Toward Cost-Effective Initial Care for Substance-Abusing Homeless
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 Trials.gov, no. NCT00368524).
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