Impact of Work Therapy on Health Status Among Homeless, Substance-Dependent Veterans: A Randomized Controlled Trial | Psychiatry | JAMA Psychiatry | JAMA Network
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Original Article
October 2002

Impact of Work Therapy on Health Status Among Homeless, Substance-Dependent Veterans: A Randomized Controlled Trial

Author Affiliations

From the Department of Veterans Affairs Medical Centers at Dallas, Tex (Drs Kashner and Surís and Ms Wicker), West Haven, Conn (Dr Rosenheck), Bedford, Mass (Mr Campinell and Ms Pyrcz), St Cloud, Minn (Mr Soyka), Topeka, Kan (Mr Crandall and Dr Garfield), and Northampton, Mass (Dr Lapuc); the Department of Psychiatry, The University of Texas Southwestern Medical Center at Dallas(Drs Kashner and Surís and Ms Wicker); and the Department of Psychiatry, Yale University (Dr Rosenheck).

Arch Gen Psychiatry. 2002;59(10):938-944. doi:10.1001/archpsyc.59.10.938
Abstract

Background  Little is known about the health outcomes of clinician-supervised, performance-based, abstinence-contingent therapeutic work programs on homeless persons with addiction disorders. This study examined the effect of the Department of Veterans Affairs compensated work therapy program (CWT) on nonvocational outcomes. With mandatory urine screenings and adherence to addiction treatment schedules, CWT provided work opportunities (wages, hours, and responsibilities) with jobs created from Veterans Affairs contracts competitively obtained from private industry.

Methods  Homeless, substance-dependent veterans (N = 142) from 4 Department of Veterans Affairs medical centers were randomized, assessed at baseline, and reassessed at 3-month intervals for 1 year. Both CWT and control groups had access to comprehensive rehabilitation, addictions, psychiatric, and medical services. Data were analyzed to determine an immediate CWT effect after treatment and rates of change during 1 year.

Results  Compared with control subjects, patients in the CWT program were more likely to (1) initiate outpatient addictions treatment, (2) experience fewer drug and alcohol problems, (3) report fewer physical symptoms related to substance use, (4) avoid further loss of physical functioning, and (5) have fewer episodes of homelessness and incarceration. No effect on psychiatric outcomes was found.

Conclusion  Work therapy can enhance nonvocational outcomes of addiction treatment for homeless persons, although long-term gains remain unknown.

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