SUSTAINING ABSTINENCE IN DUALLY DIAGNOSED HOMELESS

描述：(申请人摘要) 这项研究解决的问题是：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？ 它完善了针对双重诊断的持续创新的日间治疗计划， 滥用可卡因的无家可归者，包括工作和住房干预。 加强售后服务，研究计划提供的关键变量 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。它加强了善后服务，而且 研究了计划性住房的临界变量。它建立了一个 225名可卡因滥用流浪者的队列，患有DSM III-R Axis I精神疾病 在物质使用障碍之外的障碍，然后随机分配给他们 以3组75人为主要自变量，住房 干预。被研究的变量比较了节欲-临时住房， 非节制特遣队住房和无住房，所有这些都是在 强化日间治疗、职业干预和后续护理 来自研究小组在之前两项研究中的成功干预。 除了被研究的变量，所有的组都将分享相同的 同一辅导员分三个阶段进行干预：第一阶段、第二阶段。1-2 每日强化治疗；第二阶段，密歇根州。3~6周，术后3天/周； 密苏里州第三阶段7-12周，术后护理2天/周。科目将通过以下方式进行评估 先前使用的电池在2、6、12和18个月时对 酗酒和吸毒、无家可归和就业。一个 将完成对主要成果的成本效益/效益分析。 将衡量精神功能和艾滋病毒风险的次要结果。 这项研究调查了日间治疗加计划提供的 节制-临时住房是必要的，也是最大限度地 治疗效果或，如果白天治疗加非禁欲 仅特遣队提供的住房或日间治疗就足以 治疗滥用药物的无家可归者。结果将提供重要的 关于如何最具成本效益地提供治疗服务的知识 这一困难的人群，具有重要的临床、经济、 以及公共政策方面的影响。

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.