Journal of Substance Abuse Treatment
Volume 34, Issue 2 , Pages 180-191, March 2008

Toward cost-effective initial care for substance-abusing homeless

  • Jesse B. Milby, Ph.D.

      Affiliations

    • University of Alabama at Birmingham, Birmingham, AL, USA
    • Corresponding Author InformationCorresponding author. Department of Psychology, University of Alabama at Birmingham, CH 201, 1530 3rd Avenue South, Birmingham, AL 35294-1170, USA. Tel.: +1 205 934 8723; fax: +1 205 975 6953.
    • ,
  • Joseph E. Schumacher, Ph.D.

      Affiliations

    • University of Alabama at Birmingham, Birmingham, AL, USA
    • ,
  • Rudy E. Vuchinich, Ph.D.

      Affiliations

    • University of Alabama at Birmingham, Birmingham, AL, USA
    • ,
  • Michelle J. Freedman, Ph.D.

      Affiliations

    • University of Alabama at Birmingham, Birmingham, AL, USA
    • ,
  • Stefan Kertesz, M.D., M.Sc.

      Affiliations

    • University of Alabama at Birmingham, Birmingham, AL, USA
    • ,
  • Dennis Wallace, Ph.D.

      Affiliations

    • Rho Inc. Federal Systems Division, Chapel Hill, NC, USA

Received 22 November 2006; received in revised form 28 February 2007; accepted 4 March 2007. published online 21 May 2007.

Abstract 

In a randomized controlled trial, behavioral day treatment, including contingency management (CM+), was compared to contingency management components alone (CM). All 206 cocaine-dependent homeless participants received a furnished apartment with food and work training/employment contingent on drug-negative urine tests. CM+ also received cognitive–behavioral therapy, therapeutic goal management, and other intervention components. Results revealed that CM+ treatment attendance and abstinence were not significantly different from CM during 24 weeks of treatment. After treatment and contingencies ended, however, CM+ showed more abstinence than CM, indicating a delayed effect of treatment from 6 to 18 months. CM+ had more consecutive weeks abstinent across 52 weeks, but not during active treatment. We conclude that CM alone may be viable as initial care for cocaine-dependent homeless persons. That CM+ yields more durable abstinence indicates that it may be appropriate as stepped-up care for clients not responding to CM (Clinical Trials.gov, no. NCT00368524).

Keywords: Homeless, Substance abuse, Contingency management, Cost-effectiveness, Outcomes

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PII: S0740-5472(07)00086-4

doi:10.1016/j.jsat.2007.03.003

Journal of Substance Abuse Treatment
Volume 34, Issue 2 , Pages 180-191, March 2008

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