Skip to main content

Advertisement

SpringerLink
Log in

Long-Term Housing and Work Outcomes Among Treated Cocaine-Dependent Homeless Persons

  • Regular Article
  • Published:
The Journal of Behavioral Health Services & Research Aims and scope Submit manuscript

Abstract

Communities across the United States have initiated plans to end chronic homelessness. In many of these communities, addiction treatment programs remain the default point of entry to housing and services. This study examined the percentage of cocaine-using homeless persons (all with psychiatric distress) attaining stable housing and employment 12 months after entering a randomized trial of intensive behavioral day treatment, plus one of the following for 6 months: no housing; housing contingent on drug abstinence; housing not contingent on abstinence. Of 138 participants, the percentages with stable housing and employment at 12 months were 34.1 and 33.3%, respectively. Analyses suggested superior outcomes in trial arms that offered housing as part of the behavioral treatment. The majority of participants, however, did not achieve housing or employment, in part because of the limited capacity of the local housing programs to accommodate persons who had not achieved perfect abstinence. The findings demonstrate a helpful role for addiction treatment and suggest the need for services to support housing of persons who reduce but do not eliminate all substance use.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1
Figure 2

Similar content being viewed by others

References

  1. Burt MR, Hedderson J, Zweig J, et al. Strategies for reducing chronic street homelessness. Washington, DC: United States Department of Housing and Urban Development Office of Policy Development and Research 2004. Report No. Available at: http://www.urban.org/publications/1000775.html. Accessed September 30, 2006.

  2. United States Interagency Council on Homelessness. City and County 10-Year Plan Update. Published; 2006: Available at: http://www.ich.gov/slocal/plans/10-year-plan-communities.pdf. Accessed July 21, 2006.

  3. United States Department of Housing and Urban Development. Notice of Funding Availability (NOFA) for the Collaborative Initiative to Help End Chronic Homelessness. Published; 2003: Available at: http://www.hud.gov/offices/cpd/homeless/apply/2002nofa/index.cfm. Accessed September 30, 2006.

  4. Editorial. Up and Off the Streets. New York Times. June 9, 2003; A:30.

  5. Editorial. Ending Chronic Homelessness. New York Times. March 13, 2002; A:24.

  6. Burt MR, Aron LY, Lee E, et al. Helping America’s Homeless: Emergency Shelter or Affordable Housing? Washington, DC: The Urban Institute Press; 2001.

    Google Scholar 

  7. Meyer IH, Schwartz S. Social issues as public health: promise and peril. American Journal of Public Health. 2000;90(8):1189–1191.

    PubMed  CAS  Google Scholar 

  8. Wright JD, Rubin BA, Devine JA. Beside the Golden Door: Policy, Politics, and the Homeless. New York: Aldine de Gruyter; 1998.

    Google Scholar 

  9. Vangeest JB, Johnson TP. Substance abuse and homelessness: direct or indirect effects? Annals of Epidemiology. 2002;12(7):455–461.

    Article  PubMed  Google Scholar 

  10. The Secretary’s Work Group on Ending Chronic Homelessness. Ending Chronic Homelessness: Strategies for Action. Washington, D.C.: Department of Health and Human Services, USA 2003. Report No. Available at: http://aspe.hhs.gov/hsp/homelessness/strategies03/index.htm. Accessed September 28, 2006.

  11. Burt MR, Aron LY, Douglas T, et al. Homelessness: Programs and the People They Serve. Technical Report of Findings of the National Survey of Homeless Assistance Providers and Clients. Washington, DC: Urban Institute 1999. Report No. Available at: http://www.huduser.org/publications/homeless/homeless_tech.html. Accessed September 28, 2006.

  12. Substance Abuse and Mental Health Services Administration. Blueprint for Change: Ending Chronic Homelessness for Persons with Serious Mental Illnesses and Co-Occurring Substance Use Disorders. DNNS Pub. No. SMA-04-3870. Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, 2003. Report No. Available at: http://mentalhealth.samhsa.gov/publications/allpubs/SMA04-3870/default.asp. Accessed September 30, 2006.

  13. Orwin RG, Scott CK, Arieira C. Transitions through homelessness and factors that predict them: three-year treatment outcomes. Journal of Substance Abuse Treatment. 2005;28(Suppl 1):S23–S39.

    Article  PubMed  Google Scholar 

  14. Burnam MA, Morton SC, McGlynn EA, et al. An experimental evaluation of residential and nonresidential treatment for dually diagnosed homeless adults. Journal of Addictive Diseases. 1995;14(4):111–134.

    Article  PubMed  CAS  Google Scholar 

  15. Smith EM, North CS, Fox LW. Eighteen-month follow-up data on a treatment program for homeless substance abusing mothers. Journal of Addictive Diseases. 1995;14(4):57–72.

    Article  PubMed  Google Scholar 

  16. Lapham SC, Hall M, Skipper BJ. Homelessness and substance use among alcohol abusers following participation in Project H&ART. Journal of Addictive Diseases. 1995;14(4):41–55.

    Article  PubMed  CAS  Google Scholar 

  17. Conrad KJ, Hultman CI, Pope AR, et al. Case managed residential care for homeless addicted veterans. Results of a true experiment. Medical Care. 1998;36(1):40–53.

    Article  PubMed  CAS  Google Scholar 

  18. Sosin MR, Bruni M, Reidy M. Paths and impacts in the progressive independence model: a homelessness and substance abuse intervention in Chicago. Journal of Addictive Diseases. 1995;14(4):1–20.

    Article  PubMed  CAS  Google Scholar 

  19. Milby JB, Schumacher JE, Wallace D, et al. To house or not to house? Does it make a difference? American Journal of Public Health. 2005;95(7):1259–1265.

    Article  PubMed  Google Scholar 

  20. Milby JB, Schumacher JE. To House or not to house? Does it make a difference? American Journal of Public Health. 2005;95:1259–1265.

    Article  PubMed  Google Scholar 

  21. Milby JB, Schumacher JE, Raczynski JM, et al. Sufficient conditions for effective treatment of substance abusing homeless persons. Drug and Alcohol Dependence. 1996;43(1-2):39–47.

    Article  PubMed  CAS  Google Scholar 

  22. Milby JB, Schumacher JE, McNamara C, et al. Initiating abstinence in cocaine abusing dually diagnosed homeless persons. Drug and Alcohol Dependence. 2000;60(1):55–67.

    Article  PubMed  CAS  Google Scholar 

  23. United States Congress. Stewart B. McKinney Homeless Assistance Act. Public Law 100-77; 1987.

  24. McNamara C, Schumacher JE, Milby JB, et al. Prevalence of nonpsychotic mental disorders does not affect treatment outcome in a homeless cocaine-dependent sample. American Journal of Drug and Alcohol Abuse. 2001;27(1):91–106.

    Article  PubMed  CAS  Google Scholar 

  25. Derogatis LR. The SCL-R-Manual I: Scoring, Administration and Procedures for the SCL-90. Baltimore, MD: Clinical Psychometric Research; 1977.

    Google Scholar 

  26. Iguchi MY, Belding MA, Morral AR, et al. Reinforcing operants other than abstinence in drug abuse treatment: an effective alternative for reducing drug use. Journal of Consulting and Clinical Psychology. 1997;65(3):421–428.

    Article  PubMed  CAS  Google Scholar 

  27. Hansten ML, Downey L, Rosengren DB, et al. Relationship between follow-up rates and treatment outcomes in substance abuse research: more is better but when is “enough” enough? Addiction. 2000;95(9):1403–1416.

    Article  PubMed  CAS  Google Scholar 

  28. Barrow S, Hellman F, Lovell A, et al. Personal History Form. In: Community Support Systems Evaluation Program, Epidemiology of Mental Disorders Research Department. New York State Psychiatric Institute; 1985.

  29. Drake RE, McHugo GJ, Biesanz JC. The test–retest reliability of standardized instruments among homeless persons with substance use disorders. Journal of Studies on Alcohol. 1995;56(2):161–167.

    PubMed  CAS  Google Scholar 

  30. Orwin RG, Scott CK, Arieira CR. Transitions through homelessness and factors that predict them: residential outcomes in the Chicago Target Cities treatment sample. Evaluation and Program Planning. 2003;26:379–392.

    Article  Google Scholar 

  31. Fischer PJ, Breakey WR. The epidemiology of alcohol, drug, and mental disorders among homeless persons. American Psychologist. 1991;46(11):1115–1128.

    Article  PubMed  CAS  Google Scholar 

  32. Kowal J. Homeless alcoholics receive a permanent place to live, and drink. The New York Times. July 5, 2006; A:12.

  33. Tsemberis S, Gulcur L, Nakae M. Housing First, consumer choice, and harm reduction for homeless individuals with a dual diagnosis. American Journal of Public Health. 2004;94(4):651–656.

    PubMed  Google Scholar 

  34. Gladwell M. Million-dollar Murray: why problems like homelessness may be easier to solve than to manage. The New Yorker. February 13, 2006:96–107.

  35. Rosenheck R, Kasprow W, Frisman L, et al. Cost-effectiveness of supported housing for homeless persons with mental illness. Archives of General Psychiatry. 2003;60(9):940–951.

    Article  PubMed  Google Scholar 

  36. Orwin RG, Goldman HH, Sonnefeld LJ, et al. Community Demonstration Grant Projects for Alcohol and Drug Abuse Treatment of Homeless Individuals: Final Evaluation Report. Rockville, MD: National Institute on Alcohol Abuse and Alcoholism 1993. Report No.: NIH Pub. No. 93-3541.

  37. Higgins ST, Budney AJ, Bickel WK, et al. Incentives improve outcome in outpatient behavioral treatment of cocaine dependence. Archives of General Psychiatry. 1994;51:568–576.

    PubMed  CAS  Google Scholar 

  38. Stitzer ML, Iguchi MY, Felch LJ. Contingent take-home incentive: effects on drug use of methadone maintenance patients. Journal of Consulting and Clinical Psychology. 1992;60(6):927–934.

    Article  PubMed  CAS  Google Scholar 

  39. Milby JB, Schumacher JE, McNamara C, et al. Initiating abstinence in cocaine abusing dually diagnosed homeless persons. Drug and Alcohol Dependence. 2000;60(1):55–67.

    Article  PubMed  CAS  Google Scholar 

  40. McLellan AT, Lewis DC, O’Brien CP, et al. Drug dependence, a chronic medical illness: implications for treatment, insurance, and outcomes evaluation. JAMA. 2000;284(13):1689–1695.

    Article  PubMed  CAS  Google Scholar 

  41. Dennis M, Scott CK, Funk R. An experimental evaluation of recovery management checkups (RMC) for people with chronic substance use disorders. Evaluation and Program Planning. 2003;26(3):339.

    Article  Google Scholar 

  42. Caton CL, Hasin D, Shrout PE, et al. Risk factors for homelessness among indigent urban adults with no history of psychotic illness: a case-control study. American Journal of Public Health. 2000;90(2):258–263.

    Article  PubMed  CAS  Google Scholar 

  43. Code of Federal Regulations, Shelter Plus Care, 24 C.F.R. 582.

  44. Bipartisan Millennial Housing Commission. Meeting Our Nation’s Housing Challenges. Washington, D.C.: Congress of the United States; May 30, 2002. Report No. Available at: http://govinfo.library.unt.edu/mhc/MHCReport.pdf. Accessed September 30, 2006.

  45. Simpson DD, Joe GW, Fletcher BW, et al. A national evaluation of treatment outcomes for cocaine dependence. Archives of General Psychiatry. 1999;56(6):507–514.

    Article  PubMed  CAS  Google Scholar 

  46. Stahler GJ, Shipley TF, Jr., Bartelt D, et al. Evaluating alternative treatments for homeless substance-abusing men: outcomes and predictors of success. Journal of Addictive Diseases. 1995;14(4):151–167.

    Article  PubMed  CAS  Google Scholar 

  47. Kertesz SG, Horton NJ, Friedmann PD, et al. Slowing the revolving door: stabilization programs reduce homeless persons’ substance use after detoxification. Journal of Substance Abuse Treatment. 2003;24(3):197–207.

    Article  PubMed  Google Scholar 

  48. McLellan AT, McKay JR. The treatment of addiction: what can research offer practice. In: Lamb S, Greenlick MR, McCarty D, eds. Bridging the Gap Between Practice and Research: Forging Partnerships with Community-Based Drug and Alcohol Treatment. Washington, D.C.: National Academy Press; 1998:147–185.

    Google Scholar 

  49. Kraybill K, Zerger S. Providing Treatment for Homeless People with Substance Use Disorders: Case Studies of Six Programs. Memphis: National Health Care for the Homeless Council; August, 2003. Report No. Available at: http://www.nhchc.org/Advocacy/FactSheets/CA05RCaseStudies-FINAL5.pdf. Accessed June 5, 2005.

  50. O’Brien CP. Anticraving medications for relapse prevention: a possible new class of psychoactive medications. American Journal of Psychiatry. 2005;162(8):1423–1431.

    Article  PubMed  Google Scholar 

  51. Beyond Shelter. The “Housing First” Program for Homeless Families: Methodology Manual. Los Angeles, California: Beyond Shelter, Inc.; 1998.

Download references

Acknowledgments

Data collection, analysis, and manuscript preparation were supported by the National Institute on Drug Abuse (awards DA08475, DA11789, K23-DA15487). The author is grateful for the analytic assistance of Tony Horn, MS and Young-il Kim, MS.

Author information

Authors and Affiliations

  1. Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham and the Deep South Center on Effectiveness at the Birmingham Veterans’ Affairs Medical Center, 1530 3rd Ave South MT608, Birmingham, AL, 35294-4410, USA

    Stefan G. Kertesz

  2. The Wright Institute, 2728 Durant Ave., Berkeley, CA, 94704, USA

    Ashley N. Mullins

  3. Division of Preventive Medicine, School of Medicine, 1530 3rd Ave South MT 616, Birmingham, AL, 35294-4410, USA

    Joseph E. Schumacher

  4. Rho Federal Systems, Inc., 6330 Quadrangle Drive Suite 500, Chapel Hill, NC, 27517, USA

    Dennis Wallace

  5. Division of Preventive Medicine, School of Medicine and the Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, 1530 3rd Ave South MT627, Birmingham, AL, 35294-4410, USA

    Katharine Kirk

  6. Department of Psychology, The University of Alabama at Birmingham, 1530 3rd Ave South CH 201, Birmingham, AL, 35294-4410, USA

    Jesse B. Milby

Authors
  1. Stefan G. Kertesz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ashley N. Mullins
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Joseph E. Schumacher
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Dennis Wallace
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Katharine Kirk
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jesse B. Milby
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Stefan G. Kertesz.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kertesz, S.G., Mullins, A.N., Schumacher, J.E. et al. Long-Term Housing and Work Outcomes Among Treated Cocaine-Dependent Homeless Persons. J Behav Health Serv Res 34, 17–33 (2007). https://doi.org/10.1007/s11414-006-9041-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11414-006-9041-3

Keywords

Search

Navigation