Modified Therapeutic Community for Homeless Mentally III Chemical Abusers: Treatment Outcomes

Center for Therapeutic Community Research, National Development and Research Institutes, Inc., New York, New York 10048, USA.
The American Journal of Drug and Alcohol Abuse (Impact Factor: 1.78). 09/2000; 26(3):461-80. DOI: 10.1081/ADA-100100256
Source: PubMed


This study compared homeless mentally ill chemical abuser (MICA) clients (n = 342), male and female, sequentially assigned to either of two modified therapeutic community programs (TC1 and TC2) and to a treatment-as-usual (TAU) control group. Follow-up interviews were obtained at 12 months postbaseline and at time F (on average more than 2 years postbaseline) on a retrieved sample of 232 (68%) clients and 281 (82%) clients, respectively. Outcome measures assessed five domains: drug use, crime, HIV risk behavior, psychological symptoms, and employment. Individuals in both modified TC groups showed significantly greater behavioral improvement than TAU at 12 months and time F, and the modified TC2, with lower demands and more staff guidance, was superior to modified TC1. Completers of both TC programs showed significantly greater improvement than dropouts and a subgroup of TAU clients with high exposure (i.e., more than 8 months) to other treatment protocols. The present findings support the effectiveness and longer term stability of effects of a modified TC program for treating homeless MICA clients.

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    • "Available reviews have been biased by a selective focus on some types of TCs or study designs and a predominant focus on drug abstinence. e frequently cited Cochrane review by Smith and colleagues [23] only included randomized trials, while random group allocation appeared to be either not feasible (i.e., signiicantly higher drop-out among controls) or advisable (i.e., motivation and self-selection are considered to be crucial ingredients of the treatment process) in several studies [24] [25]. Consequently, this meta-analysis included some studies without true randomization and excluded a large number of good quality quasi-experimental studies. "
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    ABSTRACT: Therapeutic communities (TCs) for addictions are drug-free environments in which people with addictive problems live together in an organized and structured way to promote change toward recovery and reinsertion in society. Despite a long research tradition in TCs, the evidence base for the effectiveness of TCs is limited according to available reviews. Since most of these studies applied a selective focus, we made a comprehensive systematic review of all controlled studies that compared the effectiveness of TCs for addictions with that of a control condition. The focus of this paper is on recovery, including attention for various life domains and a longitudinal scope. We searched the following databases: ISI Web of Knowledge (WoS), PubMed, and DrugScope. Our search strategy revealed 997 hits. Eventually, 30 publications were selected for this paper, which were based on 16 original studies. Two out of three studies showed significantly better substance use and legal outcomes among TC participants, and five studies found superior employment and psychological functioning. Length of stay in treatment and participation in subsequent aftercare were consistent predictors of recovery status. We conclude that TCs can promote change regarding various outcome categories. Since recovering addicts often cycle between abstinence and relapse, a continuing care approach is advisable, including assessment of multiple and subjective outcome indicators.
    The Scientific World Journal 01/2013; 2013(1):427817. DOI:10.1155/2013/427817 · 1.73 Impact Factor
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    • "Studies of unspecified collections of linear approach programs could be improved by including formal measures of addiction severity and the treatments provided. When these elements have been closely examined , as in the Birmingham and modified Therapeutic Community studies (DeLeon et al. 2000; Schumacher et al. 2007), improvements in addiction severity have been found. Only one of the Birmingham studies (Milby et al. 2008) measured housing outcomes after one year, so longer-term follow-up would help (the need for such follow-up needs to be recognized by research-funding agencies). "
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    ABSTRACT: More than 350 communities in the United States have committed to ending chronic homelessness. One nationally prominent approach, Housing First, offers early access to permanent housing without requiring completion of treatment or, for clients with addiction, proof of sobriety. This article reviews studies of Housing First and more traditional rehabilitative (e.g., "linear") recovery interventions, focusing on the outcomes obtained by both approaches for homeless individuals with addictive disorders. According to reviews of comparative trials and case series reports, Housing First reports document excellent housing retention, despite the limited amount of data pertaining to homeless clients with active and severe addiction. Several linear programs cite reductions in addiction severity but have shortcomings in long-term housing success and retention. This article suggests that the current research data are not sufficient to identify an optimal housing and rehabilitation approach for an important homeless subgroup. The research regarding Housing First and linear approaches can be strengthened in several ways, and policymakers should be cautious about generalizing the results of available Housing First studies to persons with active addiction when they enter housing programs.
    Milbank Quarterly 07/2009; 87(2):495-534. DOI:10.1111/j.1468-0009.2009.00565.x · 3.38 Impact Factor
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    • "Growing evidence suggests an integrated approach, in which co-occurring disorders are treated simultaneously, is more effective than treating each disorder separately (Drake et al. 1998; Nuttbrock et al. 1998; De Leon et al. 2000). However, little research has examined the effectiveness of trauma-informed services in the treatment of co-occurring disorders (e.g., Triffleman et al. 1999; Hien et al. 2004; Najavits et al. 2005; Cusack et al. 2008), and no previous study has focused specifically on women with co-occurring disorders to examine treatments addressing the impact of physical and sexual abuse on the lives of these women. "
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    ABSTRACT: The experience of trauma is highly prevalent in the lives of women with mental health and substance abuse problems. We examined how an intervention targeted to provide trauma-informed integrated services in the treatment of co-occurring disorders has changed the content of services reported by clients. We found that the intervention led to an increased provision of integrated services as well as services addressing each content area: trauma, mental health and substance abuse. There was no increase in service quantity from the intervention. Incorporation of trauma-specific element in the treatment of mental health and substance abuse may have been successfully implemented at the service level thereby better serve women with complex behavioral health histories.
    Community Mental Health Journal 04/2009; 45(5):375-84. DOI:10.1007/s10597-009-9192-9 · 1.03 Impact Factor
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