Impediments to Recovery in Treatment Programs for Dually Diagnosed Homeless Adults

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.