Substance users in treatment programs, including methadone patients, historically have had poor rates of workforce participation. Nationally, 76 percent of methadone patients are unemployed at admission, with virtually the same rate at discharge. Traditionally, addicts in treatment have experienced substantial disincentives to enter employment because of the ready availability of public assistance, disability benefits for addiction disorders and Medicaid. However, policy changes are now creating a new environment. Recent federal and state welfare reform legislation (e.g., federal Personal Responsibility and Work Opportunity Reconciliation Act of 1996; New York State Welfare Reform Act of 1997) requires that drug treatment clients achieve work readiness in specific time frames or lose public benefits and other supports. There is evidence that most methadone patients are potentially capable of and interested in productive activity. However, few methadone programs have offered adequate vocational services. The proposed study will implement and evaluate an innovative vocational rehabilitation model to facilitate the transition of methadone patients from welfare to competitive employment.
The specific aims are: 1) To implement and Individual Placement and Support Model for Substance Users (IPS-SU) among opiate addicts in methadone treatment. The innovative IPS vocational rehabilitation model was originally developed, manualized and favorably evaluated for a seriously mentally-ill (SMI) population. 2) To conduct a randomized field trail of the IPS-SU model's efficacy by voluntarily assigning unemployed methadone patients to either: (a) the innovative IPS-SU model (N=144), or (b) a traditional vocational services program (N=144). The primary outcomes, assessed at 6, 12, and 18 months after admission, are measures of competitive employment; the secondary outcomes are methadone program retention, substance use, and other measures of patient functioning. 3) To determine the static and dynamic patient attributes and intervention process variable which may predict differences in patient outcomes. 4) To conduct benefit-cost and cost-effectiveness analyses of the modified IPS vocational rehabilitation program.
