Toward cost-effective initial care for substance-abusing homeless

Academic Article


  • 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, no. NCT00368524). © 2008 Elsevier Inc. All rights reserved. + + + + + +
  • Authors

    Published In

    Digital Object Identifier (doi)

    Author List

  • Milby JB; Schumacher JE; Vuchinich RE; Freedman MJ; Kertesz S; Wallace D
  • Start Page

  • 180
  • End Page

  • 191
  • Volume

  • 34
  • Issue

  • 2