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.
| Smith, J E; Meyers, R J; Delaney, H D (1998) The community reinforcement approach with homeless alcohol-dependent individuals. J Consult Clin Psychol 66:541-8 |
