The Therapeutic Workplace is a novel treatment designed to address the chronic and persistent nature of drug addiction and unemployment. Under this intervention, drug abuse patients are hired and paid to work in an income-producing Therapeutic Workplace business. To promote abstinence, participants are required to provide drug-free urine samples to maintain daily access to the workplace. Applicants actively using drugs and lacking job skills participate in an initial training phase to initiate abstinence and establish job skills. If the business is financially successful, this treatment could be maintained over extended periods of time at little cost to society. This application is a competing continuation of a grant in which we developed and pilot tested a computerized Therapeutic Workplace designed to train and employ adults as data entry operators. A randomized trial is planned over 5 years to investigate the Therapeutic Workplace business as a maintenance intervention to sustain long-term abstinence and employment. Welfare recipients in methadone treatment, actively using cocaine, and at risk for contracting or spreading HIV infection will participate in an initial Therapeutic Workplace training phase. Participants (N=156) who become abstinent and skilled will be randomly assigned to a """"""""Usual Care Control,"""""""" an """"""""Employment Only,"""""""" or an """"""""Abstinence & Employment"""""""" group. """"""""Usual Care Control"""""""" participants will be referred to seek a job in the community. """"""""Employment Only"""""""" participants will be offered employment for one year in a Therapeutic Workplace business, but these participants will not have to provide drug-free urine samples to work. Participants in the """"""""Abstinence & Employment"""""""" group will be employed for one year also, but these participants will have to provide drug-free urine samples to work and earn salary. This study will provide a rigorous evaluation of the efficacy of the Therapeutic Workplace business as a long-term treatment of cocaine addiction and unemployment; determine the benefits of requiring daily evidence of abstinence to work; and provide information on the extent to which a Therapeutic Workplace business can become self-sustaining. This research could provide firm scientific foundation for the dissemination of Therapeutic Workplace businesses in the long-term treatment of cocaine addiction and unemployment.
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