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Impact of Work Therapy on Health Status Among Homeless, Substance-Dependent Veterans
A Randomized Controlled Trial
T. Michael Kashner, PhD, JD;
Robert Rosenheck, MD;
Anthony Brian Campinell, MEd;
Alina Surís, PhD;
Randy Crandall, MS;
Nancy J. Garfield, PhD;
Paul Lapuc, PhD;
Karen Pyrcz, MS;
Thomas Soyka, MS;
Annie Wicker, BS;
and the CWT Study Team
Arch Gen Psychiatry. 2002;59:938-944.
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.
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).
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