Study Details | Pathways to Work

28458-Study of Abstinence-

Study quality: Low

Low

Reason for the rating: This study received a low study quality rating because it is a high-attrition randomized controlled trial that does not adjust estimated impacts for potentially important differences between the intervention and comparison groups.

Intervention: Behavioral Day Treatment Plus Abstinence-Contingent Housing and Work Therapy (DT+) (as compared with Behavioral Day Treatment Alone [DT])

Population and employment barriers:

Specific employment barriers (Homelessness, Substance use disorder)

Services provided:

Housing, Work and work-based learning, Work readiness activities

Setting: Urban only

Study design

Design:

Randomized controlled trial

Study group formation:

Evaluators recruited participants from a health care agency for persons experiencing homelessness, and participants came from a variety of clinics and homeless shelters. Eligibility criteria included homelessness, a diagnosis of cocaine or multisubstance dependence that included cocaine use, coexisting and nonpsychotic mental disorders, an intention to stay in the area for 12 months, willingness to provide voluntary consent for treatment, no severe medical problems requiring inpatient treatment, and willingness to participate in interventions. One hundred and ten individuals were deemed eligible for the study. Participants were randomly assigned to behavioral day treatment with abstinence-contingent housing and work therapy or to behavioral day treatment only.

Time period of study:

Participants were randomly assigned between April 1995 and May 1996. The study reported impacts up to 12 months after random assignment.

Pathways only reports results from studies with a study quality rating of high or moderate.

Sample characteristics

Age

Mean age

38 years

Sex

Female	24%
Male	76%

Participant race and ethnicity

Black or African American	81%
White, not Hispanic	19%

The race and ethnicity categories may sum to more than 100 percent if the authors reported race and ethnicity separately; in these cases, we report the category White, rather than White, not Hispanic.

Specific employment barriers

Had a mental illness	79%
Had a substance abuse disorder	100%
Were experiencing homelessness	100%
Were military veterans	26%

Intervention implementation

Implementing organization:

Birmingham Health Care for the Homeless Coalition

Intervention services:

This intervention served homeless persons with a diagnosis of cocaine or polysubstance abuse that included cocaine use and a coexisting, nonpsychotic mental disorder. Participants had access to eight weeks of behavioral day treatment, housing contingent on abstinence from drug use, staff-assisted employment and housing goal setting, work therapy, and referrals to job opportunities, including food service positions and construction work.

Mandatory services:

None

Comparison services:

Participants in the comparison group had access to eight weeks of behavioral day treatment, including lunch and transportation to and from shelters.

Study publications

Milby, Jesse, Joseph Schumacher, Cecilia McNamara, Dennis Wallace, Stuart Usadan, Troy McGill, and Max Michael (2000). Initiating abstinence in cocaine abusing dually diagnosed homeless persons, Drug and Alcohol Dependence 60: 55-67. Available at https://pubmed.ncbi.nlm.nih.gov/10821990/.

Milby, Jesse, Joseph Schumacher, Dennis Wallace, Sonja Frison, Cecilia McNamara, Stuart Usdan, and Max Michael (2003). Day treatment with contingency management for cocaine abuse in homeless persons: 12 month follow-up, Journal of Consulting and Clinical Psychology 71(3): 619-621. Available at https://psycnet.apa.org/record/2003-00756-024.

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The Pathways Clearinghouse refers to interventions by the names used in study reports or manuscripts. Some intervention names may use language that is not consistent with our style guide, preferences, or the terminology we use to describe populations.

Study of Behavioral Day Treatment Plus Abstinence-Contingent Housing and Work Therapy (DT+) versus Behavioral Day Treatment Alone (DT)