Reducing Offenders' HIV Risk: MI Enhanced Case Management With Drug-Free Housing
Phase: NA
Conditions: Alcohol and Drug Abuse
Sponsor: Public Health Institute, California

Version: October 7, 2016 
1 
REDUCING OFFENDERS’ HIV RISK: MI ENHANCED CASE 
MANAGEMENT WITH DRUG-FREE HOUSING 
Protocol
Version October 7, 2016
PI: Doug Polcin
Clinicialtrials.gov ID: NCT01977092
A. Study Aims, Background and Design
B. Subject Population
C. Recruitment Process
D. Procedures
E. Assessment of Benefits
F. Assessment of Risks
G. Confidentiality
H.Informed Consent
I. Financial Issues

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A. Study Aims, Background and Design
At the conclusion of 2005 one in every one hundred thirty-six adults in the U.S. was
incarcerated in criminal justice institutions (Pew Charitable Trusts, 2009). When 
individuals on probation and parole are added, the proportion is a striking one in every 
thirty-two.  The risk for HIV infection among criminal justice offenders is significant.  
Rates of infection are 4 to 10 times higher than that found in the general population 
(Golembeski & Fullilove, 2008).  Leukefeld et al. (2009) noted that 25% of all HIV 
infected persons have had contact with the criminal justice system and women offenders 
are 15 times more likely to be HIV infected than their non-offending peers.  However, 
offenders are under tested and under treated for HIV, which puts them and their 
partners at risk (Maruschak, 2004).  Offenders who are currently HIV negative are at 
high risk for infection due to high rates of injection drug use and unprotected sex 
(Belenko, 2006). 
This application is based on the premise that probationers and parolees must have 
access to stable, drug free housing to reduce HIV risk, access needed services and avoid 
rearrests and reincarceration.  Drug free housing at the Sober Living Network (SLN) in 
California will be studied as a way to provide a positive living environment for 
probationers and parolees.  The houses use a sober living house (SLH) model of 
recovery that includes a communal recovery environment, abstinence from drugs and 
alcohol, peer support, and encouragement to attend self-help groups such as Alcoholics 
Anonymous. Preliminary data based on a sample of 300 individuals entering 20 SLHs in 
California showed resident improvement in a variety of areas, including drug and 
alcohol use, employment, psychiatric symptoms, and arrests (Polcin et al., 2010).  
Although residents referred from parole and probation systems had substance use 
reductions that were comparable to voluntary residents, they had had far more 
problems maintaining employment, higher rates of arrest and incarceration, and lower 
attendance at self- help groups (Polcin, et al., 2010).  Thirty seven percent had been 
rearrested at 6 month follow-up and 0ne reason may be that probationers and parolees 
received only 35% of the services that they felt they needed to succeed.  Although over 
half met DSM IV criteria for methamphetamine dependence during the last year, a very 
high risk group for HIV, we did not assess HIV outcomes.       
The proposed study will improve SLHs for offenders by adding a Motivational 
Interviewing Case Management (MICM) intervention specifically targeted to the 
problems presented by each offender.  The list of potential problems that MICM can 
address is extensive: 1) adapting to the SLH environment, 2) complying with parole and 
probation, 3) finding and maintain work, 4) successfully accessing and maintaining 
retention in services, 5) addressing HIV risk, testing and treatment, 6) mobilizing 
personal and informal resources, and 7) managing setbacks (e.g., relapse, loss of 
housing, loss of work).    
 Men and women offenders (N=330) entering SLHs will be assigned to a condition 
consisting of drug free housing and provision of a resources manual where residents can 
seek help for a variety of problems (a control group) or drug free housing plus the MICM 
(intervention).  
Aim 1: To assess HIV testing rates, HIV risk behaviors, and utilization for HIV services 
at baseline, 6, and 12 months.  
H1.1 Residents receiving MICM in addition to drug free housing will have higher rates 

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of HIV testing, higher utilization of HIV services, and fewer HIV risk behaviors than the 
drug free housing and resources condition.  
Aim 2: To compare baseline substance use within each study condition with 6- and 12-
month substance use.   
 
H2.1 Residents in each study condition will show significant reductions in drug and 
alcohol use between baseline and follow-up time points as measured by the Time Line 
Follow Back (TLFB).   
H2.2 Residents in each study condition will show significant reductions in drug and 
alcohol problems between baseline and follow-up time points on the Addiction Severity 
Index alcohol and drug scales.   
Aim 3: To compare outcomes between the two study conditions at baseline, 6, and 12 
months.     
 
H3.1 Residents receiving MICM in addition to drug free housing will have less 
substance use (TLFB) and lower ASI alcohol and drug severity than the drug free 
housing and resources condition.  
 
H3.2 Residents receiving MICM in addition to drug free housing will have fewer 
arrests, fewer days incarcerated and lower ASI legal severity than the drug free housing 
and resources condition.  
  H3.3 Residents receiving MICM in addition to drug free housing will have fewer work 
problems (ASI Employment scale) and more days worked than the drug free housing 
and resources condition.  
Aim 4:  To assess mediators and moderators of the MICM.       
    H4.1 Service utilization (Hser et al., 1999) will mediate the relationship between drug 
free housing plus MICM and outcome (TLFB, ASI Alcohol and Drug scales and criminal 
justice recidivism).     
Exploratory Aims:  1) To explore additional outcomes (e.g., ASI Family, Medical, and 
Psychiatric scales, long-term housing status) and covariates (e.g., social support, 
supportive confrontation, motivation). (2) To conduct 30 qualitative interviews (15 per 
condition) to identify general and intervention specific factors affecting outcome.   
B. Subject Population
Study Sites
All of the SLHs taking part in the study have distinct similarities.  All of the houses 
are associated with the Sober Living Network (SLN) in California and have common 
standards that address health, safety and organization of the SLHs. Thus, we should 
have a reasonably homogenous group of houses to study and we do not expect large 
clustering effects that could confound results. The costs of residency in SLHs in the Los 
Angeles area range from $300 to $750 per month depending on size and location.  In 
general, the primary criteria for admission to SLHs include a willingness to 1) abstain 
from substance use, 2) comply with financial obligations such as rent, and 3) comply 
with basic house rules such as curfew, chores and attendance at house meetings.  
Because there are over 500 houses in southern California, we will have ready access 
to more than a sufficient number of houses from which to collect our target sample 
(N=330).  Houses taking part in the study will be asked to sign a Letter Agreement 
outlining expectations of the house and the project staff. Expectations of the house will 
include the designation of primary contact person to serve as a representative of the 
house in resident recruitment matters (ensuring weekly communication about new 

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residents coming into the house and allowing voluntary and confidential recruitment by 
project staff), allowing project staff to post a flyer about the study in a prominent place 
in the house, and allowing project staff to screen and recruit residents at the house or 
over the phone. Expectations of the project staff will include the development and 
posting the study flyer, screening and recruitment of participants, provision of support 
to participants in accordance to the houses random assignment to study condition, 
provision of an annual stipend to the house for costs associated with assisting project 
staff in recruitment matters based on the number of participants enrolled in the study, 
availability to attend house meetings to introduce the study to and update residents on 
study progress, and assurance that no house or residents names will be used outside the 
research study.  
Sample Characteristics 
Three hundred and thirty SLH residents who are on probation or parole and are 
HIV+ or at high risk for HIV will be recruited into the study within their first month of 
entering the SLH. The director of the Sober Living Network in Southern California, Jeff 
Christensen, states over 60 houses in Los Angeles County accept large numbers of male 
and female offenders and the vast majority will be willing to participate in the study. 
This is consistent with our previous study of SLHs, where less than 5% of potential 
participants declined to participate. Belenko (2006) has documented that criminal 
justice offenders have very high rates of HIV infection and high risk behaviors.  This 
supports the feasibility of meeting our recruitment goal to enroll HIV+ or high risk 
individuals.  To be parsimonious in our efforts, we will select the 70 houses with the 
largest number of offenders admitted.  Half of the houses (N=35) will be gender specific 
for men and half (N=35) will be gender specific for women.  Stratified random sampling 
procedures will be used to ensure an equal number of male and female houses within 
each study condition. Thus, individuals enrolled in houses assigned to the MICM 
condition will receive that intervention and individuals assigned to the comparison 
condition will receive SLH services as usual along with a list of referral resources for a 
wide variety of problems.  Risks for contamination of intervention effects on non-
intervention offenders are eliminated because of our randomization of houses.   These 
procedures will enable us to reach our target recruitment with an average of only 10.3 
residents per house over 3 years of recruitment.  We will randomize more houses if we 
need them to meet our recruitment goals.   
We chose to target a broad group of criminal justice offenders (i.e. those on probation 
or parole) because both groups have been problematic in terms of having high rates of 
HIV risk, HIV infection, and re-arrest rates that contribute to serious overcrowding in 
criminal justice institutions that in turn fuel the spread of HIV (Belenko, 2006).  Studies 
have also shown that both probationers and parolees have difficulty accessing services 
they need and that these unmet needs play a role in recidivism (e.g., Freudenberg et al, 
2005; Urban Institute, 2006).  In our preliminary study, we found no reason to suspect 
that there were differences in how these two groups responded to SLH residency. 
However, we will conduct comparisons between those residents on parole and those on 
probation to assess whether there are differences in outcome.  Based on enrollment in 
our preliminary studies we expect about 60% of the sample will consist of parolees and 
40% probationers.   

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The application targets equal proportions of men and women.  All participants will be 
adults age 18 and older.  Based on information obtained from the Sober Living Network 
on residents entering SLHs in Los Angeles County we expect the racial breakdown to be 
approximately 40% African American,  25% White, 20% Hispanic/Latino, and 15% 
Other.   
 
Summary of Inclusion/Exclusion Criteria     
 
We plan to recruit only offenders who are HIV+ or at high risk for HIV.  Inclusion 
criteria will require at least one of the following: HIV+, MSM, history of injection drug 
use, history of sex work, and past month unprotected anal or vaginal sex with more than 
one partner.  All potential participants will be recruited from a pool of individuals who 
have a history of substance dependence and criminal justice involvement, factors known 
to be associated with HIV infection and risk (Belenko, 2006).  Over half of our potential 
sample will have a history of methamphetamine dependence, another high risk factor 
(Center for Disease Control, 2007).  Offenders must be able to speak English and those 
who show evidence of a serious mental health disorder that would hinder their ability to 
provide informed consent will be excluded.  Study therapists will conduct these 
assessments when necessary and make a determination. In addition, to be included in 
the study residents must agree to be randomly assigned to one of the 2 study conditions 
and provide some contact information that can be used to locate them for follow-up 
interviews.   
  
C. Recruitment Process  
 
All participants will be recruited into the study within their first month of entering 
the SLHs. We will monitor resident entry into houses by contacting house managers on 
a weekly basis.  When a new resident enters the house the house manager will hand 
them a flyer describing the study and a phone number and e-mail where the research 
assistant can be reached.  In addition, research assistants will routinely attend house 
meetings to address general questions about the research and to be available to meet 
with new residents who may have specific questions or be interested in participating. 
Efforts will be made to attend house meetings particularly when new residents are 
entering the facility.  Residents will be able to enroll in the study by approaching the 
research assistant when they are on site, calling the research assistant or sending them 
an e-mail.  Interviews can take place at the research assistant’s office, the SLH residence 
(provided there is adequate privacy), or a mutually agreed upon public space (e.g., 
public park, coffee shop) provided there is adequate privacy.  The initial baseline 
interview will take approximately 2 hours and can be divided into two sessions if 
necessary. The adequacy of confidentiality will be protected through certification of the 
study from the Office of Human Research Protection (OHRP) and an NIH “Federal 
Certificate of Confidentiality.” 
  Recruitment for the qualitative component will include a minimum of 28 
participants, 13-15 in each of the two study conditions.  These interviews will take place 
after the 6-month follow up time point.   Because our goal is to learn what is most 
helpful as well as counterproductive in the intervention we will use “maximum variation 
sampling” (Kuzel, 1992).  This strategy employs a purposive sampling strategy that 
seeks to interview individuals with different points of view and different experiences.  
Within each condition, five will be interviewed in each group (1-3) that is determined by 

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their responses on the 6-month data that reflects either low, medium or high HIV risk. 
Participants were consecutively selected to fill slots based on data provided in their 6-
month interviews. Selection will stop once all slots have been filled. Replacements for 
participants whose interviews were not completed within 6 weeks after their 6-month 
follow-up will be marked as missed and another participant will be selected for that slot.   
 
D. Procedures 
Design Summary   
This study will use a stratified randomization design to assess male (N=165) and 
female (N=165) offenders on probation or parole who are either HIV+ or at high risk for 
HIV.  Study participants will be recruited from individuals entering selected SLHs in Los 
Angeles County.  Seventy SLHs (35 gender-specific for men and 35 gender-specific for 
women) that are members of the Sober Living Network will be randomly stratified 
between MICM (the intervention) and referral resources (the control).  Using an “intent 
to treat model,” we will interview all participants at three time points over a 1-year 
period:  baseline (within one month of entering the house) and 6- and 12-month follow 
up.  The two study conditions will be compared on the primary and secondary outcome 
measures.  Qualitative interviews will be conducted with 13-15 residents in each study 
condition (N=28) to explore strengths, weaknesses, and potential mechanisms of action 
of SLHs and MICM.    
 
Focus Groups 
Two focus groups consisting of sober living house managers who will be conducted 
during the first year. The purpose will be to inform final modification of the intervention 
and the procedures used to assess outcome.  Two groups of 12 will be interviewed, one 
consisting of managers of houses for women and one consisting of managers of houses 
for men.  We will recruit participating managers through the Sober Living Network, our 
collaborating partner on this project.  The Executive director, Jeff Christensen, will send 
an e-mail to Los Angeles area house managers who are members of SLN inviting them 
to participate.  If they are interested they will contact the PI (Doug Polcin) by e-mail.  
Once an adequate number agree to take part meetings will be scheduled.  Groups will 
take place after regularly scheduled coalition meetings in Los Angeles. Groups will be 
audiotapes and transcribed to identify important themes. All audio and transcribed data 
will be stored in a locked file.   
The procedures for collection of focus group data do not include collection of 
individual data. Data collected from these procedures will not be on the focus group 
participants themselves. Rather, it will be on their views about the needs of offenders 
entering sober living houses and reactions to our study intervention and data collection 
procedures.  We therefore do not think they need to be consented as research 
participants.  Participants will be told that all content of the groups is confidential. No 
participants will be identified.    
Content of the groups will focus on the following themes:  1) What do offenders need 
as they transition from prison or jail into the community? 2) Relative to other residents, 
what are the unique needs of residents on probation or parole and how do their 
outcomes compare? Do they receive the types of help they need?  Why or why not. What 
types of services are needed more? 3) How successful are offenders at finding and 
keeping employment? 4) How do the needs and outcomes of male and female offenders 

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differ?  5) Does your facility offer any information to residents about HIV testing, 
treatment, or prevention?  How much does that help?          
We will also ask questions about our proposed Motivational Interviewing Case 
Management intervention. After a brief explanation of the intervention we will ask 
about strengths, weaknesses, and suggested changes.  
 
Research Interviews 
 
 Residents who are interested in participating will attend a research interview that 
will begin with an assessment of inclusion/exclusion criteria.  Those who meet the 
criteria will be administered the baseline interview after they are consented.   
Randomization will occur at the house level, so individuals in houses randomized to the 
MICM condition will receive that intervention and individuals in houses assigned to the 
comparison condition will receive SLH services as usual along with a list of referral 
resources for a variety of problems.  Using an “Intent to Treat” design, all participants 
will be followed up at all of the time points even if they leave the SLH immediately after 
completion of the baseline interview. Follow-up interview procedures will include 
updating contact information at each interview as well as at 3 and 9 months.  During 
these interim 3- and 9-month contacts, we will first reach out to participants by phone 
and, if we were unsuccessful, we would send a letter encouraging them to call us. Those 
who we were able to speak with would receive a $5 gift card at the 3-month contact and 
a $10 gift card at the 9-month contact. For participants who are difficult to reach we will 
use tracking methods described by Anglin et al (1996).  They include procedures to 
utilize contact information from respondents’ families and friends and locating 
participants in jails, prisons, and other institutions. Participants will receive $30 for the 
baseline interview and $50 for interviews at 6- and 12-month follow up. We expect 
baseline sessions to last 2 hours and follow up sessions to last about 90 minutes. We are 
using Survey Gizmo as the platform for the interviews, which will require an internet 
connection for us to access the survey. The connection being used while transferring 
data between ARG equipment and Survey Gizmo will be protected by a 128-bit 
encrypted SSL tunnel so as to prevent confidential data from being sniffed. Interviewers 
will conduct interviews only on ARG laptops, which will be password protected and 
configured on the ARG secure network. 
  
Qualitative Interviews 
 
13-15 study participants in each of the study conditions (Total N=28) will be asked a 
series of questions about the houses where they live. Based up on their 6-month follow-
up data,we will retrospectively approach participants who have relatively successful, 
mixed, and unsuccessful outcomes. Questions for all 28 participants will elicit their 
views about the physical characteristics of houses, rules and requirements for residency, 
supportiveness of the household, level of structure, amount of resident involvement in 
management of the house and decision making, and ways the SLH environment 
impacted HIV and substance use outcomes.  The overriding goal will be to identify 
characteristics of the physical and social environment that are perceived to be 
supportive and detrimental to HIV and recovery from substance use disorders.     
Additional content of the qualitative interviews for MICM condition will assess:  1) 
what was helpful about the intervention, 2) what was unhelpful, 3) what might be 
improved in terms of the process, structure or dose of the intervention, 4) how the 

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intervention did and did not help with adjustment to the SLH environment, and 5) how 
might the intervention be improved to respond to issues gender, race, culture or class?  
A final list of items will be developed based on pilot interviews with participants.  
Qualitative findings will be used to inform the development of mediator and moderator 
analyses as well as to improve the content and process of the interventions.  Qualitative 
interviews will take place after the 6-month follow up period. This ensures enough time 
for residents to experience significant success as well as problems that can be discussed 
in the interviews.  
 
Motivational Interviewing Case Management 
MICM intervention combines aspects of motivational interviewing along with case 
management to influence HIV risk and recovery from alcohol and drug problems.  The 
theoretical rationale for increasing motivation draws upon the Stages of Change Theory 
developed by Prochaska et al. (1992) and adapted to Motivational Interviewing by Miller 
and Rollnick (2001).  The model posits that clients proceed from little or no motivation 
(pre-contemplation) to stages that incrementally involve increased motivation: 
contemplation –increasing recognition of substance related problems, preparation – 
consideration of options for making changes, action – enactment of a change plan, and 
maintenance – maintaining improvements.   
MICM differs from standard MI in that it targets a much broader range of problems 
as they apply to each client.   The therapist uses MI techniques to enhance case 
management procedures that connect clients with services they need and then helps 
them succeed in using those services. Thus, standard MI techniques (e.g., reflections, 
open questions, feedback, developing discrepancies, engaging ambivalence, etc.) are 
used to 1) help offenders address obstacles and challenges encountered as they use 
services, begin employment, and adapt to a drug-free living environment, 2) help 
offenders examine options if they discontinue services, residence in the SLH, or 
employment, 3) mobilize informal sources of support (e.g., social networks, self-help 
groups, and religious institutions) that might help them manage problems when 
services are not available or when they decline services, and 4) reduce the harm 
associated with problem behaviors such as HIV risk and substance use.  The therapist is 
given maximum flexibility to address the most pressing issues as clinically indicated for 
each offender.  See Appendix A for details of how MI techniques are used to increases 
motivation and then help offenders succeed in adapting to a drug-free living 
environment, access and succeed in use of services, and find and maintaining 
employment.  The broad range of problems addressed is based on syndemic theory 
(Koblin, et al., 2006; Kurtz, 2008; Singer, 2008), which posits a broad range of 
problems (e.g., substance use, mental health problems, housing instability and 
unemployment) exacerbate HIV disease.  We do not know of any other studies that use 
MI as a way of helping clients succeed in service utilization, employment, drug free 
housing and mobilization of informal supports.  
 
Structure of MICM Sessions  
 
Participants assigned to the MICM condition will receive 3 individual sessions within 
the first month of entering the SLH. Thereafter they will have contact with the MICM 
therapist monthly throughout the duration of their enrollment in the study (12 months).  
However, therapists will also be available to address crises that occur, such as 

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psychiatric emergencies, arrests, and sudden loss of job or housing. For participants 
who have left the geographical area the session will be conducted by phone.    
 
Comparison Condition 
 
The comparison condition will consist of offenders receiving SLH services as usual 
along with a list of resources that can be used to address a variety of problems.   
This will help ensure that intervention effects for MICM are not simply the result of 
receiving information about various services that are available in the community.   
 
Pilot Testing 
We plan to test the survey measures and MICM with pilot subjects before we begin 
recruitment. The purpose of testing the survey is to see how respondents react to the 
questions, evaluate whether the questions need to be adjusted, test out the skip patterns 
and reliability of the online technology, and see how long the survey will take to 
administer. We do not plan to use the data in any of our analyses.  
 
Some of the pilot subjects will be asked to participate in testing the MICM sessions. 
These subjects will meet with the therapists 1-3 times, depending on how the sessions 
go. The purpose of testing out the MICM is to gain a better understanding of how the 
intervention is received and for our therapist supervisors to ensure that the therapists 
are following the intervention manual appropriately and consistently. As names and 
contact information will be collected for some of these pilot subjects, a separate consent 
form will be administered. 
 
Measures 
Baseline Only 
1) DSM-IV Checklist for Lifetime and 12-Month Alcohol and Drug Abuse and 
Dependence.  Items are based on DSM-IV diagnostic criteria (American Psychiatric 
Association, 2000) and have been used in NIDA Clinical Trial Network studies (Forman 
et al., 2004).  2) Demographic and Descriptive Characteristics.  In addition to standard 
demographics (e.g., sex, age, race/ethnicity, and education), we ask about criminal 
justice history.       

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Primary Outcomes 
1) Criminal Justice Outcomes are taken 
from Petersilia (2003) and Petteruti and 
Walsh (2008) and include:  a) 
Parole/Probation Violations, b) Arrests and 
c) Days Incarcerated.  Arrests will be 
specified by type of offense and whether the 
respondent was convicted. Incarceration 
will be specified as due to arrest for a new 
offense and due to a technical violation of 
probation or parole.  Data will be self-
report but also will be confirmed using 
publicly available criminal justice records.  
2) Timeline Follow-Back (TLFB) will be 
used to record the subject’s self-report of 
alcohol and drug use during each interview 
period assessed.  To maximize recall of 
alcohol and drug use we will assess 90-day 
time periods.  This instrument has been 
used extensively in a variety of drug and 
alcohol studies (Sobel et al., 1996). 3) Four 
scales from the Addiction Severity Index 
Lite (ASI) (McLellan et al., 1992) will be 
used as primary outcomes. Alcohol and 
drug scales will be used to assess alcohol 
and drug severity, the legal scale will be 
uses to assess legal severity and the employment scale will be used to assess 
employment problems. 3) The Risk Assessment Battery (RAB) (Metzger, et al, 2001) will 
be used to assess injection and sexual risk behaviors.  An additional measure of HIV will 
include a count of HIV testing overall and the number who are tested for their first time.  
We will also record self-report of HIV status and current engagement in HIV treatment 
services (coded yes\no) for those who are positive.    
Secondary Outcomes 
1) Other scales on the ASI constitute some of our secondary outcomes, including 
medical, family/social and psychological. 2) Days worked over the assessment time 
period is a measure is taken from Gerstein et al. (1994) and is a simple count of number 
of days worked over the follow-up time point.  We will also assess days involved in 
vocational training, GED or other schooling. 3) Housing stability is taken from our 
previous study of SLHs depicting the usual housing situation over the past 6 months as 
well as the number of day homeless or residence in a shelter. We will have additional 
questions that assess whether there are any requirements to live in the home, such as 
abstinence from alcohol and drug use, compliance with a curfew, attendance at 12-step 
meetings, or involvement in counseling.  
Mediators and Moderators of Outcome 
 
1) A short form measuring social support will ask about support from people close to 
the respondent. 2) We will ask three questions to assess the extent to which individuals 
in their social network are heavy alcohol and drug users.  3) The Alcoholics Anonymous 
Table 1.  Administration of Instruments at Each Time Point       
Instrument  
 
   
  Baseline 
 6 Months     1 Year 
Baseline Only 
Lifetime DSM Checklist for X 
Alcohol/Drug Disorders 
Demographics   
 
 
X 
Primary Outcome 
HIV Measures:   
 
 
X 
 
 
X 
 
 
X 
 
RAB 
 
 
 
 
 
 
HIV Status  
 
 
 
 
HIV Testing 
 
 
 
 
HIV Treatment 
Probation/Parole  
  
 
X 
 
 
X 
 
 
X 
 
Violations  
Arrests  
 
 
 
 
X 
 
 
X 
 
 
X 
Days Incarcerated   
 
X 
 
 
X 
 
 
X 
TLFB for Drugs and Alcohol X  
 
X 
 
 
X 
ASI Alcohol and Drug 
 
X 
 
 
X 
 
 
X 
Secondary Outcomes 
ASI Scales   
 
 
 
X 
 
 
X 
 
 
X 
Work/Income History  
X 
 
 
 
 
 
X 
Housing Stability 
 
 
X 
 
 
X 
 
 
X 
Moderators/Mediators 
General Social Support  
X 
 
 
X 
 
 
X 
Social Network ` 
 
 
X 
 
 
X 
 
 
X 
AA/NA Involvement  
 
X 
 
 
X 
 
 
X 
Services Received 
 
 
X 
 
 
X 
 
 
X  
Retention  
 
 
 
X 
 
 
X 
 
 
X 
Confrontation (ADCS)  
X 
 
 
X 
 
 
X 
Trauma, PTSD, Abuse  
X 
 
 
 
 
 
 
ADCQ  
 
 
 
 
X                    X  
 
X 
Biological Measures 
Urine Screen 
 
 
 
X 
 
 
X 
 
 
X 
Qualitative Interview 
 
 
 
X 
House Environment 
SMPS  
 
 
 
 
 
 
 
N/A 
 

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Affiliation Scale (AAS) is a nine-item scale that measures the strength of an individual’s 
affiliation with AA and other 12-step groups (Humphreys, Kaskutas & Weisner, 1998).  
4) Services Received is a measure from our current study of SLHs that assesses the 
extent to which participants are involved in a variety of services (e.g., substance abuse, 
mental health, healthcare, legal and job training) (Hser et al., 1999).  5) Supportive 
confrontation will be assessed using the Alcohol and Drug Confrontation Scale (ADCS) 
developed by Polcin et al (2006; Polcin & Greenfield, 2006). Confrontation is defined as 
warnings individuals receive about potential consequences of alcohol or drug use from 
family, friends, peers and professionals. 6) Retention will be assessed as number of 
continuous days of residence after admission.  7) We will ask a set of questions about the 
effects of traumatic life events using a PTSD checklist. We will ask about their history of 
physical and sexual abuse using questions adapted from the National Alcohol Study and 
the WHO women and violence study.  8) The Alcohol and Drug Consequences 
Questionnaire (Cunningham, et al., 1997) will be used to assess motivation for change. 
Two scales assess the consequences and benefits of changing substance use.  Consistent 
with previous studies of SLHs (Polcin & Greenfield, 2006) we will also use these items 
to assess motivation to maintain abstinence. 
Biological Measures 
 
1) Urine screens will be administered to corroborate self-report of drug use.  Self-
reported use will be the default measure unless a report of no use is falsified by a 
positive urine screen (Leiderman & Bigelow, 1999).    
Qualitative Interviews 
  Qualitative interviews will be conducted with approximately 13-15 participants in 
each study condition (N=28).  See the subheading above entitled “Qualitative 
Interviews” for a description of the items used. 
House Environment 
   The Social Model Philosophy Scale (SMPS) (Kaskutas et al, 1998) will be used to 
measure the physical and social environment at each house.  The SMPS assesses the 
physical environment, house manager roles, authority base, governance, view of 
recovery, and orientation toward the surrounding community. The scale will be assessed 
at each house that has signed a letter agreement and where we enrolled study 
participants.  The respondent will be compensated with a $5 gift card for this scale that 
will take approximately 15 minutes to complete. The SMPS is scored along six domains 
and has an overall internal reliability of 0.92.  Should differences exist across the 30 
houses used in the proposed study, we will investigate whether those differences are 
associated with outcome.     
 
E. Assessment of Benefits 
Direct benefits include $30 for participation in the baseline interview and $50 for 
participation in the 6- and 12-month follow up interviews as well as a $5 gift card for 
confirming/updating their locator information at the 3-month interim contact and a $10 
gift card for confirming/updating their locator information at the 9-month interim 
contact. The 28 individuals taking part in the qualitative component will be 
compensated $20.  Participants in the 2 study conditions may benefit through residing 
in a sober living residence that supports abstinence from alcohol and drugs.  The MICM 
intervention condition may also benefit through accessing community supports with the 
assistance of the therapist.  The comparison condition might benefit through provision 

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of alcohol and drug free housing and acquisition of a list of referral resources that might 
be helpful to them.  All individuals in the study may benefit by the self-reflection 
required of the research questions.  
F. Assessment of Risks
This study is a clinical trial. Our sample targets 330 individuals who are on probation
or parole and are entering a sober living house in Los Angeles County.  Risks that the 
research participants may undergo are expected to be minimal.  They may feel 
uncomfortable or embarrassed by some questions.  For example, they may feel 
discomfort about providing information about their substance use patterns, illegal 
behaviors, and psychiatric symptoms. However, the questions asked of them are typical 
counseling questions that are often asked as part of any treatment or recovery program.  
Participants may also be embarrassed by a positive urine screen.  While extensive efforts 
are made to ensure confidentiality of all research procedures, there is a possibility that 
confidentiality could compromised to the detriment of the study participant.  Although 
the supportive living environment of the SLH and supportive case management are not 
likely to cause psychiatric crisis such as suicide, homicide, or psychotic regression, these 
problems are always possible among the population we are investigating. 
 
To minimize risk, participants will be informed before each research and case 
management interview that they may decline to answer questions with which they are 
uncomfortable, and they may terminate the interview at any time without penalty.  Case 
management sessions and qualitative interviews will be audiotaped, but residents will 
be free to turn off the tape at any point.  Audiotapes and case report forms will not 
contain any identifying information and will be kept in a locked cabinet.  Audiotape 
recordings will be destroyed 5 years after completion of the study.  Case management 
meetings and research interviews will only be conducted when there is sufficient 
privacy.  We have extensive experience conducting interviews within criminal justice 
institutions and have not had any concerns about privacy.  Typically, these meetings 
take place in “interview rooms” where attorneys meet with their incarcerated clients.  
We will obtain approval for these procedures from our IRB, the OHRP, and a federal 
Certificate of Confidentiality.  We have used many similar items to those proposed here 
in other studies and have not experienced reports of excessive discomfort from 
participants. Risks that the research participants may undergo are expected to be 
minimal.  The questions asked of participants in the study are opinions or typical 
counseling questions that clients are often asked as part of their treatment.  Although 
the supportive living environment of the SLH and supportive case management are not 
likely to cause psychiatric crisis such as suicide, homicide, or psychotic regression, these 
problems are always possible among the population we are investigating.  The therapist 
will be a licensed mental health professional trained in how to manage such issues.  
Voluntary or involuntary psychiatric hospitalization will be considered if clinically and 
legally appropriate. The therapist will work with local psychiatric emergency centers to 
coordinate hospitalization if necessary.  Dr. Polcin will supervise the therapists and be 
available for consultation as needed. Dr. Polcin is a licensed mental health practitioner 
with many years of experience in psychiatric day treatment settings, and he has 
addressed psychiatric crises as a regular part of his work.      
G. Confidentiality

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All participant data will be reported on case report forms without identifying 
information.  Similarly, all audiotape recordings will be coded with a number and no 
identifying information will be on them.   Respondents will be reassured that all data 
will be kept under lock and key to assure confidentiality of the data.  Only research staff 
will have access to the data.  A federal Certificate of Confidentiality will be obtained for 
this project to add further safeguards to confidentiality. 
All research staff will sign pledges of confidentiality and receive training on data 
security procedures. Because we may interview subjects in state prisons or local jails, we 
will obtain approval from the Office of Human Research Protection (OHRP).    The 
study will be analyzed statistically in an aggregate manner and will not identify specific 
respondents. Data for tracking will be kept in a password protected database accessible 
only to staff.  
Case report forms and audiotapes will be kept for 5 years after the study ends. At that 
point Dr. Polcin will arrange for shredding of case report forms and erasure and 
destruction of audiotapes.  All data will be kept locked during this time.  
H. Informed Consent
All participants will be required to sign an IRB approved consent form before
beginning interviews.  This form will include the following information: 1) participation 
is voluntary and refusing to participate or deciding to discontinue participation at any 
time is  without penalty, 2) the general research purpose, 3) participation consists of 
completing questionnaires and interview questions, 4) questions will address issues 
pertaining to community support, substance use, psychiatric symptoms, and related 
problem areas (e.g., work, family and medical), 5) participants will be compensated  $30 
for their participation in the baseline interview and $50 for their participation in the 6-, 
and 12-month interviews as well as a $5 gift card for confirming/updating their locator 
information at the 3-month interim contact and a $10 gift card for confirming/updating 
their locator information at the 9-month interim contact, 6) all responses will be entirely 
confidential and no identifying information will appear in any research reports, 7) data 
will be presented in aggregate form, 8) the study is approved by the Public Health 
Institute Institutional Review Board (IRB), 9) the study is approved by the Office of 
Human Research Protection (OHRP), 10) the study has acquired a federal Certificate of 
Confidentiality, and 11) whom to contact if they wish additional information.   
 
The 28 individuals selected for qualitative interviews at the 6-month interview will 
sign an additional consent form that describes the purpose and procedures for these 
interviews.  They will be informed that the sessions will be audiotaped but stored in a 
locked file cabinet without any identifying information 
I. Financial Issues
There are no costs to participants taking part in the study.  There are no costs
associated with receiving MICM in the intervention condition and no cost for receiving a 
list of referral resources in the comparison condition.  Payment to participants for their 
time completing research interviews is $30 for participation in the baseline interview 
and $50 for participation in the 6- and 12-month follow up interviews as well as a $5 gift 
card for confirming/updating their locator information at the 3-month interim contact 

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and a $15 gift card for confirming/updating their locator information at the 9-month 
interim contact. The 28 individuals taking part in the qualitative component will be 
compensated $20. Individuals entering SLHs will be required to pay ordinary fees 
associated with living in the facility.