Modified therapeutic community for mentally ill chemical abusers: outcomes and costs

Eval Health Prof. 1999 Mar;22(1):60-85. doi: 10.1177/016327879902200104.


Several studies have established that the personal and social consequences of substance abuse are extensive and costly. These consequences are frequently compounded by mental illness. Although interventions that target mentally ill chemical abusers (MICAs) present several challenges, the potential benefits of successful interventions are significant. This article presents outcomes and costs of a modified therapeutic community (TC) intervention for homeless MICAs. Outcomes at follow-up are compared with those for a control group of homeless MICAs receiving standard services in a "treatment-as-usual" (TAU) condition. Annual economic costs for the modified TC and the average weekly cost of treating a single client are estimated. Treatment and other health service costs at 12 months postbaseline are compared for modified TC and TAU clients. The results of this study indicate that, suitably modified, the TC approach is an effective treatment alternative for homeless MICAs, with the potential to be highly cost-effective relative to standard services.

Publication types

  • Clinical Trial
  • Comparative Study
  • Controlled Clinical Trial
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Cost-Benefit Analysis
  • Diagnosis, Dual (Psychiatry)
  • Health Care Costs*
  • Homeless Persons*
  • Humans
  • Mental Disorders / complications
  • Mental Disorders / therapy*
  • New York City
  • Outcome Assessment, Health Care
  • Program Evaluation
  • Prospective Studies
  • Substance-Related Disorders / complications
  • Substance-Related Disorders / therapy*
  • Therapeutic Community*