Pre- and post-admission attrition of homeless, mentally ill chemical abusers referred to residential treatment programs

AIMS: To assess the magnitude and psychopathologic predictors of attrition among homeless, mentally ill chemical abusers (MICAs) referred to residential treatment programs in New York City. DESIGN: Homeless, MICAs were randomly referred to a therapeutic community (TC) or community residence (CR) and monitored with regard to pre- and post-admission attrition. SETTINGS: Community based treatment facilities modified to treat both substance abuse and major mental illness. PARTICIPANTS: Homeless individuals with a major mental illness (DSM-III-R) and a history of abusing alcohol or other drugs. MEASUREMENTS: Attrition rates and selected scales of psychopathology. FINDINGS: From an initial pool of 694 treatment candidates, 147 (22%) were rejected for admission at their assigned facility; 247 (36%) failed to show up for treatment; and 212 (31%) dropped out of treatment at some point during the first 12 months. Contrary to expectation, those with severe levels of psychotic ideation, depressive symptoms and hostility were admitted to treatment more frequently and stayed in treatment longer at the TC, a high demand approach, than the CR, a low demand approach. CONCLUSION: Clinicians should consider the TC as a viable treatment option for MICAs.