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.

Agency
National Institute of Health (NIH)
Institute
National Institute on Drug Abuse (NIDA)
Type
Research Project (R01)
Project #
5R01DA008475-07
Application #
6329137
Study Section
Human Development Research Subcommittee (NIDA)
Program Officer
Flanzer, Jerry
Project Start
1994-09-30
Project End
2003-05-31
Budget Start
2000-12-01
Budget End
2003-05-31
Support Year
7
Fiscal Year
2001
Total Cost
$584,810
Indirect Cost
Name
University of Alabama Birmingham
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
004514360
City
Birmingham
State
AL
Country
United States
Zip Code
35294
Kertesz, Stefan G; Mullins, Ashley N; Schumacher, Joseph E et al. (2007) Long-term housing and work outcomes among treated cocaine-dependent homeless persons. J Behav Health Serv Res 34:17-33
Schumacher, Joseph E; Milby, Jesse B; Wallace, Dennis et al. (2007) Meta-analysis of day treatment and contingency-management dismantling research: Birmingham Homeless Cocaine Studies (1990-2006). J Consult Clin Psychol 75:823-8
Milby, Jesse B; Schumacher, Joseph E; Vuchinich, Rudy E et al. (2004) Transitions during effective treatment for cocaine-abusing homeless persons: establishing abstinence, lapse, and relapse, and reestablishing abstinence. Psychol Addict Behav 18:250-6
Schumacher, Joseph E; Milby, Jesse B; Wallace, Dennis et al. (2003) Diagnostic compared with abstinence outcomes of day treatment and contingency management among cocaine-dependent homeless persons. Exp Clin Psychopharmacol 11:146-57
Milby, Jesse B; Schumacher, Joseph E; Wallace, Dennis et al. (2003) Day treatment with contingency management for cocaine abuse in homeless persons: 12-month follow-up. J Consult Clin Psychol 71:619-21
Usdan, S L; Schumacher, J E; Milby, J B et al. (2001) Crack cocaine, alcohol, and other drug use patterns among homeless persons with other mental disorders. Am J Drug Alcohol Abuse 27:107-20
McNamara, C; Schumacher, J E; Milby, J B et al. (2001) Prevalence of nonpsychotic mental disorders does not affect treatment outcome in a homeless cocaine-dependent sample. Am J Drug Alcohol Abuse 27:91-106
Milby, J B; Schumacher, J E; McNamara, C et al. (2000) Initiating abstinence in cocaine abusing dually diagnosed homeless persons. Drug Alcohol Depend 60:55-67
Schumacher, J E; Usdan, S; Milby, J B et al. (2000) Abstinent-contingent housing and treatment retention among crack-cocaine-dependent homeless persons. J Subst Abuse Treat 19:81-8