Search

This paper, the first in a series of reports from a field study on the efficacy of modified therapeutic community (TC) treatment for homeless mentally ill chemical abusers, presents sociodemographic profiles, psychiatric diagnosis, and psychological symptom data on 342 homeless mentally ill chemical abusing clients seeking treatment in mental health community residence settings. The findings reflect the multidimensional deficits, social dysfunctionality, and severity of psychopathology of the study sample. The paper discusses the implications of these findings for program design and program planning, with special reference to modified TC programs.

The present study describes the diagnostic profile of over 800 adolescents admitted to residential therapeutic community programs for treatment of drug abuse and related problems. The relationship between race/ethnicity and psychiatric disturbance is examined, and the association among these factors to outcome is investigated. Over 90% of the sample had a DSM-III-R nonsubstance diagnosis. There were significant differences among the race/ethnic groups on attention deficit-hyperactivity and the disruptive behavior and affective disorders. In general, African-American adolescents yielded the lowest rates of disturbance across all categories of disorders. There was no relationship among race/ethnicity, psychiatric disturbance, and 1-year posttreatment outcomes.

Substance abuse and severe mental illness are factors that have been linked to homelessness, and the rates of mental illness have been reported to be higher among homeless women than men. Only recently have investigators begun to examine the prevalence of abuse among the homeless population and its relationship to indicators of psychopathology. This study builds on the existing literature and examines the relationship among psychiatric disturbance, abusive experiences, and homelessness among adult men and women admitted to shelter-based therapeutic community (TC) drug treatment programs.The sample presents with extensive psychopathology and a history of physical and sexual abuse. Gender differences indicate that, except for antisocial personality, females yield higher rates on measures of both psychiatric disturbance and abuse. The relationship between psychopathology and abuse also appears to be much stronger for females than for males. However, the relationship between abuse and adult homelessness appears to be similar for men and women. The gender differences in the relationship between histories of abuse and manifestations of psychiatric disturbance support a hypothesis that has been proposed elsewhere: Females internalize the trauma associated with abusive experience, while males externalize it. The findings suggest that, although there may be a need for gender-specific targeted interventions, treatment providers must also recognize that the impact of abuse seems to transcend gender within this population.

Given the dearth of information concerning outcomes for adolescents who have been in treatment for substance abuse and related problems, the purpose of the present article is to examine the posttreatment status of adolescents who have been in residential therapeutic communities (TCs). One-year posttreatment outcome data are described for 485 adolescents, and separately for treatment “completers” and “noncompleters.” The majority of the sample had been mandated to treatment by the criminal justice system. Most reported marijuana as their main drug of abuse. There were significant reductions in drug use and criminal activity, and the most consistent predictors of positive outcomes were completion of treatment and not associating with deviant peers posttreatment. The findings were obtained on a treatment sample for whom there is relatively little research to date; they provide important evidence for the effectiveness of the therapeutic community for this population.