title: Toward cost-effective initial care for substance-abusing homeless.
abstract: In a randomized controlled trial, behavioral day treatment, including contingency management (CM+), was compared to contingency management components alone (CM). All 206 cocaine-dependent homeless participants received a furnished apartment with food and work training/employment contingent on drug-negative urine tests. CM+ also received cognitive-behavioral therapy, therapeutic goal management, and other intervention components. Results revealed that CM+ treatment attendance and abstinence were not significantly different from CM during 24 weeks of treatment. After treatment and contingencies ended, however, CM+ showed more abstinence than CM, indicating a delayed effect of treatment from 6 to 18 months. CM+ had more consecutive weeks abstinent across 52 weeks, but not during active treatment. We conclude that CM alone may be viable as initial care for cocaine-dependent homeless persons. That CM+ yields more durable abstinence indicates that it may be appropriate as stepped-up care for clients not responding to CM (Clinical Trials.gov, no. NCT00368524).
authors.affiliation: Department of Psychology, University of Alabama at Birmingham, Birmingham, AL 35294-1170, USA. jmilby@uab.edu
authors.forename: Jesse B
authors.initials: JB
authors.lastname: Milby
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Schumacher
authors.forename: Rudy E
authors.initials: RE
authors.lastname: Vuchinich
authors.forename: Michelle J
authors.initials: MJ
authors.lastname: Freedman
authors.forename: Stefan
authors.initials: S
authors.lastname: Kertesz
authors.forename: Dennis
authors.initials: D
authors.lastname: Wallace
mesh_terms: D000328:Adult; D019970:Cocaine-Related Disorders / Q000534:rehabilitation*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs; D006703:Ill-Housed Persons; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D012050:Rehabilitation, Vocational; D012054:Reinforcement, Psychology; D012201:Reward; D019966:Substance-Related Disorders / Q000534:rehabilitation*