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Vanzetto S, Quarenghi A, Varinelli A, Dragoni C, Conti D, Boscacci M, Carrà G, Percudani M, Morganti C, Gambini O, Barbieri V, Brambilla P, Lazzaretti M, Rubelli P, Mencacci C, Fusi A, Viganò C, Dell'Osso B. Longitudinal outcomes of a work inclusion program in mental health departments in the city of Milan. Int J Soc Psychiatry 2024; 70:507-517. [PMID: 38312065 DOI: 10.1177/00207640231217177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Abstract
BACKGROUND Work functioning impairment is a key diagnostic and prognostic criterion in patients with psychiatric disorders and work inclusion is a major goal of their therapeutic pathway. Since 2009, the Regional Innovative Program (PIR) TR106, promoted by ASST Fatebenefratelli-Sacco of Milan in collaboration with other Departments of Mental Health and Addictions (DSMDs) in the town of Milan (Italy), has been developing the employment inclusion of psychiatric patients. AIMS The objective of this study is to evaluate its outcomes over 8 years of observation. METHOD We reported the results of a retrospective epidemiologic analysis on 2,142 interventions on 1,066 patients recruited, investigating PIR TR106 outcomes per year focusing on different subgroups. We focused on 'positive', 'negative', and 'other' outcomes. RESULTS We preliminary calculated job maintenance interventions (5%, 107) and excluded these interventions from the overall. We observed 29 job firing (1.4%) and 15 job resignations (0.7%) as negative results (equal to 2.2% of the total) and 388 job hiring (16.6%), 647 traineeships (31.8%), and 413 work formation (20.3%) as positive outcomes (equal to 68.75%). In other outcomes (29.1%) we found 305 dismissals from PIR TR 106 (15%) and transitory outcomes (14.1%).Job hiring increased from 8.9% in 2012 to 23.8 % in 2019 (p < .001), while the dismissals diminished from 26.7% to 13.3% (p < .001). The effectiveness of traineeships in terms of job hiring increased in the ratio of annual job hiring versus job traineeship (+48.8%). The majority of hired patients (15.1%) were affected by a psychotic disorder. A significant hiring increase was observed in patients with psychotic disorders and personality disorders (p < .005). CONCLUSIONS PIR-TR106 represents a territorial employment inclusion program with progressively increasing effectiveness and specificity, as suggested by changes in outcomes during the 8-year observation. The adaptive capacity and sustainability of the intervention are worth further investigation.
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Affiliation(s)
- Simone Vanzetto
- Department of Biomedical and Clinical Sciences, Department of Mental Health and Addictions, ASST Fatebenefratelli Sacco, University of Milan, Italy
| | - Andrea Quarenghi
- Department of Biomedical and Clinical Sciences, Department of Mental Health and Addictions, ASST Fatebenefratelli Sacco, University of Milan, Italy
| | - Alberto Varinelli
- Department of Biomedical and Clinical Sciences, Department of Mental Health and Addictions, ASST Fatebenefratelli Sacco, University of Milan, Italy
| | - Chiara Dragoni
- Department of Biomedical and Clinical Sciences, Department of Mental Health and Addictions, ASST Fatebenefratelli Sacco, University of Milan, Italy
| | - Dario Conti
- Department of Biomedical and Clinical Sciences, Department of Mental Health and Addictions, ASST Fatebenefratelli Sacco, University of Milan, Italy
| | - Maria Boscacci
- Department of Biomedical and Clinical Sciences, Department of Mental Health and Addictions, ASST Fatebenefratelli Sacco, University of Milan, Italy
| | - Giuseppe Carrà
- Department of Mental Health and Addiction Services, ASST Nord Milano, Italy
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - Mauro Percudani
- Department of Mental Health and Addiction Services, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Carla Morganti
- Department of Mental Health and Addiction Services, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Orsola Gambini
- Department of Mental Health, ASST Santi Paolo e Carlo, Milan, Italy
- CRC 'Aldo Ravelli' for Neurotechnology and Experimental Brain Therapeutics, University of Milan, Lombardy, Italy
- Department of Health Sciences, University of Milan, Italy
| | | | - Paolo Brambilla
- Department of Neurosciences and Mental Health, IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Italy
| | - Matteo Lazzaretti
- Department of Neurosciences and Mental Health, IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Italy
| | - Paola Rubelli
- Department of Biomedical and Clinical Sciences, Department of Mental Health and Addictions, ASST Fatebenefratelli Sacco, University of Milan, Italy
| | - Claudio Mencacci
- Department of Biomedical and Clinical Sciences, Department of Mental Health and Addictions, ASST Fatebenefratelli Sacco, University of Milan, Italy
| | - Antonio Fusi
- Department of Biomedical and Clinical Sciences, Department of Mental Health and Addictions, ASST Fatebenefratelli Sacco, University of Milan, Italy
| | - Caterina Viganò
- Department of Biomedical and Clinical Sciences, Department of Mental Health and Addictions, ASST Fatebenefratelli Sacco, University of Milan, Italy
| | - Bernardo Dell'Osso
- Department of Biomedical and Clinical Sciences, Department of Mental Health and Addictions, ASST Fatebenefratelli Sacco, University of Milan, Italy
- CRC 'Aldo Ravelli' for Neurotechnology and Experimental Brain Therapeutics, University of Milan, Lombardy, Italy
- Department of Psychiatry and Behavioural Sciences, Bipolar Disorders Clinic, Stanford Medical School, Stanford University, CA, USA
- Neuroscience Research Center, Department of Biomedical and Clinical Sciences, University of Milan, Italy
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Bertz JW, Panlilio LV, Stull SW, Smith KE, Reamer D, Holtyn AF, Toegel F, Kowalczyk WJ, Phillips KA, Epstein DH, Silverman K, Preston KL. Being at work improves stress, craving, and mood for people with opioid use disorder: Ecological momentary assessment during a randomized trial of experimental employment in a contingency-management-based therapeutic workplace. Behav Res Ther 2022; 152:104071. [PMID: 35390535 PMCID: PMC9206864 DOI: 10.1016/j.brat.2022.104071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/21/2022] [Accepted: 03/04/2022] [Indexed: 11/02/2022]
Abstract
Employment problems are common among people with substance use disorders (SUDs), and improving vocational functioning is an important aspect of SUD treatment. More detailed understanding of the psychosocial benefits of employment may help refine vocational interventions for people with SUDs. Here, we used ecological momentary assessment to measure possible affective improvements associated with work. Participants (n = 161) with opioid use disorder were randomized to work (job-skills training) in a contingency-management-based Therapeutic Workplace either immediately or after a waitlist delay. Throughout, participants responded via smartphone to randomly scheduled questionnaires. In linear mixed models comparing responses made at work vs. all other locations, being at work was associated with: less stress, less craving for opioids and cocaine, less negative mood, more positive mood, and more flow-like states. Some of these differences were also observed on workdays vs. non-workdays outside of work hours. These results indicate that benefits associated with work may not be restricted to being actually in the workplace; however, randomization did not reveal clear changes coinciding with the onset of work access. Overall, in contrast to work-associated negative moods measured by experience-sampling in the general population, Therapeutic Workplace participants experienced several types of affective improvements associated with work.
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Bertz JW, Smith KE, Panlilio LV, Stull SW, Reamer D, Murville ML, Sullivan M, Holtyn AF, Toegel F, Epstein DH, Phillips KA, Preston KL. Quality of life during a randomized trial of a therapeutic-workplace intervention for opioid use disorder: Web-based mobile assessments reveal effects of drug abstinence and access to paid work. DRUG AND ALCOHOL DEPENDENCE REPORTS 2021; 1:100011. [PMID: 36843907 PMCID: PMC9948824 DOI: 10.1016/j.dadr.2021.100011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/25/2021] [Accepted: 12/01/2021] [Indexed: 11/25/2022]
Abstract
Background Employment and improved quality of life (QOL) are, separately, valued outcomes of substance use disorder (SUD) treatment. It is also important to understand QOL changes caused by employment itself; therefore, we assessed QOL during a randomized trial of a contingency-management-based Therapeutic Workplace for people with opioid use disorder. Methods For 12 weeks, participants (n = 61) responded to QOL questionnaires in a mobile web app accessed with study-issued smartphones. At enrollment, participants were randomized to work in the Therapeutic Workplace immediately (immediate work group, IWG) or after a 3-week waitlist delay (delayed work group, DWG). Once both groups could work, wage-resetting contingencies were introduced for their opiate- and cocaine-urinalysis. Data were analyzed by (1) access to work with and without contingencies and (2) overall urinalysis-verified opiate- and cocaine-abstinence. Results DWG and/or IWG reported improvements in several QOL areas (sleep, transportation, recreation); however, they also reported increased money-related difficulties and less time spent with friends/family. These changes did not coincide with DWG's work access, but some (more sleep, money-related difficulties) coincided with the urinalysis contingencies. Greater opiate- and/or cocaine-abstinence was also associated with several improvements: sleep, paying bills, time spent with friends/family, and exercising. Surprisingly, intermediate cocaine abstinence was associated with reductions in work-capacity satisfaction and recreation. Conclusions Participants reported complex QOL differences during their experimental employment and associated with drug abstinence. Future work should help participants address issues that may be relevant to employment generally (e.g., time with friends/family) or contingency management specifically (e.g., money-related issues for non-abstinent participants).
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Affiliation(s)
- Jeremiah W. Bertz
- Intramural Research Program, National Institute on Drug Abuse, 251 Bayview Blvd., Suite 200, Baltimore, MD 21224, United States,Corresponding author.
| | - Kirsten E. Smith
- Intramural Research Program, National Institute on Drug Abuse, 251 Bayview Blvd., Suite 200, Baltimore, MD 21224, United States
| | - Leigh V. Panlilio
- Intramural Research Program, National Institute on Drug Abuse, 251 Bayview Blvd., Suite 200, Baltimore, MD 21224, United States
| | - Samuel W. Stull
- Intramural Research Program, National Institute on Drug Abuse, 251 Bayview Blvd., Suite 200, Baltimore, MD 21224, United States
| | - David Reamer
- Intramural Research Program, National Institute on Drug Abuse, 251 Bayview Blvd., Suite 200, Baltimore, MD 21224, United States
| | | | | | - August F. Holtyn
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Forrest Toegel
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - David H. Epstein
- Intramural Research Program, National Institute on Drug Abuse, 251 Bayview Blvd., Suite 200, Baltimore, MD 21224, United States
| | - Karran A. Phillips
- Intramural Research Program, National Institute on Drug Abuse, 251 Bayview Blvd., Suite 200, Baltimore, MD 21224, United States
| | - Kenzie L. Preston
- Intramural Research Program, National Institute on Drug Abuse, 251 Bayview Blvd., Suite 200, Baltimore, MD 21224, United States
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Imboden R, Frey JJ, Bazell AT, Mosby A, Ware OD, Mitchell CS, Cloeren M. Workplace Support for Employees in Recovery From Opioid Use: Stakeholder Perspectives. New Solut 2021; 31:340-349. [PMID: 34510999 DOI: 10.1177/10482911211043522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The dual challenges of COVID-19 and the opioid epidemic have heightened the need of Maryland workplaces for accessible resources and supports. This paper describes efforts of the Workplace PROSPER (Partnering to Reduce Opioid Stigma and Support Employment in Recovery) project team to explore opioid-related state employment needs from Key Stakeholder perspectives. Discussion revealed significant overlap between the needs identified by stakeholders and pre-existing recovery friendly initiatives in other states. However, this convening identified the need for increased training of medical professionals in communicating about work capacity and safety as well as for resources to support family members of individuals with Opioid Use Disorder and model programs for hiring individuals in recovery. Next steps include the creation and dissemination of a survey to obtain a broader base of feedback and the development of a robust set of online recovery resources for Maryland employers and employees.
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Affiliation(s)
- Rachel Imboden
- School of Social Work, University of Maryland, Baltimore, Baltimore, MD, USA
| | - Jodi J Frey
- School of Social Work, University of Maryland, Baltimore, Baltimore, MD, USA
| | - Alicia T Bazell
- School of Social Work, University of Maryland, Baltimore, Baltimore, MD, USA
| | - Amanda Mosby
- School of Social Work, University of Maryland, Baltimore, Baltimore, MD, USA
| | - Orrin D Ware
- Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Lu W, Oursler J, Herrick S, Beninato J, Gao N, Brown L, Durante A. Work-Related Interview Skills Training for Persons with Substance Use Disorders. JOURNAL FOR SPECIALISTS IN GROUP WORK 2021. [DOI: 10.1080/01933922.2021.1900959] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Weili Lu
- The State University of New Jersey
| | | | | | | | - Ni Gao
- The State University of New Jersey
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Employment Cessation, Long Term Labour Market Engagement and HIV Infection Risk Among People Who Inject Drugs in an Urban Canadian Setting. AIDS Behav 2019; 23:3267-3276. [PMID: 30924066 DOI: 10.1007/s10461-019-02472-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
The potential for changes in socio-economic status, such as employment exits, to increase HIV infection risk are not well examined among people who inject illicit drugs (PWID). We used longstanding cohort data from Vancouver, Canada, to longitudinally assess associations between employment cessation and outcomes with documented linkages to HIV infection risk among PWID. From 2005 to 2015, 1222 participants reported 1154 employment exits. Employment exits were significantly associated with transitions into unstable housing; moving to the inner-city; initiating informal, prohibited or illegal income generation; high risk drug use practices; and exiting methadone maintenance therapy. HIV infection rates were higher among participants with lower long-term labour market engagement. These findings suggest that employment cessation coincides with initiating exposure to aspects of socioeconomic marginalization and drug use associated with HIV infection risk. Support for employment retention that prevents poverty entrenchment and harmful drug use could contribute to HIV prevention measures for PWID.
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Subramaniam S, Everly JJ, Silverman K. Reinforcing Productivity in a Job-Skills Training Program for Unemployed Substance-Abusing Adults. ACTA ACUST UNITED AC 2017; 17:114-128. [PMID: 28824954 DOI: 10.1037/bar0000077] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Chronically unemployed adults may benefit from intensive job-skills training; however, training programs do not always reliably engage participants in mastering skills. This study examined effects of voucher reinforcement for performance on a job-skills training program in the therapeutic workplace. Participants were four unemployed, substance abusing adults who earned monetary vouchers for working on programs targeting typing skills. Participants were exposed to two payment conditions that differed in whether or not pay was dependent on performance in a within-subject reversal design. In the productivity-pay condition, participants earned $8.00 per hour for attending the workplace plus a bonus for performance. In the base-pay condition, participants were paid an hourly wage that was equivalent to the total hourly earnings from the previous productivity-pay condition. Participants completed less work on the typing programs in the base- than the productivity-pay condition, but the amount of time spent in the workroom and the accuracy and rate of typing were not affected by the pay manipulation. All participants reported preferring base pay over productivity pay. Explicit reinforcement of productivity maintains consistent work in training programs, but more aspects of productivity pay need to be refined for effective, efficient, and socially valid implementation with unemployed, substance-abusing adults.
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Affiliation(s)
- Shrinidhi Subramaniam
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
| | - Jeffrey J Everly
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
| | - Kenneth Silverman
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
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8
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Donohue B, Plant CP, Barchard KA, Gillis DJ. Examination of the Extent to which Employment Factors are Associated with Reduced Child Maltreatment Potential and Drug Use. JOURNAL OF CHILD AND FAMILY STUDIES 2017; 26:168-175. [PMID: 28983184 PMCID: PMC5624733 DOI: 10.1007/s10826-016-0540-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Job assistance programs are commonly recommended for parents of children who have been victimized by child maltreatment, particularly when illicit drugs are indicated. However, the relationship between employment factors, substance abuse and risk of child maltreatment has received limited empirical attention. Therefore, the current study examines employment factors in a sample of 72 mothers who were referred by Child Protective Services (CPS) for treatment of substance abuse and child neglect. Child maltreatment potential was found to be negatively associated with number of hours employed and self-reported happiness with employment. The association between child abuse potential and personal income of participants approached significance (p = .057), and the results were not influenced by social desirability. Employment satisfaction significantly contributed to the prediction of child maltreatment potential over and above other employment factors and control variables. These findings suggest that when mothers are involved in CPS their risk of perpetrating child maltreatment may be reduced when they are assisted in gainful employment that is personally satisfying. Happiness with employment was the only employment factor correlated (inversely) with substance use (biological testing, self-report of participants). Future directions are discussed in light of the results, including the importance of considering employment satisfaction when conducting vocational assistance programs in this population.
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Keyser-Marcus L, Alvanzo A, Rieckmann T, Thacker L, Sepulveda A, Forcehimes A, Islam LZ, Leisey M, Stitzer M, Svikis DS. Trauma, gender, and mental health symptoms in individuals with substance use disorders. JOURNAL OF INTERPERSONAL VIOLENCE 2015; 30:3-24. [PMID: 24811286 PMCID: PMC4766974 DOI: 10.1177/0886260514532523] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Individuals with substance use disorders are often plagued by psychiatric comorbidities and histories of physical and/or sexual trauma. Males and females, although different in their rates of expressed trauma and psychiatric symptomatology, experience comparable adverse consequences, including poorer substance abuse treatment outcomes, diminished psychosocial functioning, and severe employment problems. The goal of the current study was to examine the relationships between trauma history, lifetime endorsement of psychiatric symptoms, and gender in a sample of individuals participating in outpatient substance abuse treatment. Study participants (N = 625) from six psychosocial counseling and five methadone maintenance programs were recruited as part of a larger study conducted through the National Institute on Drug Abuse Clinical Trials Network (NIDA CTN). Study measures included lifetime trauma experience (yes/no), type of trauma experienced (sexual, physical, both), lifetime depression/anxiety, and lifetime suicidal thoughts/attempts (as measured by the Addiction Severity Index-Lite [ASI-Lite]). Lifetime endorsement of psychiatric symptoms was compared between individuals with and without trauma history. The role of gender was also examined. Results indicated that the experience of trauma was associated with an increase in lifetime report of psychiatric symptoms. Experience of physical and combined physical and sexual trauma consistently predicted positive report of psychiatric symptoms in both males and females, even when controlling for demographic and treatment-related variables. Employment outcomes, however, were not predicted by self-reported history of lifetime trauma.
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Affiliation(s)
| | - Anika Alvanzo
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | | | - Alyssa Forcehimes
- University of New Mexico Center on Alcoholism, Substance Abuse, and Addictions, Albuquerque, USA
| | | | | | - Maxine Stitzer
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Holtyn AF, DeFulio A, Silverman K. Academic skills of chronically unemployed drug-addicted adults. JOURNAL OF VOCATIONAL REHABILITATION 2015; 42:67-74. [PMID: 25635162 DOI: 10.3233/jvr-140724] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The strong association between unemployment and drug addiction suggests that employment interventions are an important and needed focus of drug-addiction treatment. The increasing necessity of possessing basic academic skills to function in the workplace may require that some individuals receive educational training along with vocational training. OBJECTIVE This study investigated the academic skills of drug-addicted and chronically-unemployed adults (N = 559) who were enrolled in one of six studies conducted at the Center for Learning and Health in Baltimore, MD. METHODS Upon study enrollment, academic skills in math, spelling, and reading were examined using the Wide Range Achievement Test (WRAT-3 or WRAT-4) and educational history was examined using the Addiction Severity Index-Lite. RESULTS Although participants completed an average of 11 years of education, actual academic skill level was at or below the seventh grade level for 81% of participants in math, 61% in spelling, and 43% in reading, and most participants were classified as Low Average or below based on age group norms. Despite the fact that participants in this analysis were studied across several years and were from diverse populations, rates of high school completion and academic skill levels were remarkably similar. CONCLUSIONS Programs designed to improve the long-term employment status of drug-addicted individuals may benefit from the inclusion of basic adult education; future research on the topic is needed. Although establishing basic skills does not directly address chronic unemployment, it may help individuals obtain the jobs they desire and function effectively in those jobs.
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Affiliation(s)
- August F Holtyn
- Center for Learning and Health, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Anthony DeFulio
- Center for Learning and Health, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kenneth Silverman
- Center for Learning and Health, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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11
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Holtyn AF, Koffarnus MN, DeFulio A, Sigurdsson SO, Strain EC, Schwartz RP, Silverman K. Employment-based abstinence reinforcement promotes opiate and cocaine abstinence in out-of-treatment injection drug users. J Appl Behav Anal 2014; 47:681-93. [PMID: 25292399 DOI: 10.1002/jaba.158] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 05/29/2014] [Indexed: 11/06/2022]
Abstract
We examined the use of employment-based abstinence reinforcement in out-of-treatment injection drug users, in this secondary analysis of a previously reported trial. Participants (N = 33) could work in the therapeutic workplace, a model employment-based program for drug addiction, for 30 weeks and could earn approximately $10 per hr. During a 4-week induction, participants only had to work to earn pay. After induction, access to the workplace was contingent on enrollment in methadone treatment. After participants met the methadone contingency for 3 weeks, they had to provide opiate-negative urine samples to maintain maximum pay. After participants met those contingencies for 3 weeks, they had to provide opiate- and cocaine-negative urine samples to maintain maximum pay. The percentage of drug-negative urine samples remained stable until the abstinence reinforcement contingency for each drug was applied. The percentage of opiate- and cocaine-negative urine samples increased abruptly and significantly after the opiate- and cocaine-abstinence contingencies, respectively, were applied. These results demonstrate that the sequential administration of employment-based abstinence reinforcement can increase opiate and cocaine abstinence among out-of-treatment injection drug users.
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12
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Webster JM, Staton-Tindall M, Dickson MF, Wilson JF, Leukefeld CG. Twelve-month employment intervention outcomes for drug-involved offenders. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2014; 40:200-5. [PMID: 24405160 DOI: 10.3109/00952990.2013.858722] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Employment has been identified as an important part of substance abuse treatment and is a predictor of treatment retention, treatment completion, and decreased relapse. Although employment interventions have been designed for substance abusers, few interventions have focused specifically on drug-involved offenders. OBJECTIVES The purpose of this study was to examine employment outcomes for drug-involved offenders who received a tailored employment intervention. METHODS In a randomized controlled trial, baseline and follow-up data were collected from 500 drug-involved offenders who were enrolled in a drug court program. Participants were randomly assigned to drug court as usual (control group) or to the employment intervention in addition to drug court. RESULTS Intent-to-treat analyses found that the tailored intervention was associated only with more days of paid employment at follow-up (210.1 vs. 199.9 days). When focusing on those with greater employment assistance needs, a work trajectory analyses, which took into account participants' pre-baseline employment pattern (negative or positive), revealed that intervention group participants had higher rates of employment (82.1% vs. 64.1%), more days paid for employment (188.9 vs. 157.0 days), and more employment income ($8623 vs. $6888) at follow-up than control group participants. CONCLUSION The present study adds to the growing substance abuse and employment literature. It demonstrates the efficacy of an innovative employment intervention tailored for drug-involved offenders by showing positive changes in 12-month employment outcomes, most strongly for those who have not had recent employment success.
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13
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Laudet AB. Rate and predictors of employment among formerly polysubstance dependent urban individuals in recovery. J Addict Dis 2012; 31:288-302. [PMID: 22873190 DOI: 10.1080/10550887.2012.694604] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Employment is a key functioning index in addiction services and consistently emerges as a goal among individuals in recovery. Research on the employment status in the addiction field has focused on treatment populations or welfare recipients; little is known of employment rates or their predictors among individuals in recovery. This study seeks to fill this gap, capitalizing on a sample (N = 311) of urban individuals at various stages of recovery. Fewer than half (44.5%) of participants were employed; in logistic regressions, male gender and Caucasian race enhanced the odds of employment, whereas having a comorbid chronic physical or mental health condition decreased the odds by half. Implications center on the need to identify effective strategies to enhance employability among women and minorities and for integrated care for individuals with multiple chronic conditions.
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Affiliation(s)
- Alexandre B Laudet
- Center for the Study of Addictions and Recovery, National Development and Research Institutes, Inc., New York, New York 10010, USA.
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Moshier SJ, McHugh RK, Calkins AW, Hearon BA, Rosellini AJ, Weitzman ML, Otto MW. The role of perceived belongingness to a drug subculture among opioid-dependent patients. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2012; 26:812-20. [PMID: 22732052 DOI: 10.1037/a0029107] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Illicit drug use frequently occurs in a context of a drug subculture characterized by social ties with other drug users, feelings of excitement and effectiveness deriving from illicit activities, and alienation from mainstream society. Identification with this subculture is recognized anecdotally as a barrier to recovery, but clear quantification of individual differences in perceived belongingness to the drug subculture has been absent from the literature. The purpose of this study was to describe the development and psychometric properties of a brief self-report measure designed to assess this construct, the Belongingness to Drug Culture Questionnaire (BDCQ). Ninety-six opioid-dependent, methadone-maintained participants completed the BDCQ, related self-report measures, and assessment of drug use patterns. The BDCQ demonstrated high internal consistency (α = .88) and was significantly associated with self-reported days of drug use in the past 30 days, desire to quit, impulsivity, psychopathy, and social, enhancement, and coping drug use motives. These findings encourage continued psychometric evaluation of the BDCQ and study of the role of belongingness in the development and maintenance of substance use disorders.
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Hartzler B, Lash SJ, Roll JM. Contingency management in substance abuse treatment: a structured review of the evidence for its transportability. Drug Alcohol Depend 2012; 122:1-10. [PMID: 22153943 PMCID: PMC3307900 DOI: 10.1016/j.drugalcdep.2011.11.011] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Revised: 11/14/2011] [Accepted: 11/16/2011] [Indexed: 10/14/2022]
Abstract
AIMS Extant literature on contingency management (CM) transportability, or its transition from academia to community practice, is reviewed. The Consolidated Framework for Implementation Research (CFIR; Damschroder et al., 2009) guides the examination of this material. METHODS PsychInfo and Medline database searches identified 27 publications, with reviewed reference lists garnering 22 others. These 49 sources were examined according to CFIR domains of the intervention, outer setting, inner setting, clinicians, and implementation processes. RESULTS Intervention characteristics were focal in 59% of the identified literature, with less frequent focus on clinicians (34%), inner setting (32%), implementation processes (18%), and outer setting (8%). As intervention characteristics, adaptability and trialability most facilitate transportability whereas non-clinical origin, perceived inefficacy or disadvantages, and costs are impediments. Clinicians with a managerial focus and greater clinic tenure and CM experience are candidates to curry organizational readiness for implementation, and combat staff disinterest or philosophical objection. A clinic's technology comfort, staff continuity, and leadership advocacy are inner setting characteristics that prompt effective implementation. Implementation processes in successful demonstration projects include careful fiscal/logistical planning, role-specific staff engagement, practical adaptation in execution, and evaluation via fidelity-monitoring and cost-effectiveness analyses. Outer setting characteristics-like economic policies and inter-agency networking or competition-are salient, often unrecognized influences. CONCLUSIONS As most implementation constructs are still moving targets, CM transportability is in its infancy and warrants further scientific attention. More effective dissemination may necessitate that future research weight emphasis on external validity, and utilize models of implementation science.
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Affiliation(s)
- Bryan Hartzler
- Alcohol and Drug Abuse Institute, University of Washington, 1107 NE 45th Street, Seattle, WA 98105, USA.
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Sigurdsson SO, Ring BM, O'Reilly K, Silverman K. Barriers to employment among unemployed drug users: age predicts severity. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2012; 38:580-7. [PMID: 22242680 DOI: 10.3109/00952990.2011.643976] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Drug users in treatment or exiting treatment face many barriers to employment when entering the job market, such as low levels of education and technical skills, and low levels of interpersonal skills. As a result of these and other barriers, employment rates in these groups are generally low. OBJECTIVE This article examines the existence and possible predictors of specific barriers to employment related to interpersonal and technical skills in a sample of participants enrolled in a therapeutic workplace intervention for substance abuse. METHODS In Study I (N = 77), we characterized and examined predictors of participant scores on a staff-rated scale of interpersonal skills (Work Behavior Inventory). In Study II (N = 29), we examined whether participants had lower levels of computer knowledge than job seekers in the general population, and investigated possible predictors of computer knowledge in the sample. RESULTS In general, participants in Study I displayed low levels of interpersonal skills, and participants in Study II scored lower on the computer knowledge test than job seekers in the general population. Older participants tended to have lower levels of interpersonal skills and lower levels of computer knowledge. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE These results suggest that providers of workforce development services for drug users in treatment or exiting treatment should attend to these specific barriers to employment, which may also be more pronounced among older clients.
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Affiliation(s)
- Sigurdur Oli Sigurdsson
- Department of Psychology, University of Maryland-Baltimore County, Baltimore, MD 21250, USA.
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Svikis DS, Keyser-Marcus L, Stitzer M, Rieckmann T, Safford L, Loeb P, Allen T, Luna-Anderson C, Back SE, Cohen J, DeBernardi MA, Dillard B, Forcehimes A, Jaffee W, Killeen T, Kolodner K, Levy M, Pallas D, Perl HI, Potter JS, Provost S, Reese K, Sampson RR, Sepulveda A, Snead N, Wong CJ, Zweben J. Randomized multi-site trial of the Job Seekers' Workshop in patients with substance use disorders. Drug Alcohol Depend 2012; 120:55-64. [PMID: 21802222 PMCID: PMC3579551 DOI: 10.1016/j.drugalcdep.2011.06.024] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2010] [Revised: 06/25/2011] [Accepted: 06/27/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND Unemployment is associated with negative outcomes both during and after drug abuse treatment. Interventions designed to increase rates of employment may also improve drug abuse treatment outcomes. The purpose of this multi-site clinical trial was to evaluate the Job Seekers' Workshop (JSW), a three session, manualized program designed to train patients in the skills needed to find and secure a job. METHOD Study participants were recruited through the NIDA Clinical Trials Network (CTN) from six psychosocial counseling (n=327) and five methadone maintenance (n=301) drug treatment programs. Participants were randomly assigned to either standard care (program-specific services plus brochure with local employment resources) (SC) or standard care plus JSW. Three 4-h small group JSW sessions were offered weekly by trained JSW facilitators with ongoing fidelity monitoring. RESULTS JSW and SC participants had similar 12- and 24-week results for the primary outcome measure (i.e., obtaining a new taxed job or enrollment in a training program). Specifically, one-fifth of participants at 12weeks (20.1-24.3%) and nearly one-third at 24 weeks (31.4-31.9%) had positive outcomes, with "obtaining a new taxed job" accounting for the majority of cases. CONCLUSION JSW group participants did not have higher rates of employment/training than SC controls. Rates of job acquisition were modest for both groups, suggesting more intensive interventions may be needed. Alternate targets (e.g., enhancing patient motivation, training in job-specific skills) warrant further study as well.
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Affiliation(s)
- Dace S Svikis
- Department of Psychology, AWHARE (Addiction & Women's Health: Advancing Research and Evaluation), Virginia Commonwealth University, Old City Hall, Room 350A, 1001 East Broad Street, PO Box 980343, Richmond, VA 23298-0343, USA.
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KERWIN MARYLOUISEE, FARRIS MAREND, HANTULA DONALDA. Consumer Choices of Women in Residential Drug Treatment: An Analysis of Risk and Impulsivity1. JOURNAL OF APPLIED SOCIAL PSYCHOLOGY 2011. [DOI: 10.1111/j.1559-1816.2011.00830.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Storti CC, De Grauwe P, Sabadash A, Montanari L. Unemployment and drug treatment. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2011; 22:366-73. [DOI: 10.1016/j.drugpo.2011.05.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2010] [Revised: 04/28/2011] [Accepted: 05/05/2011] [Indexed: 10/17/2022]
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Sigurdsson SO, DeFulio A, Long L, Silverman K. Propensity to work among chronically unemployed adult drug users. Subst Use Misuse 2011; 46:599-607. [PMID: 20964531 PMCID: PMC3985271 DOI: 10.3109/10826084.2010.526982] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Analyses were conducted to compare rates of employment before, during, and after employment at the therapeutic workplace, which is a novel employment-based treatment for drug misuse. Participants in two clinical trials attended the therapeutic workplace at higher rates than they worked before intake and six months after discharge. These data suggest that unemployed chronic drug misusers will attend work at higher rates at the therapeutic workplace than in the community when paid modest wages, and that the failure of chronic drug misusers to obtain employment in the community may not result from lack of interest in work.
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Affiliation(s)
- Sigurdur Oli Sigurdsson
- Department of Psychology, University of Maryland, Baltimore County, Baltimore, Maryland 21250, USA.
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Sung HE, Chu D. The impact of substance user treatment participation on legal employment and income among probationers and parolees. Subst Use Misuse 2011; 46:1523-35. [PMID: 21428743 DOI: 10.3109/10826084.2010.537007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Employment is essential for recovery. But treatment could conflict with work schedules, and employment gains could be short lived. This study examined how employment and income varied during and after treatment, what aspects of treatment impacted on employment, and whether treatment improved income. Baseline and follow-up data were analyzed for 760 probationers and parolees in 11 US cities that participated in the 1992-1995 Drug Abuse Treatment Outcomes Study. Results showed that only residential/inpatient treatment was associated, temporarily, with employment. Retention, compliance, and self-efficacy were correlated to posttreatment employment. However, treatment had no impact on income, which was determined by education and work history.
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Affiliation(s)
- Hung-En Sung
- Department of Criminal Justice, John Jay College of Criminal Justice, New York, New York 10019, USA.
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DeFulio A, Iati C, Needham M, Silverman K. Modification of perseverative responding that increased earnings but impeded skill acquisition in a job-skills training program. J Appl Behav Anal 2010; 42:627-40. [PMID: 20190923 DOI: 10.1901/jaba.2009.42-627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2008] [Accepted: 09/02/2008] [Indexed: 11/22/2022]
Abstract
Adults in a therapeutic workplace working on a computerized keyboarding training program earned vouchers for typing correct characters. Typing technique was evaluated on review steps. Participants could pass the review and earn a bonus, or skip the review and proceed with no bonus. Alternatively, participants could continue practicing on the same step. Participants persistently repeated the same step, which halted progress through the program but allowed them to increase their rate of responding and, as a result, their earnings. Blocking the initiation of practice on review steps and removing payment for practice initiated after prompts (extinction) both produced rapid progress through the program. These results underscore the importance of careful arrangement of the contingencies in adult education programs.
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Affiliation(s)
- Anthony DeFulio
- Center for Learning and Health, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Suite 142 West, Baltimore, Maryland 21224, USA.
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