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Subgroups
To qualify for study enrollment, participants had to be experiencing homelessness and have a clinical diagnosis of substance abuse or dependency. People who were eligible and provided consent were randomly assigned to the intervention or the comparison condition. Eighty-six of the 176 participants were randomly assigned to the intervention condition (enhanced day treatment program plus abstinent contingent work therapy and housing), and the remaining 89 participants were randomly assigned to the comparison condition (usual care).
Random assignment took place from April 1991 through July 1992. The study followed individuals for 12 months.
The Birmingham Health Care for the Homeless Coalition (BHCHC) and University of Alabama at Birmingham (UAB)
The intervention group enrolled in a two-stage enhanced treatment program for people who were experiencing homelessness and problems with substance use. During the first stage, participants received services for five and a half hours each weekday and resided in shelters or other temporary housing. Services included group and individual therapy and coaching focused on helping participants address their substance use issues. After two months, and once participants demonstrated at least two weeks of sobriety (as evidenced by drug-free test results), they could enter the second stage of the intervention. The second stage provided participants with paid work experience, including on-the-job training in the construction sector, and low-cost rental housing. The second stage lasted for four months, and participants were required to keep abstaining from substance use to remain eligible for housing assistance. After completing this stage, the program phased out participation in paid work experience and helped participants find regular employment. In addition, the program encouraged people who had completed the two stages of the intervention to attend after-care services focused on relapse prevention and other topics at the administering agency or in the community. After completing both stages of the intervention, participants were able to remain in their low-cost housing on a permanent basis.
The comparison group had access to usual care for people who were experiencing homelessness and experiencing substance use issues. Participants had access to individual and group counseling twice per week. The counseling sessions were facilitated by substance abuse counselors who also served as case managers and provided participants with referrals to additional treatment, medical services, employment services, and housing services as needed.
None
The study took place in Birmingham, AL. The intervention was implemented by the city’s largest community-based agency providing heath and other services to people experiencing homelessness.
Substance use; Mental health; Self-esteem; Housing