Long-Term Efficacy of a Therapeutic Community Program for the Homeless: Personality, Substance Abuse, and Social Support Factors that Affect Outcome

Homelessness is a social problem that is multidetermined and requires complex and comprehensive solutions. The issues of homelessness are heterogeneous in nature, with a multitude of complex problems encumbering this diverse population. The high incidence of co-occurring mental illness and substance abuse compound the already harsh consequences of homelessness and often exacerbate the extreme disaffiliation from others experienced by these individuals. Many attempts have been made to remedy this problem, often by addressing each of the issues of homelessness separately. However, there exists a consensus among researchers that this problem must be addressed from a multidimensional treatment approach in order to effectively bring about lasting change. The Therapeutic Community Program at Austin Street Centre in Dallas, Texas is an approach that has combined several treatment modalities into one comprehensive program addressing a variety of issues simultaneously. Group therapy is the cornerstone of this approach, whereby individuals work out their interpersonal difficulties and gain a sense of community and belonging while addressing the issues of mental illness and substance abuse. Previous research on the effectiveness of this Therapeutic Community Program has been promising, albeit preliminary. Despite a high attrition rate, participants demonstrated significant improvements with regard to substance abuse, psychological distress, occupational performance, and interpersonal functioning compared to a group of controls who did not participate in the program. The current study aimed to further these results by demonstrating similar gains in terms of social and psychological functioning, as well as, provide a preliminary investigation into factors that affect program attrition and outcome. A group of 75 therapeutic community program participants at Austin Street were compared to a group of 30 controls who utilized only the basic overnight shelter services offered. As in the previous study, the therapeutic community program was found to be an effective means to a positive outcome. Program participants remained in the therapeutic community for longer and were more likely to experience a positive outcome than controls. Significantly fewer program participants evidenced signs of substance dependence at 3 month follow-up than at intake. Those program participants who evidenced less substance abuse at 3 months were more likely to experience a positive outcome. Additionally, these individuals were shown to have fewer problems relating interpersonally and fewer psychiatric symptoms at baseline than those who continued to abuse substances. Program participants also demonstrated a steady decrease in psychiatric symptoms, symptom distress, problems relating interpersonally, and problems in their social role.