Communities across the United States have initiated plans to end chronic homelessness. In many of these communities, addiction
treatment programs remain the default point of entry to housing and services. This study examined the percentage of cocaine-using
homeless persons (all with psychiatric distress) attaining stable housing and employment 12 months after entering a randomized
trial of intensive behavioral day treatment, plus one of the following for 6 months: no housing; housing contingent on drug
abstinence; housing not contingent on abstinence. Of 138 participants, the percentages with stable housing and employment
at 12 months were 34.1 and 33.3%, respectively. Analyses suggested superior outcomes in trial arms that offered housing as
part of the behavioral treatment. The majority of participants, however, did not achieve housing or employment, in part because
of the limited capacity of the local housing programs to accommodate persons who had not achieved perfect abstinence. The
findings demonstrate a helpful role for addiction treatment and suggest the need for services to support housing of persons
who reduce but do not eliminate all substance use.
Keywords homeless persons - randomized controlled trials - addiction treatment - rehabilitative outcomes - employment - contingency management - health policy