COMMUNITY REINFORCEMENT APPROACH WITH THE HOMELESS

建议的研究项目将是第一次应用 对无家可归人口的社区强化办法。 先前 研究表明，这种多方面的一揽子计划是高度 有效或酗酒者（Hunt & Azrin，1973; Azrin，1976），以及 社会不稳定，单身，失业的酗酒者子集， （Azrin，Sisson，Meyers，& Godley，1982）。 因此，它似乎是理想的 为无家可归的人。 本研究将比较CRA治疗 (with和不含双硫仑）和标准服务（STD） 圣马丁的无家可归者接待中心 受试者（N=100）将 酒精依赖或酒精滥用，长期无家可归的成年人招募 从圣马丁教堂的多元文化参与者那里。 兴趣 个人将被问及他们的意愿和能力， 双硫仑（Antabuse）。 那些同意这部分治疗的人将 随机分配到第二轨道中的两个组之一：STD或CRA-D。 最初的CRA包将被修改，以更好地为无家可归者服务 （a）允许一个次级抽样的个人参加 不使用双硫仑的CRA;（B）在大多数情况下， 个人辅导与小组会议;（c）强调主题最 相关或无家可归者（例如，独立生活能力，解决问题能力 （d）以单亲家庭疗法取代婚姻疗法; (e)增加一个社区会议，作为一个机会， （f）为无家可归者发声，并选出每周一次的发言人; 为每个小组提供大量的每周会议时间， 在不影响治疗的情况下允许相当数量的“失误” （g）将治疗长度延长至约12 （h）提供许多机会赚取或赢得财务 每日出勤和完成随访的记录员。 是 假设CRA将被证明是一个更有效的 治疗STD，CRA+D将比 - D 治疗前预测变量的差异结果也将 确定，以便将来将无家可归者与CRA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.