Pre- and post-admission attrition of homeless, mentally ill chemical abusers referred to residential treatment programs.
OBJECTIVE
To assess the magnitude and psychopathologic predictors of attrition among homeless, mentally ill chemical abusers (MICAs) referred to residential treatment programs in New York City.


METHODS
Homeless, MICAs were randomly referred to a therapeutic community (TC) or community residence (CR) and monitored with regard to pre- and post-admission attrition.


METHODS
Community based treatment facilities modified to treat both substance abuse and major mental illness.


METHODS
Homeless individuals with a major mental illness (DSM-III-R) and a history of abusing alcohol or other drugs.


METHODS
Attrition rates and selected scales of psychopathology.


RESULTS
From an initial pool of 694 treatment candidates, 147 (22%) were rejected for admission at their assigned facility; 247 (36%) failed to show up for treatment; and 212 (31%) dropped out of treatment at some point during the first 12 months. Contrary to expectation, those with severe levels of psychotic ideation, depressive symptoms and hostility were admitted to treatment more frequently and stayed in treatment longer at the TC, a high demand approach, than the CR, a low demand approach.


CONCLUSIONS
Clinicians should consider the TC as a viable treatment option for MICAs.
Nuttbrock
L H
LH
National Development and Research Institutes (NDRI), New York, NY 10048, USA.
Ng-Mak
D S
DS
Rahav
M
M
Rivera
J J
JJ
D000328:Adult; D003155:Community Mental Health Centers / Q000706:statistics & numerical data*; D017831:Diagnosis, Dual (Psychiatry); D006703:Ill-Housed Persons / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D009519:New York City; D010352:Patient Dropouts / Q000706:statistics & numerical data*; D012114:Residential Treatment / Q000706:statistics & numerical data*; D019966:Substance-Related Disorders / Q000523:psychology / Q000628:therapy*; D016312:Treatment Refusal