Initiating abstinence in cocaine abusing dually diagnosed homeless persons

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Abstract

This study measured effectiveness of behavioral day treatment plus abstinence contingent housing and work therapy (DT+) versus behavioral day treatment alone (DT). A randomized controlled trial assessed participants at baseline, 2 and 6 months. Participants (N = 110) met criteria for cocaine abuse or dependence, non-psychotic mental disorders, and homelessness. DT+ achieved greater abstinence at 2 and 6 months and more days housed at 6 months than DT. Effectiveness of DT+ was demonstrated, with greatest impacts on abstinence outcomes. Results replicated earlier work demonstrating effectiveness of behavioral day treatment and contingency management as an effective combination for cocaine abusing homeless persons.

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      These interventions involve the delivery of tangible consequences (e.g., money or vouchers exchangeable for goods and services) contingent on objective evidence of drug abstinence (Higgins et al., 2002; Silverman et al., 1999). Milby et al. (1996, 2000, 2005) used abstinence-contingent housing and work therapy to promote drug abstinence in homeless adults and Miller (1975) used a contingency management intervention to promote abstinence from alcohol in so-called “chronic public drunkenness offenders.” In a recent study, Koffarnus et al. (2011) used abstinence-contingent access to a therapeutic workplace to promote abstinence from alcohol in homeless alcohol-dependent adults.

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    1

    Present address: Kansas University Medical School.

    2

    Also at Birmingham Health Care for the Homeless Coalition.

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