COMMUNITY REINFORCEMENT APPROACH WITH THE HOMELESS

拟议的研究项目将是 针对无家可归人口的社区强化方法(CRA)。上一首 研究表明，这一多方面的一揽子计划是高度 有效或酗酒(Hunt&Azrin，1973；Azrin，1976)，以及 社会不稳定、单身、失业的酗酒者群体 特别地(Azrin，Sisson，Meyers，&Godley，1982)。因此，它看起来很理想。 为无家可归者准备的。这项研究将是CRA治疗的比较 (带和不带双硫兰)和由 圣马丁无家可归者接待中心。受试者(N=100)将为 酗酒或酗酒，长期无家可归的成年人招募 来自圣马丁教堂不同文化背景的参与者。感兴趣 个人将被问及他们的意愿和能力 双硫兰(安非他明)。那些同意这一部分治疗的人将 被随机分配到第二轨道中的两个组之一：STD或CRA-D。 最初的CRA方案将进行修改，以更好地为无家可归者服务 通过：(A)允许一小部分个人参与 不使用双硫兰的CRA；(B)大部分情况下 通过小组会议进行个人咨询；(C)最强调主题 相关或无家可归者(例如，独立生活技能、解决问题 (D)以单亲家庭治疗取代婚姻治疗； (E)增加一次社区会议，以解决 发出无家可归者的声音，并挑选每周的增援人员；(F) 为每个小组提供大量的每周会议时间，以 在不危及治疗的情况下允许相当数量的“未命中” 有效性，(G)将治疗时间延长到大约12天 ；和(H)提供许多机会赚取或赢得财政收入 用于日常出勤和完成后续工作的增强剂。它是 假设CRA将被证明是一个明显更有效的 治疗STD，CRA D将比 CRA-D不同结果的预处理预测变量也将 被识别，允许未来将无家可归者与CRA进行匹配 程序。

The proposed research project will be the first application of the Community Reinforcement Approach (CRA) to a homeless population. Previous studies have demonstrated that this multi-faceted package is highly effective or alcoholics in general (Hunt & Azrin, 1973; Azrin, 1976), and the socially unstable, single, unemployed subset of alcoholics in particular (Azrin, Sisson, Meyers, & Godley, 1982). Thus, it appears ideal for the homeless. The study will be a comparison of the CRA treatment (with and without disulfiram) and the standard services (STD) offered by St. Martin's Hospitality Center for the homeless. Subjects (N=100) will be alcohol-dependent or alcohol abusing, chronically homeless adults recruited from the culturally diverse participants at St. Martin's. Interested individuals will be asked about their willingness and ability to take disulfiram (Antabuse). Those agreeing to this part of the treatment will be randomly assigned to one of two groups in a second track: STD or CRA-D. The original CRA package will be modified to better serve the homeless population by: (a) allowing a subsample of individuals to participate in the CRA without using disulfiram; (b) for the most part replacing individual counseling with group sessions; (c) emphasizing topics most relevant or the homeless (e.g., independent living skills, problem-solving skills); (d) replacing marital therapy with single-parent family therapy; (e) adding a community meeting as an opportunity for the concerns of the homeless to be voiced and for weekly reinforcers to be selected; (f) offering an extensive number of weekly meeting times for each group, to allow for a sizeable number of "misses" without jeopardizing treatment effectiveness, (g) extending the treatment length to approximately 12 weeks; and (h) offering many opportunities to earn or win financial reinforcers for daily attendance and for completing follow-ups. It is hypothesized that the CRA will prove to be a significantly more effective treatment that the STD, and that the CRA+D will be more successful than the CRA-D. Pretreatment predictor variables of differential outcomes also will be identified, permitting future matching of homeless persons to a CRA program.