Effectiveness of Psychosocial Treatment for Homeless Substance Abusers: A Meta-Analytic Review

Objective: Homeless substance abusers pose particular challenges for providers because of their residential instability, poor economic and employment status, lack of social support, general isolation, and high rate of co-occurring disorders. This meta-analysis investigates the published treatment outcome literature on psychosocial interventions specifically targeted toward homeless substance abusers.

Method: This investigation followed standard meta-analysis (PRISMA) procedures. A comprehensive literature search was conducted, and 16 randomized controlled trials with a total of 4,230 participants met selection criteria for inclusion in this analysis. Treatment modalities included case management with outpatient substance abuse treatment (4 studies), behavioral day treatment with abstinent-contingent housing (4 studies), modified therapeutic community/residential treatment (7 studies), and abstinent-contingent work therapy (1 study). Primary outcomes examined were post-treatment substance use and housing stability.

Results: Across all studies, the aggregate effect size for both outcomes using Cohen's standards were in the moderate range, but varied by treatment modality. Substance use and housing stability effect sizes ranged from high/moderate (behavioral day treatment) to moderate (modified therapeutic community/residential treatment) to low (case management). Interventions with housing components were more effective than outpatient programs, and treatments targeting cocaine or alcohol had greater effect sizes than those targeting polysubstance use.

Conclusions: Effective interventions are available for homeless substance abusers, but the most effective treatments for this difficult-to-treat population incorporated some type of residential component. Behavioral day treatment programs and modified therapeutic community/residential treatment programs with some form of housing were the most effective treatment modalities, with outcomes comparable to psychosocial treatments for domiciled substance abusers.