Research That Matters (January 17 - 20, 2008)

Sober Housing and Motivational Interviewing: The Treatment Access Project

Purpose: Untreated substance use disorders represent a major risk factor for homelessness (Braucht et al., 1995; Hartwell, 2003). An estimated 30-40% of persons who are homeless have alcohol disorders (Burt, 2001); more than 15% have other substance use disorders (McCarty, Argeriou, Huebner, & Lubran, 1991); and two-thirds have either a substance use and/or a mental health problem (Burt, 1999). Despite the high prevalence of substance-related disorders among homeless persons, assertive outreach programs for these individuals are scarce when compared to those for persons with mental illness (Cohen, Mowbray, Gillette, & Thompson, 1991; Dennis, Buckner, Lipton, & Levine, 1991; Hopper, Jost, Hay, Welber, & Haugland, 1997; Kuhlman, 1994; Martin, 1990). In this paper, we report on an innovative program—The Treatment Access Project (TAP)—that provides sober housing rental subsidies and support services for homeless people with substance use disorders in the early stages of their recovery. Evaluation data point to the success of this innovative initiative.

Methods: A semi-structured data form, designed by the author, was used to collect information on all TAP clients who were discharged in the calendar year 2005 when they were 1) referred for housing subsidies, and 2) discharged from the project. Demographic data collected including age, gender, and race. Additional information collected at referral included the number of days that individuals were homeless, and the case managers' assessment of their motivational stage. At discharge, case managers provided information about whether or not clients were abstinent and housed. The discharge was coded as positive when clients were abstinent and housed at discharge and negative when clients were discharged due to relapse.

Results: A statistically significant relationship was found between stage of treatment readiness and discharge status (p = .022); clients who were in higher stages of treatment readiness when they were referred were more likely to be discharged from the project with a positive status. A statistically significant relationship was also found between stage of treatment readiness and length of time homeless ( p = .048). Post-hoc comparisons found that clients who were in the maintenance stage of treatment at the point they were referred for rental subsidies were significantly homeless for more days than clients who were in the contemplation or pre-contemplation stage. Additionally, clients who were in the action stage of treatment at referral were significantly homeless for more days than clients who were in the contemplation stage.

Implications: These findings suggest that the availability of sober housing subsidies and support services may enhance the motivation for recovery for individuals who are chronically homeless, thus providing support for the importance of assertive engagement programs with contingencies for persons who are homeless and have substance use disorders. These findings have important implications for social work practice and research in the areas of substance abuse delivery and homeless services.