Women and families now comprise about 30 percent of the homeless population and they are viewed as the fastest rising subgroup. Alcoholism is their most widespread health problem It is unfortunate, then, that despite the availability of efficacious treatment programs, women enter and remain in them at much lower rates than do men. Some suggest that women will only seek treatment if women's issues are addressed or when they have options other than predominantly male programs. Since the proposed study will attempt to recruit a large sample of homeless women, an all-female program will be conducted utilizing a treatment that has been modified to take women's issues into consideration. Ninety-nine alcohol-dependent or alcohol-abusive homeless women will be randomly assigned to one of three conditions: case management (CM), the Community Reinforcement Approach (CRA), or an enhanced CRA program called CREATE (Community Reinforcement, Employment, and Training Enhancement). It is considered essential to investigate a CM program, both due to its widespread popularity, and the fact that it has only inconsistent empirical backing. The behavioral intervention, CRA, has proven to be efficacious for treating alcoholics and was listed as the most cost-effective treatment in the latest meta- analytic review. In its recent successful application to a homeless population, promising preliminary outcomes were detected for the small sample of female participants. However, two limitations were apparent. First, a considerable number of women relapsed when both their treatment and their stay in the abstinence-contingent, free housing ended. Consequently, the current proposal is an attempt to provide aftercare services during this high-risk period. It also will specifically address critical issues for these women (e.g. sexual victimization) from the start. A second problem was the high rate of unemployment posttreatment. In response, this project will offer basic computer skills training to the CREATE group through an empirically-based contingency management (voucher) program proven to enhance job-training attendance. The CREATE condition also will receive motivational CRA procedures called Systematic Encouragement to bolster job-training attendance and to make the work environment a reinforcing community. It is predicted that both of the CRA conditions will result in significant improvement in alcohol use, employment, and housing stability compared to CM, and that the CREATE group will obtain employment outcomes superior to the regular CRA group.
