Toward cost-effective initial care for substance-abusing homeless

J Subst Abuse Treat. 2008 Mar;34(2):180-91. doi: 10.1016/j.jsat.2007.03.003. Epub 2007 May 23.


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).

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Cocaine-Related Disorders / rehabilitation*
  • Cognitive Behavioral Therapy / methods*
  • Cost-Benefit Analysis
  • Female
  • Health Care Costs
  • Humans
  • Ill-Housed Persons*
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Patient Compliance
  • Rehabilitation, Vocational
  • Reinforcement, Psychology
  • Reward
  • Substance-Related Disorders / rehabilitation*

Associated data