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Am J Public Health. 2010 May;100(5):913-8. doi: 10.2105/AJPH.2008.152975. Epub 2009 Oct 15.

Effects of sustained abstinence among treated substance-abusing homeless persons on housing and employment.

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  • 1Department of Psychology, University of Alabama at Birmingham, CH 201, 1530 3rd Ave S, Birmingham, AL 35294-1170, USA.



We examined whether cocaine-dependent homeless persons had stable housing and were employed 6, 12, and 18 months after they entered a randomized controlled trial comparing 2 treatments.


One group (n = 103) received abstinence-contingent housing, vocational training, and work; another group (n = 103) received the same intervention plus cognitive behavioral day treatment. We examined baseline and early treatment variables for association with long-term housing and employment.


Although the enhanced-treatment group achieved better abstinence rates, the groups did not differ in long-term housing and employment stability. However, consecutive weeks of abstinence during treatment (and to a lesser extent, older age and male gender) predicted long-term housing and employment stability after adjustment for baseline differences in employment, housing, and treatment.


Our data showed a relationship of abstinence with housing stability. Contrasting these results with the increasingly popular Housing First interventions reveals important gaps in our knowledge to be addressed in future research.

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