INITIATING ABSTINENCE IN DUALLY DIAGNOSED HOMELESS

这项研究建议加强正在进行的创新日治疗 滥用药物无家可归者方案，包括工作和住房 干预措施，以及对可卡因依赖的最先进的新治疗。 1991年NIAAA/NIDA研究演示的结果显示， 治疗比常规护理更有效， 禁欲，改善独立住房，增加就业天数 和收入。调查结果还显示，77%的客户 可卡因滥用者或可卡因依赖者，大多数与DSM III-R相关 精神障碍这项研究建议更有针对性地治疗 在1991年的示威中发现的人口， 从最近开始可卡因戒断的最有效的治疗方法 一个更不正常的双重诊断无家可归的人群。 这项研究还旨在解决这个问题： 有效处理无家可归物质的充分条件 施虐者药物使用障碍的有效治疗是否足以 不仅改善了药物滥用，而且改善了无家可归的问题， 失业？该提案建立了一个新的150名可卡因滥用者的队列 同时患有非精神病性精神疾病的无家可归者。 它将 比较行为社会强化日治疗计划， 可卡因滥用，加上禁欲或有住房和工作治疗与 日间治疗控制，不包括禁欲情况 住房和工作治疗，关于开始禁欲和减少 无家可归和失业。 这项研究将提供重要信息， 有效治疗无家可归者所需的充分条件 物质使用障碍 拟议的研究迈出了第一步， 将对无家可归者的干预与对药物滥用的干预分开， 发现这些联合干预是否必要和充分 或者，如果对药物滥用的有效干预足以 治疗滥用药物的无家可归者。因此，这项研究的信息 将提供关于如何最有效地治疗这种疾病的重要知识， 困难人群，具有重要临床、经济和 公共政策影响。

This research proposes to enhance an ongoing innovative day treatment program for substance abusing homeless persons, including work and housing interventions, with new state-of-the-art treatment for cocaine dependance. Results from a NIAAA/NIDA research demonstration in 1991 revealed that day treatment was significantly more effective than usual care in establishing abstinence, improving independent housing, and increasing days employed and earned income. Findings also showed that 77% of the clients were cocaine abusers or cocaine dependent and most had associated DSM III-R mental disorders. This research proposes to target treatment more precisely to the population found in the 1991 demonstration and to extend the most effective treatment for initiating cocaine abstinence from recent research to a more dysfunctional dually diagnosed homeless population. This study is also designed to address the question: What are the sufficient conditions for effective treatment of homeless substance abusers? Is effective treatment for Substance Use Disorders sufficient to produce improvement in, not only substance abuse, but homelessness and unemployment? The proposal establishes a new cohort of 150 cocaine abusing homeless persons with a co-existing non-psychotic mental illness. It will compare a behavioral social reinforcement day treatment program for cocaine abuse, plus abstinence contingent housing and work therapy vs. a day treatment control, which does not include abstinence contingent housing and work therapy, on initiating abstinence and reducing homelessness and unemployment. This study will yield important information on the necessary and sufficient conditions needed for effective treatment of homeless persons with Substance Use Disorders. The proposed study takes a first step in separating interventions for homelessness vs. substance abuse, and discovering if these combined interventions are necessary and sufficient or, if effective intervention for substance abuse is sufficient alone for treatment of substance abusing homeless. Thus, information from this study will provide important knowledge on how to most effectively treat this difficult population, knowledge which has important clinical, economic and public policy implications.