Behavioral Day Treatment Plus Abstinence-Contingent Housing and Work Therapy (DT+) (as compared with Behavioral Day Treatment Alone [DT])

The DT+ intervention served people experiencing homelessness who had (1) a diagnosis of cocaine or multisubstance dependence that included cocaine use and (2) a coexisting nonpsychotic mental disorder. Participants had access to (1) eight weeks of behavioral day treatment, including lunch and transportation, followed by weekly group therapy; (2) housing; (3) support with setting goals related to employment and housing; (4) vocational counseling; and (5) referrals to job opportunities. All services, including housing, were contingent on participants remaining abstinent from drugs and alcohol. If drug or alcohol use was detected in a urine toxicology test result, participants were evicted and moved to a homeless shelter until they reestablished abstinence with two consecutive negative urine toxicology tests.

The duration of the intervention was 6 months, and it took place in Birmingham, AL. During the first two months, behavioral day treatment groups met for five hours each weekday for eight weeks. Each week, participants in behavioral day treatment received up to two vouchers worth $7.50 each for attaining goals. During these first two months, participants received rent-free housing. During months 3 to 6, participants attended group therapy sessions for 1.5 hours per week; received vocational counseling, including a work-skills and interest assessment; and were referred to job opportunities at a construction company or in food service. Participants working for the construction company worked 5.5 hours per day, five days per week, for $5.25 per hour. Participants were suspended from work for drug or alcohol use but could return after two consecutive negative urine toxicology tests. During months 3 to 6, abstinence-contingent housing was available to participants for $161.28 per month.

Comparing the effectiveness of DT+ with the effectiveness of DT indicates the effect of being referred to a set of services that includes those unique to DT+. The comparison indicates whether DT+ meets participants’ needs better than DT does. Participants in both DT+ and DT had access to eight weeks of behavioral day treatment in months 1 to 2 and weekly group therapy during months 3 to 6. All other services were unique to DT+.