Effective services for homeless substance abusers.

A heterogeneous and representative sample of 323 homeless individuals in the metropolitan-Denver area with alcohol or other substance abuse problems received a comprehensive array of substance-abuse treatment services. Following treatment, these individuals showed dramatic improvement on average in their (a) levels of alcohol and drug use, (b) housing status, (c) physical and mental health, (d) employment, and (e) quality of life. Those who received more service improved more than those who received less service. These improvements are attributable, at least partly, to the treatment rather than to alternative hypotheses such as spontaneous remission. However, the rate of improvement generally slowed during the six-month follow-up period. A random half of the clients received intensive case management in addition to the other services. Case management marginally increased clients' contacts with addictions counselors, but had little effect on the level of other services received or on the tailoring of services to client needs. As a result, case management also had little, if any, effect on outcomes.

How environments and persons combine to influence problem drinking. Current research issues.

In this chapter, a brief review of existing empirical research on environmental correlates of problem drinking is presented. The review shows that environmental factors do relate to the prevalence of drinking problems and also to the way drinking problems are expressed. In the major section of the chapter, however, it is shown that our present knowledge of how environmental and personal factors combine to influence problem drinking is quite limited, perhaps because almost all of the existing empirical research has attempted to account for problem drinking by means of individual variables alone, environmental variables alone, or in terms of linear combinations of individual and environmental variables. It is shown that alternative approaches offer more promise for understanding how individual and environmental factors combine to influence problem drinking; these approaches are aimed at accounting for problem drinking in terms of the mutual interdependence between persons and their environments. Within two hypothetical sets of data, a number of conceptual and methodological issues, problems, and features of these kinds of interactional or transactional approaches are then illustrated. It is shown that although such approaches offer a promise of greater understanding, they also present a set of interrelated problems which run the gamut from measurement, statistical analysis, experimental design, and sampling issues to paradigm issues lying close to the realm of the philosophy of science.

ANALYSIS AND REDUCTION OF COMPONENTS OF SYSTEMATIC ERROR IN RATINGS '.

A formal model of rating behavior was deveioped in which true and systematic error components of ratings were differentiated. A general error reduction procedure was developed, and the effects of the transformation of ratings on the validity of inter-rater agreement were analyzed within a computer simulation methodology. The method of mathematical mode1 simulation allowed the error reduction procedure to be validated, and the interactive effects of various components of error were demonstrated. Specifically, it was shown that characteristics of both the perceiver (rater) and the perceived person were invalidating sources of error which were reduced by the data reduction procedure. The proposition that the method of mathematical model simulation will prove valuable in the analysis of more complex psychological phenomena was advanced.

An empirical typology of the chronically mentally ill.

This paper describes the demographic, clinical, and psychosocial characteristics of a sample of chronically mentally ill clients at a large comprehensive community mental health center. Utilizing cluster analytic procedures, five basic types of chronically mentally ill clients are empirically identified. The differential pattern of psychosocial characteristics associated with each type is explored and the distinctive profile of each type is delineated. Finally, the implications of this typology for the design of community support treatment programs and allocation of increasingly scarce resources are presented.