The specific aim of this project is to demonstrate the efficacy of providing a manual-guided vocational intervention, which can be easily and feasibly implemented by methadone maintenance counselors with unemployed clients in drug treatment. Although findings vary by clinic, approximately 40 to 80% of methadone clients are unemployed throughout their stay in methadone treatment. However, nearly two-thirds of the unemployed clients report that they would like to improve their vocational skills as part of methadone treatment. Unfortunately, less than 35% of methadone programs provide vocational services. Furthermore, utilization of vocational services, when available, has been inconsistent with limited improvements in patient vocational functioning. To address several of these service delivery barriers, the vocational services outlined in this proposal will satisfy two commonly cited problems derived from previous vocational services research. Specifically this vocational intervention will: 1) demonstrate that methadone counselors, using a manual-guided vocational intervention implemented during individual one-to-one counseling sessions, can deliver a 10 unit course of vocational services 80% of the clients randomized to the vocational group. 2) demonstrate that the individual based, manual-guided method of service delivery is effective as evidenced by a 50% increase in total days of employment for the vocational vs comparison group. Thereby, supporting the hypotheses that methadone counselors can be an effective, cost-efficient agent of change in delivering employment services to methadone maintained clients. A total of 140 unemployed methadone clients from two community based methadone programs will complete a baseline evaluation. Thirty-five subjects from each clinic will be randomly assigned to one of 5 methadone counselors trained to deliver 12 weeks of manual-guided vocational counseling. A comparison group of 35 subjects from each clinic will be randomly assigned to another set of 5 methadone counselors supervised to delivery 12 weeks of manual guided interpersonal problem solving techniques. The comparison and experimental conditions will be similar in time, frequency and duration of treatment. Counselors selected for the project will be considered standard, defined as a minimum of two years but less than five years of substance abuse counseling experience. To help reduce variability in the quantity, type and quality of counseling provided, selected counselors will participate in two hours of weekly supervision conducted by a case manager, independent of the clinic. Subjects will be assessed at 6 and 12 month intervals after completing the 12 week intervention. During these follow-up evaluations, we will examine the total number of days employed, income, substance use patterns, clinic attendance, and psychosocial functioning to compare the efficacy of the vocational intervention versus a time and condition controlled comparison group. Secondly, we will monitor the ability of methadone counselors to deliver a manual-guided vocational intervention by measuring quantity, quality and impact of services as well as adherence to protocol in the delivery of the structured intervention.
| Coviello, Donna M; Zanis, David A; Lynch, Kevin (2004) Effectiveness of vocational problem-solving skills on motivation and job-seeking action steps. Subst Use Misuse 39:2309-24 |
| Badon, Lisa A; Hicks, Alissa; Lord, Kevin et al. (2002) Changes in cardiovascular responsiveness and cardiotoxicity elicited during binge administration of Ecstasy. J Pharmacol Exp Ther 302:898-907 |
