While some methadone treatment programs have found success in motivating patients to obtain employment, the next challenge is to design integrative programs to show improvements in job functioning and sustain patients in long-term employment. Pilot work at our Center has shown the importance of integrating drug and employment counseling. Training methadone counselors to deliver the intervention allows clinics to be reimbursed for services and patients to have ongoing long-term support from a trusted member of their recovery team. The proposed intervention is comprised of three components including: 1) standard methadone counseling techniques that evaluates patients' performance in treatment, 2) integrated drug and employment counseling based on interpersonal cognitive problem solving (ICPS), and 3) the provision of integrative ICPS maintenance counseling to help sustain employment. ICPS drug counseling is integrated with the ICPS employment counseling through the use of a decision-making protocol that systematically assesses patients' needs during each counseling session. We propose to conduct an integrative Stage I A/B study under the behavioral therapies development program with the following objectives: 1) develop a training manual that incorporates methadone maintenance counseling and employment services, 2) train four MMT counselors to deliver the intervention and then monitor and evaluate their performance, and 3) conduct a pilot study with 48 methadone patients randomized to either this integrative ICPS counseling intervention or to ICPS drug counseling alone (control condition). We hypothesize that integrative ICPS patients will be more likely controls to: 1) be working at the end of the 26 week intervention, 2) be working at the 12 month follow-up, 3) sustain employment at the 12 month follow-up if employed at 6 months, 4) obtain a job more quickly and keep it longer, 5) show improvements in self-reported substance use and social functioning (e.g., family, legal), and 6) have cleaner urines throughout the intervention. Thus, we will evaluate whether this comprehensive intervention is effective in assisting methadone patients in obtaining work, reducing drug use, improving social functioning and sustaining patients in long-term employment.
