SUSTAINING ABSTINENCE IN DUALLY DIAGNOSED HOMELESS

描述：（申请人摘要） 本研究探讨的问题是：什么是必要的和充分的 为无家可归的药物滥用者提供有效治疗服务的条件？ 它完善了一个正在进行的创新日治疗计划， 滥用可卡因的无家可归者，包括工作和住房干预。 它加强了善后和研究的关键变量的方案提供 住房 它建立了一个由225名滥用可卡因的无家可归者组成的队列， 包括工作和住房干预。 它可以加强善后工作， 研究计划提供住房的关键变量。 它建立了一个 225名可卡因滥用无家可归者的队列，DSM III-R轴I精神 除了物质使用障碍，然后随机分配他们 根据主要自变量，住房， 干预 所研究的变量比较了禁欲-应急住房， 非禁欲应急住房和没有住房，所有这些都是在 强化日间治疗、职业干预和善后护理 来自研究小组先前两项研究的成功干预。 除了研究的变量，所有组将共享相同的 干预由相同的辅导员在3个阶段：第一阶段，月。 1-2 每日强化治疗; II期，每月 3-6，术后护理3天/周; 第三阶段，月。 7-12，术后护理2天/周。 受试者将接受以下评估： 先前在2、6、12和18个月时使用的主要结局组合， 酗酒和吸毒、无家可归和就业。 一 将完成主要成果的成本效益/效益分析。 将测量精神功能和HIV风险的次要结局。 该研究调查了日间治疗加上提供的项目是否 禁欲住房是必要的，也是足够的， 治疗效果，或如果治疗日加非禁欲 单是特遣队提供的住房或日间治疗就足以 治疗滥用药物的流浪汉 结果将提供重要的 了解如何以最具成本效益的方式提供治疗服务， 这个困难的人群，知识，具有重要的临床，经济， 和公共政策影响。

DESCRIPTION: (Applicant's Abstract) This study addresses the question: what are necessary and sufficient conditions for effective treatment services for homeless substance abusers? It refines an ongoing innovative day treatment program for dually diagnosed, cocaine-abusing homeless persons, including work and housing interventions. It enhances aftercare and studies the critical variable of program-provided housing. It establishes a cohort of 225 cocaine-abusing homeless persons, including work and housing interventions. It enhances aftercare, and studies the critical variable of program-provided housing. It establishes a cohort of 225 cocaine-abusing homeless persons, with DSM III-R Axis I Mental Disorders in addition to Substance Use Disorders, then randomly assigns them to 3 groups of 75 based on the main independent variable, housing intervention. The studied variable compares abstinent-contingent housing, non-abstinent contingent housing and no housing, all in the context of intensive day treatment, vocational interventions, and aftercare derived from successful intervention in two previous studies by the research team. Except for the studied variable, all groups will share in the same interventions by the same counselors in 3 phases: Phase I, mo. 1-2 intensive daily day treatment; Phase II, mo. 3-6, aftercare 3 days/wk; Phase III, mo. 7-12, aftercare 2 days/wk. Subjects will be assessed with the previously used battery at 2, 6, 12 and 18 months on primary outcomes of alcohol and substance use, homelessness and employment. A cost-effectiveness/benefits analysis for primary outcomes will be completed. Secondary outcomes of psychiatric functioning and HIV risk will be measured. The study investigates whether day treatment plus program-provided abstinent-contingent housing is necessary and sufficient for maximum treatment effects or, if day treatment plus non-abstinent contingent-provided housing or day treatment alone are sufficient for treating substance abusing homeless. Results will provide important knowledge on how to most cost-effectively provide treatment services for this difficult population, knowledge which has important clinical, economic, and public policy implications.