Modified therapeutic community for homeless mentally ill chemical abusers:Treatment outcomes

This study compared homeless mentally ill chemical abuser (MICA) clients (n = 342), male and female, sequentially assigned to either of two modified t herapeutic community programs (TC1 and TC2) and to a treatment-as-usual (TA U) control group. Follow-up interviews were obtained at 12 months postbasel ine and at time F (on average more than 2 years postbaseline) on a retrieve d sample df 232 (68%) clients and 281 (82%) clients; respectively. Outcome measures assessed five domains: drug use, crime, HIV risk behavior, psychol ogical symptoms, and employment. Individuals in both modified TC groups sho wed significantly greater behavioral improvement than TAU at 12 months and time F, and the modified TC2, with lower demands and more staff guidance, w as superior to modified TC1. Completers of both TC programs showed signific antly greater improvement than dropouts and a subgroup of TAU clients with high exposure (i.e., more than 8 months) to other treatment protocols. The present findings support the effectiveness and longer term stability of eff ects of a modified TC program for treating homeless MICA clients.