March 10, 1994
Vol. 13, No. 13

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    Intervention effective in helping homeless

    A joint University of Chicago and Travelers Aid of Chicago homelessness intervention program has proved effective in reducing both homelessness and substance abuse. The three-year demonstration project involved an innovative case-management approach that provided immediate housing, attention to tangible needs and treatment for drug and alcohol abuse.

    Conducted by the School of Social Service Administration and Travelers and Immigrants Aid of Chicago, the study involved more than 400 homeless people in the Chicago area -- 231 of whom previously had been in short-term inpatient substance-abuse programs, plus a control group of 187 other homeless individuals.

    "There is a perception that homeless people will misuse resources allocated to help them, that they are not interested in improved housing and are not motivated to help themselves," said Michael Sosin, Professor in SSA and principal investigator on the project. "This project dispels these myths and shows that substance abuse within homeless populations is treatable."

    The study, titled "Treating Homelessness and Substance Abuse in Community Context," was funded by the National Institute for Alcohol Abuse and Alcoholism. All individuals in the study were provided comprehensive case-management services that ranged from general assistance to help with temporary expenses, furniture, security deposits for rents, and transportation to clinics. Participants were divided into two groups. Participants in the first group had temporary housing placements before beginning drug treatments; participants in the second group had case managers who provided more intense case-management services and helped clients look for private housing. The control group received the normal after-care services.

    The evidence showed that reported drinking was reduced for both intervention groups. The group with case managers also reported reduced drug use. Homelessness was reduced within the first six months for the group given temporary housing and within one year for the group with case managers. The results also provided strong evidence that more intensive services led to more positive results in reducing homelessness, alcohol use and drug use for both groups, Sosin said.

    "We found that provision of tangible goods has a direct effect on homelessness," Sosin said. "Our approach was a balance between models that just provide material goods and models that focus on solving personal problems like drug abuse."

    The combined approach allowed client autonomy and responsibility while confronting the addiction and helping individuals in tangible ways.

    The main aspects of the intervention model were:

    _ help with material aid in the first few months of care -- for example, by providing security deposits and furniture -- along with assistance to ensure that participants could return to work or obtain income-maintenance benefits;

    _ group and individual counseling that encompassed a cognitive relapse-prevention approach;

    _ more emphasis on mental-health problems after clients were stable;

    _ consideration of the material needs of the clients throughout;

    _ required co-payments from housing participants after a period of time;

    _ tests for continued drug and alcohol use and eviction from housing for participants who failed two tests. Those evicted from housing could still obtain case-management services.

    All participants were eligible for an additional six months of less-intensive management services.

    The average age of the participants was 35, and about half had graduated from high school. Roughly 26 percent were female and half had been homeless only once, while 6 percent had no homeless experience but were in imminent danger of losing their housing. About 80 percent admitted to an alcohol problem, and 80 percent to a drug problem, including crack cocaine in a majority of the cases. Ninety percent of the clients were African-American. As the report details, the treatment programs are based on an extensive review of the literature concerning homelessness and substance-abuse treatment. They take into account findings that material problems seem to limit both recovery from substance abuse and retention in intervention programs and that homelessness may be due to a lack of family, a lack of a regular source of income, or other factors as well as the addiction.

    Even though a majority of clients did not drink or use drugs after one year and were no longer homeless, only a small minority worked regularly despite high levels of utilization of employment training and referral services. Investigators believe access to a job may depend more on opportunities available in the community than on interventions. "There is a need to create new job opportunities for people who are ready to work," Sosin said. "Our participants also face particular problems because few employers trust those with a history of substance abuse."

    -- Charles Whitt