Impediments to Recovery in Treatment Programs for Dually Diagnosed Homeless Adults

An Ethnographic Analysis

Published in: Contemporary Drug Problems, Summer 1995, p. 193-236

Posted on RAND.org on January 01, 1995

by Paul Koegel

Analyzes the experiences of homeless adults who have been dually diagnosed with both psychiatric and substance abuse problems. Data for this study were gathered through observation and unstructured interviews with clients and counselors at residential and non-residential treatment programs designed for this population. Until recently most of these individuals were either shunted back and forth between the substance abuse and mental health systems, or fell through the cracks of existing service delivery systems altogether. In comparing the experiences of persons who participate in the residential or non-residential programs, the authors state that there is no clear best alternative. Persons in residential programs do not have to worry about their basic subsistence, but those in non-residential programs achieve better independence and experience less isolation and less shock in re- entering the real world. The authors found that it is difficult to ease the hopelessness experienced by clients as they recognize their participation in treatment may not help them overcome many of the longstanding problems they have faced. Efforts to help people build meaningful social relationships and define more-productive ways of entertaining themselves may be treatment goals as important as recognition and treatment of substance abuse symptoms or psychiatric symptoms themselves.

This report is part of the RAND Corporation External publication series. Many RAND studies are published in peer-reviewed scholarly journals, as chapters in commercial books, or as documents published by other organizations.

Our mission to help improve policy and decisionmaking through research and analysis is enabled through our core values of quality and objectivity and our unwavering commitment to the highest level of integrity and ethical behavior. To help ensure our research and analysis are rigorous, objective, and nonpartisan, we subject our research publications to a robust and exacting quality-assurance process; avoid both the appearance and reality of financial and other conflicts of interest through staff training, project screening, and a policy of mandatory disclosure; and pursue transparency in our research engagements through our commitment to the open publication of our research findings and recommendations, disclosure of the source of funding of published research, and policies to ensure intellectual independence. For more information, visit www.rand.org/about/principles.

The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.