Initiating abstinence in cocaine abusing dually diagnosed homeless persons.

Area of Science:

• Addiction Medicine
• Mental Health Services
• Social Work

Background:

• Homelessness and substance use disorders, particularly cocaine dependence, represent significant public health challenges.
• Individuals with co-occurring non-psychotic mental disorders often face barriers to treatment and recovery.
• Contingency management, combined with behavioral interventions, has shown promise in addressing substance use.

Purpose of the Study:

• To evaluate the effectiveness of behavioral day treatment plus abstinence contingent housing and work therapy (DT+) compared to behavioral day treatment alone (DT).
• To assess the impact of DT+ on abstinence rates and housing stability in a population with cocaine abuse/dependence, mental disorders, and homelessness.

Main Methods:

• A randomized controlled trial was conducted with 110 participants meeting criteria for cocaine abuse or dependence, non-psychotic mental disorders, and homelessness.
• Participants were assessed at baseline, 2 months, and 6 months post-intervention.
• Outcomes measured included abstinence from cocaine and days housed.

Main Results:

• The DT+ group demonstrated significantly greater abstinence rates at both 2 and 6 months compared to the DT group.
• Participants in the DT+ group also experienced more days housed at the 6-month follow-up.
• The findings indicate a clear benefit of the integrated approach for this population.

Conclusions:

• Behavioral day treatment combined with abstinence contingent housing and work therapy (DT+) is an effective intervention for individuals with cocaine dependence, co-occurring mental disorders, and homelessness.
• The study reinforces the effectiveness of behavioral day treatment and contingency management as a combined strategy.
• DT+ significantly enhances abstinence outcomes and housing stability, suggesting its utility in clinical practice.