Impact of work therapy on health status among homeless, substance-dependent veterans: a randomized controlled trial

Arch Gen Psychiatry. 2002 Oct;59(10):938-44. doi: 10.1001/archpsyc.59.10.938.


Background: Little is known about the health outcomes of clinician-supervised, performance-based, abstinence-contingent therapeutic work programs on homeless persons with addiction disorders. This study examined the effect of the Department of Veterans Affairs compensated work therapy program (CWT) on nonvocational outcomes. With mandatory urine screenings and adherence to addiction treatment schedules, CWT provided work opportunities (wages, hours, and responsibilities) with jobs created from Veterans Affairs contracts competitively obtained from private industry.

Methods: Homeless, substance-dependent veterans (N = 142) from 4 Department of Veterans Affairs medical centers were randomized, assessed at baseline, and reassessed at 3-month intervals for 1 year. Both CWT and control groups had access to comprehensive rehabilitation, addictions, psychiatric, and medical services. Data were analyzed to determine an immediate CWT effect after treatment and rates of change during 1 year.

Results: Compared with control subjects, patients in the CWT program were more likely to (1) initiate outpatient addictions treatment, (2) experience fewer drug and alcohol problems, (3) report fewer physical symptoms related to substance use, (4) avoid further loss of physical functioning, and (5) have fewer episodes of homelessness and incarceration. No effect on psychiatric outcomes was found.

Conclusion: Work therapy can enhance nonvocational outcomes of addiction treatment for homeless persons, although long-term gains remain unknown.

Publication types

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

MeSH terms

  • Adult
  • Alcoholism / rehabilitation
  • Follow-Up Studies
  • Health Care Costs
  • Health Status*
  • Humans
  • Ill-Housed Persons / psychology*
  • Ill-Housed Persons / statistics & numerical data
  • Middle Aged
  • Occupational Therapy / economics
  • Occupational Therapy / methods*
  • Rehabilitation, Vocational
  • Substance Abuse Detection
  • Substance-Related Disorders / diagnosis
  • Substance-Related Disorders / psychology
  • Substance-Related Disorders / rehabilitation*
  • Temperance
  • Treatment Outcome
  • United States
  • United States Department of Veterans Affairs
  • Veterans / psychology
  • Work / psychology