Case-Management Increases Retention in Substance Abuse Treatment for Homeless Men

Background and Purpose: Length of stay has been repeatedly linked to improved substance abuse treatment outcomes. Because of this link retention in treatment has become an important goal of substance abuse intervention. Intensive Case Management (ICM) is a behavioral intervention that has demonstrated efficacy in improving retention of substance abusers. ICM was employed in the study to increase treatment retention of homeless substance abusing men in residential treatment. It is hypothesized that ICM will be a strong predictor of treatment retention particularly with this population because of the increased need for ancillary services (i.e. mental health, housing, employment etc.). The hypothesis for this study is: Participants receiving ICM will be retained in treatment significantly longer than those who do not.

Methods: A retrospective survival analysis of retention, by receipt of case-management was conducted. Data from a long term residential treatment center for homeless men were collected over three years. The men involved in this study were largely Caucasian (n = 78, 72%) the remainder were African American. The mean age was 31 and ranged from 18 to 58. In the 30 days prior to treatment entry, 83% of the men were homeless, 10% were renting houses or apartments, and 7% owned their own homes, though all were homeless the day of admission. The mean length of stay was 145 days with a minimum of four days and a maximum of 426. The program under study was designed to retain subjects between six months and one year.

Results: The Wilcoxon-Gehan indicates a significant increase in the survival of participants receiving ICM compared to those who did not (23.851, df = 1, p<.01). This was the single strongest predictor of survival, although both criminal justice coercion and race were also significant predictors.

Conclusions and Implications: ICM was indicated to have a significant impact on retention. This finding lends further support to the need for case management in addition to treatment for homeless substance abusers. The additional service needs of homeless substance abusers likely make ICM a more critical service for this population. Findings from this study support providing this intervention to homeless substance abusers to increase post treatment abstinence. Future research should be conducted to determine the long-term impact of ICM on treatment outcomes.