Linking the academy and the community: An assessment of a treatment program for homeless substance abusers
Description
Homelessness and substance abuse commanded the attention of both politicians and the general public in the 1980s. Although this concern proved to be short-lived, these social problems continue to contribute to the deteriorating quality of contemporary urban existence. While the connection between homelessness and substance abuse is not new, its significance has grown because of the relationship between drug abuse, risky sexual behaviors, and a number of public health problems including unwanted pregnancies, the rampant spread of sexually transmitted diseases (STDs), and the proliferation of HIV infection. Research investigating effective drug treatment approaches (particularly on crack-abusive samples which have only recently emerged) can inform policy initiatives designed to ameliorate these difficulties. Unfortunately, knowledge of treatment process and effectiveness among homeless samples participating in diverse treatment modalities is virtually non-existent. Therefore, this dissertation explores questions surrounding characteristics of clients, program theory and project services, implementation processes and barriers, and treatment outcomes among homeless crack abusers participating in the New Orleans Homeless Substance Abusers Project (NOHSAP). The NOHSAP was a federally-sponsored, multi-year randomized experiment designed to bring together clinicians and researchers to (a) provide and document expanded treatment services; (b) assess cooperation and coordination among public and private sector organizations serving the target population; and (c) evaluate the effectiveness of a three-phase intervention in helping clients achieve programmatic objectives including reduced substance use, improved employment and residential stability, and enhanced social relationships. Despite theoretical shifts and operational challenges which emerged during implementation, findings indicate that (a) homeless crack abusers can be retained in treatment as well as other treatment-seeking samples; (b) treatment is effective in reducing substance abuse as well as other negative outcomes; and (c) time-in-treatment is predictive of successful outcomes with longer stays conferring stronger benefits to clients across multiple areas of functioning. This research concludes with the observation that if success is measured by distance traveled, then what the NOHSAP intervention accomplished was much more surprising than anything that it failed to do