Retention of homeless clients in substance abuse treatment. Findings from the National Institute on Alcohol Abuse and Alcoholism Cooperative Agreement Program.

Retaining clients in treatment who are homeless presents a particular challenge for substance abuse treatment providers. A National Institute on Alcohol Abuse and Alcoholism Cooperative Agreement Program offered the first opportunity to systematically study program retention in a multisite study of interventions for homeless persons with alcohol and other drug problems. This article presents results from analyses conducted across 15 interventions implemented at 8 Cooperative Agreement sites. Both qualitative and quantitative data were collected and analyzed. Key findings were that (a) retention problems with homeless clients are as or more pervasive than in the general addicted population; (b) the provision of housing increases retention, but the increases tend to be nullified when the housing is bundled with high-intensity services; (c) homeless clients leave treatment programs for a multitude of reasons; and (d) midcourse corrections to increase retention are frequently successful. The discussion focuses on service components related to retention, the importance of attending to phase transitions, and the importance of being programmatically responsive when serving this population.