Drug addiction is a chronic relapsing disorder. High magnitude and long-duration voucher-based abstinence reinforcement is one of the most effective treatments for drug addiction and can maintain cocaine abstinence over extended periods of time, but practical methods of implementing these interventions are needed. Workplaces could be ideal and practical vehicles for arranging and maintaining abstinence reinforcement over long time periods. Our research on a model Therapeutic Workplace has shown that employment-based abstinence reinforcement, in which participants must provide drug-free urine samples to maintain maximum pay, can maintain cocaine abstinence. Now we need to develop effective and economically sound methods to arrange long-term exposure to employment-based abstinence reinforcement. We are proposing evaluate the effectiveness and economic benefits of a Wage Supplement Model of arranging long-term exposure to employment-based abstinence reinforcement. Under this model, successful Therapeutic Workplace participants are offered abstinence-contingent wage supplements if they obtain and maintain competitive employment. Governments have used wage supplements effectively to increase employment in welfare recipients. The Wage Supplement Model harnesses the power of wage supplements to promote employment, while simultaneously using the wage supplements to reinforce drug abstinence. The intervention will combine the Therapeutic Workplace, Individual Placement and Support (IPS) supported employment, and abstinence- contingent wage supplements. IPS is a supported employment intervention that has been proven effective in promoting employment in adults with severe mental illness. Under this model, participants will be exposed to the Therapeutic Workplace to initiate drug abstinence and establish job skills. To promote employment and prevent relapse to drug use, participants will receive IPS Plus Abstinence-Contingent Wage Supplements. A randomized trial will evaluate the effectiveness and economic benefits of the Abstinence-Contingent Wage Supplement Model in promoting employment and sustaining cocaine abstinence in low-income unemployed injection drug users who continue to use cocaine during opioid agonist treatment (N=120). Participants will be enrolled in the Therapeutic Workplace for 3 months and then randomly assigned to an IPS Only group or an IPS Plus Abstinence-Contingent Wage Supplement group for one year. IPS Only participants will receive the IPS intervention. IPS Plus Abstinence-Contingent Wage Supplement participants will receive the IPS intervention and abstinence-contingent wage supplements. Drug use while participants are employed in community jobs will be monitored by American Substance Abuse Professionals, Inc. (ASAP(r)), a leading provider of workplace substance abuse services in the U.S. This novel intervention could be an effective and economically sound way to promote long-term cocaine abstinence and employment in injection drug users, a population at risk for many adverse outcomes because of their poverty, unemployment and injection drug use.
To address the chronic nature of drug addiction, we propose to develop and evaluate the effectiveness and economic benefits of abstinence-contingent wage supplements as a means of arranging long-term exposure to employment-based reinforcement of cocaine abstinence in injection drug users. Under abstinence-contingent wage supplements, unemployed drug users will be offered wage supplements for obtaining and maintaining competitive employment, but they will be required to provide drug-free urine samples to maintain the maximum value of wage supplements. This novel intervention could be an effective and economically sound means of promoting long-term cocaine abstinence and employment in injection drug users, a population at great risk for HIV and many adverse outcomes because of their poverty, unemployment and continued injection drug use.
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