Journal of Substance Abuse Treatment 18 (2000) 373–386 0740-5472/00/$ – see front matter © 2000 Elsevier Science Inc. All rights reserved. PII: S0740-5472(99)00082-3 In the spotlight A program evaluation study of a nursing home operated as a modified therapeutic community for chemically dependent persons with AIDS Project Samaritan AIDS Services, Inc.’s Residential Health Care Facility, Highbridge Section, Bronx, NY Jerome F.X. Carroll, Ph.D. a, *, John J. McGovern, C.S.W. b , John J. McGinley, M.S. a , Juan Carlos Torres b , James R. Walker, M.A. c , Eileen S. Pagan, M.S., R.N., C. b , Frank A. Biafora, Ph.D. d a Project Return Foundation, Inc., 10 Astor Place, New York, NY 10003-6935, USA b H.E.L.P./PSI (Project Return Samaritan Village, Inc.), 1401 University Avenue, Bronx, NY 10452, USA c Samaritan Village, Inc., 138-02 Queens Boulevard, Brywood, NY 11435, USA d Department of Sociology, St. John’s University, 800 Utopia Parkway, Jamaica, NY 11439, USA Received 29 June 1999; accepted 28 July 1999 Abstract An interagency evaluation of the treatment effectiveness of a speciality nursing home (NH) run as a therapeutic community (TC) for residents diagnosed with acquired immunodeficiency syndrome (AIDS) and substance abuse/dependence (SA/D) was conducted. A total of 79 chemically dependent men and women with AIDS were: (a) administered the Tennessee Self-Concept Scale (TSCS; Roid & Fitts, 1991) at initial testing (T 1 ) and 8 months after their initial testing (T 2 ); and (b) assessed on specific physical health indicators (i.e., weight, CD-4 count, and viral load) and other treatment outcomes (e.g., abstinence) over the same two time periods. The TSCS results identified a valid and invalid TSCS test group and further distinguished among three subgroups of invalid responders. Significant improvements were observed from T 1 testing to T 2 testing on the TSCS, on the physical health indicators, and on other treatment outcomes. The need for addi- tional and continued mental health services for this population was noted. © 2000 Elsevier Science Inc. All rights reserved. Keywords: Program evaluation; Nursing home; Therapeutic community; Substance abuse; HIV/AIDS 1. Introduction In the latter half of the 20th century, two deadly epidem- ics rapidly spread across the globe destroying the lives of millions of men, women, and children while simultaneously threatening the very foundations of the political, economic, and social pillars upon which their respective cultures and nations rested. These two epidemics, one involving the hu- man immunodeficiency virus (HIV) and the other substance abuse/dependence (SA/D), shared many things in common which served to create a powerful, negative synergism. For example, the injection of illegal substances was identified as one of the principal means of acquiring and transmitting the HIV (Des Jarlais et al., 1996; Friedman et al., 1995; Samet et al., 1998; Swan & Benjamin, 1993). Engaging in unsafe sex practices while high or inebriated (Calzavara et al., 1993; Gorman, 1996; Ku et al., 1992; Leigh & Stall, 1993; Paul et al., 1994; Stall et al., 1986) or as a means of procuring drugs, alcohol, or both (Katz et al., 1994; Kelly et al., 1992; Rotheram-Borus et al., 1995; Savin-Williams, 1994) was also associated with the spread of HIV and its fearsome se- quela, the acquired immunodeficiency syndrome (AIDS). To appreciate the extent and scope of the AIDS epi- demic, the Joint United Nations Programme on HIV/AIDS and the World Health Organization (United Nations Pro- gramme on HIV/AIDS, 1998) estimated there were 33.4 million AIDS cases worldwide. The Centers for Disease Con- trol and Prevention (1998) reported 261,560 AIDS cases in the United States. The equivalent SA/D figures are these: the United Nations International Drug Control Programme (1997) estimated that there were 446.6 million drug abusers worldwide: 8.0 million heroin and other opiates; 13.3 million cocaine; 141.2 million cannabis; 26.5 million hallucinogens; * Corresponding author. Tel.: 212-979-8800; fax: 212-979-0100. E-mail address: jfxc4318@aol.com (J.F.X. Carroll).