Heroin addiction can have devastating social, medical and economic consequences. Methadone maintenance is an effective treatment for heroin addiction, but only about 20 percent of opiate dependent individuals receive it. Naltrexone is an opiate antagonist that could provide an extraordinarily effective alternative for many individuals. However, its utility has been limited because most individuals refuse it. A randomized study is planned over 5 years to evaluate the effectiveness of the Therapeutic Workplace in promoting naltrexone ingestion and abstinence in unemployed opiate-dependent injection drug users. The Therapeutic Workplace is a novel employment-based intervention that uses salary for work to reinforce clinically important behavior change. Drug abuse patients are hired and paid in this model workplace. To promote clinically important behaviors, salary is arranged contingent both on work and on the emission of those behaviors. Participants will be offered an opioid detoxification and naltrexone induction. Participants who complete the naltrexone induction will be randomly assigned to one of three groups. All groups will be invited to work in the Therapeutic Workplace and prescribed naltrexone for 26 weeks. The groups will differ in the contingencies imposed to work and earn salary. """"""""Work Plus Naltrexone Contingency"""""""" participants will be required to ingest naltrexone to work, and will receive a brief pay decrease for missing a dose. """"""""Work Plus Naltrexone and Abstinence Contingency"""""""" participants will be required to ingest naltrexone to work, and will receive a brief pay decrease for missing a dose of naltrexone or for providing an opiate or cocaine positive urine sample. """"""""Work Plus Naltrexone Prescription"""""""" participants will be prescribed naltrexone, but will not be required to ingest it to work. Critical measures of opiate and cocaine use and HIV risk behaviors will be assessed. This study will provide a rigorous evaluation of a novel employment based intervention, the Therapeutic Workplace, to promote naltrexone ingestion and drug abstinence in a population of injection drug users who are at considerable risk of spreading or contracting HIV infection.

Agency
National Institute of Health (NIH)
Institute
National Institute on Drug Abuse (NIDA)
Type
Research Project (R01)
Project #
5R01DA019386-02
Application #
7046722
Study Section
Behavioral and Social Consequences of HIV/AIDS Study Section (BSCH)
Program Officer
Mcnamara-Spitznas, Cecilia M
Project Start
2005-04-01
Project End
2010-03-31
Budget Start
2006-04-01
Budget End
2007-03-31
Support Year
2
Fiscal Year
2006
Total Cost
$623,767
Indirect Cost
Name
Johns Hopkins University
Department
Psychiatry
Type
Schools of Medicine
DUNS #
001910777
City
Baltimore
State
MD
Country
United States
Zip Code
21218
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Subramaniam, Shrinidhi; Everly, Jeffrey J; Silverman, Kenneth (2017) Reinforcing Productivity in a Job-Skills Training Program for Unemployed Substance-Abusing Adults. Behav Anal (Wash D C) 17:114-128
Jarvis, Brantley P; Holtyn, August F; DeFulio, Anthony et al. (2017) Effects of incentives for naltrexone adherence on opiate abstinence in heroin-dependent adults. Addiction 112:830-837
Dunn, Kelly; DeFulio, Anthony; Everly, Jeffrey J et al. (2015) Employment-based reinforcement of adherence to oral naltrexone in unemployed injection drug users: 12-month outcomes. Psychol Addict Behav 29:270-6
Holtyn, August F; DeFulio, Anthony; Silverman, Kenneth (2015) Academic skills of chronically unemployed drug-addicted adults. J Vocat Rehabil 42:67-74
Ring, Brandon M; Sigurdsson, Sigurdur O; Eubanks, Sean L et al. (2014) Reduction of classroom noise levels using group contingencies. J Appl Behav Anal 47:840-4
Dunn, Kelly E; Defulio, Anthony; Everly, Jeffrey J et al. (2013) Employment-based reinforcement of adherence to oral naltrexone treatment in unemployed injection drug users. Exp Clin Psychopharmacol 21:74-83
Aklin, Will M; Severtson, S Geoffrey; Umbricht, Annie et al. (2012) Risk-taking propensity as a predictor of induction onto naltrexone treatment for opioid dependence. J Clin Psychiatry 73:e1056-61
Sigurdsson, Sigurdur Oli; Ring, Brandon M; O'Reilly, Kristen et al. (2012) Barriers to employment among unemployed drug users: age predicts severity. Am J Drug Alcohol Abuse 38:580-7
DeFulio, Anthony; Silverman, Kenneth (2012) The use of incentives to reinforce medication adherence. Prev Med 55 Suppl:S86-94

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