discharge, a lower percentage of vet erans from DDX than SA programs left without staff consultation. A higher p ercentage of veterans from DDX than SA programs were discharged to communit y housing rather than to further institutional treatment. Program effects w ere not different for psychotic and non-psychotic veterans. Although differ ences were modes, integration of substance abuse and psychiatric treatment may promote a faster return to community living for dually diagnosed homele ss veterans. Such integration did not differentially benefit dually diagnos ed veterans whose psychiatric problems included a psychotic disorder.