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Marsden J, Anders P, Shaw C, Amasiatu C, Collate W, Eastwood B, Horgan P, Khetani M, Knight J, Knight S, Melaugh A, Clark H, Stannard J. Superiority and cost-effectiveness of Individual Placement and Support versus standard employment support for people with alcohol and drug dependence: a pragmatic, parallel-group, open-label, multicentre, randomised, controlled, phase 3 trial. EClinicalMedicine 2024; 68:102400. [PMID: 38299044 PMCID: PMC10828604 DOI: 10.1016/j.eclinm.2023.102400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 11/27/2023] [Accepted: 12/13/2023] [Indexed: 02/02/2024] Open
Abstract
Background Individual Placement and Support (IPS) is a specialist intervention to help people attain employment in the open competitive labour market. IPS has been developed in severe mental illness and other disabilities, but it is of unknown effectiveness for people with alcohol and drug dependence. The Individual Placement and Support-Alcohol and Drug (IPS-AD) is the first superiority trial to evaluate effectiveness and cost-effectiveness. Methods IPS-AD was a pragmatic, parallel-group, multi-centre, randomised, controlled, phase 3 trial of standard employment support (treatment-as-usual [TAU]) versus IPS. IPS was offered as a single episode for up to 13 months. The study was done at seven community treatment centres for alcohol and drug dependence in England. Study participants were adults (18-65 years), who had been enrolled for at least 14 days in treatment for alcohol use disorder (AUD), opioid use disorder (OUD), or another drug use disorder (DUD; mostly cannabis and stimulants); were unemployed or economically inactive for at least six months; and wished to attain employment in the open competitive labour market. After random allocation to study interventions, the primary outcome was employment during 18-months of follow-up, analysed by mixed-effects logistic regression, using multiple imputation for the management of missing outcome data. There were two cost-effectiveness outcomes: a health outcome expressed as a quality adjusted life year (QALY) using £30,000 and £70,000 willingness-to-pay [WTP] thresholds; and additional days of employment, with a WTP threshold of £200 per day worked. The study was registered with ISRCTN (ISRCTN24159790) and is completed. Findings Between 8 May 2018 and 30 September 2019, 2781 potentially eligible patients were identified. 812 were excluded before screening, and 1720 participants were randomly allocated to TAU or IPS. In error, nine participants were randomised to study interventions on two occasions-so data for their first randomisation was analysed (modified intention-to-treat). A further 24 participants withdrew consent for all data to be used (full-analysis set therefore 1687 participants [70.1% male; mean age 40.8 years]; TAU, n = 844; IPS, n = 843 [AUD, n = 610; OUD, n = 837; DUD, n = 240]). Standard employment support was received by 559 [66.2%] of 844 participants in the TAU group. IPS was received by 804 [95.37%] of 843 participants in the IPS group. IPS was associated with an increase in attainment of employment compared with TAU (adjusted odds ratio [OR] 1.29; 95% CI 1.02-1.64; p-value 0.036). IPS was effective for the AUD and DUD groups (OR 1.48; 95% CI 1.14-1.92; p-value 0.004; OR 1.45, 95% CI 1.03-2.04, p-value 0.031, respectively), but not the OUD group. IPS returned an incremental QALY outcome gain of 0.01 (range 0.003-0.02) per participant with no evidence of cost-effectiveness at either WTP threshold-but QALY gains were cost-effective for the AUD and DUD groups at the £70,000 WTP threshold (probability 0.52 and 0.97, respectively). IPS was cost-effective for additional days of employment (probability 0.61), with effectiveness relating to the AUD group only (probability >0.99). Serious Adverse Events were reported by 39 participants (13 [1.5%] of 844 participants in the TAU group and 23 [2.7%] of 43 participants in the IPS group). There was a total of 25 deaths (1.5%; 9 in the TAU group and 16 in the IPS group)-none judged related to study interventions. Interpretation In this first superiority randomised controlled trial of IPS in alcohol and drug dependence, IPS helped more people attain employment in the open competitive labour market than standard employment support. IPS was cost-effective for a QALY health outcome (£70,000 WTP threshold) for the AUD and DUD groups, and for additional days of employment for the AUD group (£200 per day worked WTP threshold). Funding UK government Work and Health Unit.
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Affiliation(s)
- John Marsden
- Addictions Department, School of Academic Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
- Department of Health and Social Care, Addiction and Inclusion, Office for Health Improvement and Disparities, United Kingdom
| | - Paul Anders
- Department of Health and Social Care, Addiction and Inclusion, Office for Health Improvement and Disparities, United Kingdom
| | - Claire Shaw
- Department of Health and Social Care, Addiction and Inclusion, Office for Health Improvement and Disparities, United Kingdom
| | - Chioma Amasiatu
- Department of Health and Social Care, Addiction and Inclusion, Office for Health Improvement and Disparities, United Kingdom
| | - Winnie Collate
- Department of Health and Social Care, Addiction and Inclusion, Office for Health Improvement and Disparities, United Kingdom
| | - Brian Eastwood
- Department of Health and Social Care, Addiction and Inclusion, Office for Health Improvement and Disparities, United Kingdom
| | - Patrick Horgan
- Department of Health and Social Care, Addiction and Inclusion, Office for Health Improvement and Disparities, United Kingdom
| | - Meetal Khetani
- Department of Health and Social Care, Addiction and Inclusion, Office for Health Improvement and Disparities, United Kingdom
| | - Jonathan Knight
- Department of Health and Social Care, Addiction and Inclusion, Office for Health Improvement and Disparities, United Kingdom
| | - Sandy Knight
- Department of Health and Social Care, Addiction and Inclusion, Office for Health Improvement and Disparities, United Kingdom
| | - Alexandra Melaugh
- Department of Health and Social Care, Addiction and Inclusion, Office for Health Improvement and Disparities, United Kingdom
| | - Helen Clark
- Department of Health and Social Care, Addiction and Inclusion, Office for Health Improvement and Disparities, United Kingdom
| | - Jez Stannard
- Department of Health and Social Care, Addiction and Inclusion, Office for Health Improvement and Disparities, United Kingdom
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Drake RE, Bond GR. Individual placement and support: History, current status, and future directions. PCN REPORTS : PSYCHIATRY AND CLINICAL NEUROSCIENCES 2023; 2:e122. [PMID: 38867819 PMCID: PMC11114326 DOI: 10.1002/pcn5.122] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 06/06/2023] [Accepted: 06/28/2023] [Indexed: 06/14/2024]
Abstract
Over the past three decades, Individual Placement and Support (IPS) has emerged as a robust evidence-based approach to helping people with severe mental illnesses, such as schizophrenia, bipolar disorder, and major depression, to obtain and succeed in competitive employment. This review addresses the history, principles, research, and future directions of IPS. It covers current evidence on employment outcomes, cost-effectiveness, and nonvocational outcomes. It also describes current attempts to extend IPS to new populations. The authors provide an overview of numerous systematic reviews and meta-analyses of randomized controlled trials involving people with serious mental illness. For studies addressing nonvocational outcomes and new populations, the review uses best available evidence. Published reviews agree that IPS enables patients with serious mental illness in high-income countries to succeed in competitive employment at a higher rate than patients who receive other vocational interventions. Within IPS programs, quality of implementation, measured by standardized fidelity scales, correlates with better outcomes. Employment itself leads to enhanced income, psychosocial outcomes, clinical improvements, and decreased mental health service use. As IPS steadily spreads to new populations and new settings, research is active across high-income countries and spreading slowly to middle-income countries. IPS is an evidence-based practice for people with serious mental illness in high-income countries. It shows promise to help other disability groups also, and emerging research aims to clarify adaptations and outcomes.
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Affiliation(s)
- Robert E. Drake
- Department of PsychiatryColumbia University Vagelos College of Physicians and SurgeonsNew York CityNew YorkUSA
- Westat CorporationRockvilleMarylandUSA
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Hjorthøj C, Stürup AE, Starzer M. A death by any other name: substance-induced or substance-related mortality. Lancet Psychiatry 2022; 9:931-932. [PMID: 36335975 DOI: 10.1016/s2215-0366(22)00370-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Carsten Hjorthøj
- University of Copenhagen, Department of Public Health, Section of Epidemiology, Copenhagen, Denmark; Copenhagen Research Center for Mental Health-CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, 2900 Hellerup, Denmark.
| | - Anne Emilie Stürup
- Copenhagen Research Center for Mental Health-CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, 2900 Hellerup, Denmark
| | - Marie Starzer
- Copenhagen Research Center for Mental Health-CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, 2900 Hellerup, Denmark
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Rognli EB, Støme LN, Kværner KJ, Wilhelmsen C, Arnevik EA. The effect of employment support integrated in substance use treatment: A health economic cost-effectiveness simulation of three different interventions. NORDIC STUDIES ON ALCOHOL AND DRUGS 2022; 40:199-211. [PMID: 37063816 PMCID: PMC10101164 DOI: 10.1177/14550725221122196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 08/09/2022] [Indexed: 11/09/2022] Open
Abstract
Background: Unemployment rates for individuals in treatment for substance use disorder (SUD) are high, with Norwegian estimates in the range of 81%–89%. Although Individual Placement and Support (IPS) represents a promising method to improved vocational outcome, cross-disciplinary investigations are needed to document implementation benefits and address reimbursements needs. The aim of this study was to model the potential socioeconomic value of employment support integrated in SUD treatment. Methods: Based on scientific publications, an ongoing randomised controlled trial (RCT) on employment support integrated in SUD treatment, and publicly available economy data, we made qualified assumptions about costs and socioeconomic gain for the different interventions targeting employment for patients with SUD: (1) treatment as usual (TAU); (2) TAU and a self-help guide and a workshop; and (3) TAU and IPS. For each intervention, we simulated three different outcome scenarios based on 100 patients. Results: Assuming a 40% employment rate and full-time employment (100%) for 10 years following IPS, we found a 10-year socioeconomic effect of €18,732,146. The corresponding effect for the more conservative TAU + IPS simulation assuming 40% part-time positions (25%) for five years, was €2,519,906. Compared to the two alternative interventions, IPS was cost-effective and more beneficial after six months to two years. Discussion: This concept evaluation study suggests that integrating employment support in the health services is socioeconomically beneficial. Our finding is relevant for decision makers within politics and health. Once employment rates from our ongoing RCT is available, real-life data will be applied to adjust model assumptions and socioeconomic value assumptions.
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Berge LI, Gjestad R, Franck J, Javaras KN, Greenfield S, Haver B. Gender specific early treatment for women with alcohol addiction (EWA): Impact on work related outcomes. A 25-year registry follow-up of a randomized controlled trial (RCT). Drug Alcohol Depend 2022; 239:109600. [PMID: 36007448 PMCID: PMC9509484 DOI: 10.1016/j.drugalcdep.2022.109600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 06/30/2022] [Accepted: 08/04/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Alcohol contributes to substantial economic burden, at both individual and community levels. We investigated the effect of the Early treatment for Women with Alcohol Addiction (EWA) treatment program on sickness leave, income, unemployment and early retirement pension up to 25 years following intake to treatment. METHODS The EWA RCT included 200 women with alcohol use disorder from 1983 to 1984 at the Karolinska University Hospital, Sweden. Participants were randomized to the EWA program, a two-year specialized woman only treatment including psychiatric, interpersonal and family concerns, or treatment as usual (TAU) in a mixed gender setting. We followed the participants in the RCT from 1985 to 2009 through linkage with a national labor market registry and applied latent growth curve modeling to estimate level and change in sickness leave, income, unemployment and early retirement pension. FINDINGS Relative to TAU, the EWA group had less increase in sickness leave up to 21 years after treatment. Overall, we found no differences in income between treatment groups, yet, a two-year interval analysis showed greater rise in income up to 8 years after treatment for the EWA group. Level and change in unemployment and early retirement pension did not differ between treatment groups. CONCLUSIONS Gender specific treatment emphasizing psychiatric, interpersonal and family issues for women with alcohol addiction had long-term positive effects on sickness leave and income. These findings complement positive clinical outcomes of the EWA treatment program on drinking patterns, mental health and mortality.
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Affiliation(s)
- Line Iden Berge
- NKS Olaviken Gerontopsychiatric Hospital, 5306 Erdal, Norway; Centre for Elderly and Nursing Home Medicine, Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Årstadveien 19, 5009 Bergen, Norway
| | - Rolf Gjestad
- Research department, Division of Psychiatry, Haukeland University Hospital, Sandviksleitet 1, 5036 Bergen, Norway; Center for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Sandviksleitet 1, 5036 Bergen, Norway
| | - Johan Franck
- Department of Clinical Neuroscience, Karolinska Institutet, Tomtebodavägen 18 A, 17177 Stockholm, Sweden
| | - Kristin Nicole Javaras
- Division of Women's Mental Health, McLean Hospital, 115 Mill Street, Belmont, MA 02478, United States; Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, United States
| | - Shelly Greenfield
- Division of Women's Mental Health, McLean Hospital, 115 Mill Street, Belmont, MA 02478, United States; Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, United States; Division of Alcohol, Drugs and Addiction, McLean Hospital, 115 Mill Street, Belmont, MA 02478, United States
| | - Brit Haver
- Department of Clinical Neuroscience, Karolinska Institutet, Tomtebodavägen 18 A, 17177 Stockholm, Sweden; Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Haukelandsbakken, 5009 Bergen, Norway
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Rognli EB, Aas EM, Drake RE, Marsden J, Anders P, Bond GR, Lystad JU, Reme SE, Arnevik EA. The effect evaluation of Individual Placement and Support (IPS) for patients with substance use disorders: study protocol for a randomized controlled trial of IPS versus enhanced self-help. Trials 2021; 22:705. [PMID: 34654464 PMCID: PMC8518218 DOI: 10.1186/s13063-021-05673-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 09/30/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Employment is associated with better outcomes of substance use treatment and protects against relapse after treatment completion. Unemployment rates are high for people with substance use disorders (SUD) who undergo treatment, with Norwegian estimates ranging from 81 to 91%. Evidence-based vocational models are lacking for patients in SUD treatment but exist for patients with psychosis in terms of Individual Placement and Support (IPS). The aim of the IPS for substance use disorders (IPS-SUD) trial is to investigate the effect of IPS in a SUD population. METHODS/DESIGN The IPS-SUD trial is a randomized controlled trial (RCT) comparing IPS to an enhanced control intervention. The study is a seven-site, two-arm, pragmatic, parallel-group, superiority RCT. Participants are randomly assigned (1:1) to receive either IPS plus treatment as usual (TAU) or to receive a self-help guide book and 12-h workshop plus 1-h individual vocational guidance plus TAU. Aiming to recruit 200 participants, we will be able to detect a 20% difference in the main outcome of employment with 90% power. We will make assessments at inclusion and at 6- and 12-month follow-ups and obtain outcome data on employment from national mandatory registries. The primary outcome will be at least 1 day of competitive employment during the 18-month follow-up period. Secondary employment outcomes will capture the pattern and extent of employment in terms of total time worked (days/hours), time to first employment, number of different jobs, duration of the longest employment, and sustained employment. Secondary non-employment outcomes will be substance use, mental distress, and quality of life measured by validated instruments at 6, 12, and 18 months follow-up assessments. To be eligible, participants must be between 18 and 65 years, currently unemployed and in treatment for SUD. DISCUSSION The IPS-SUD trial will provide evidence for the use of IPS in a SUD population. Findings from the study will have implications for service delivery. TRIAL REGISTRATION ClinicalTrials.gov NCT04289415 . Registered on February 28, 2020.
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Affiliation(s)
- Eline Borger Rognli
- Division of Mental Health and Addiction, Oslo University Hospital, P.O. Box 4956 Nydalen, 0424 Oslo, Norway
| | - Erlend Marius Aas
- Division of Mental Health and Addiction, Oslo University Hospital, P.O. Box 4956 Nydalen, 0424 Oslo, Norway
| | - Robert E. Drake
- Westat, Lebanon, New Hampshire USA
- IPS Employment Center, Laconia, New Hampshire USA
| | - John Marsden
- Addictions Department, Institute of Psychiatry, King’s College London, London, UK
| | | | - Gary R. Bond
- Westat, Lebanon, New Hampshire USA
- IPS Employment Center, Laconia, New Hampshire USA
| | - June Ullevoldsæter Lystad
- Division of Mental Health and Addiction, Oslo University Hospital, P.O. Box 4956 Nydalen, 0424 Oslo, Norway
| | | | - Espen Ajo Arnevik
- Division of Mental Health and Addiction, Oslo University Hospital, P.O. Box 4956 Nydalen, 0424 Oslo, Norway
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Yamashita A, Yoshioka SI, Yajima Y. Resilience and related factors as predictors of relapse risk in patients with substance use disorder: a cross-sectional study. Subst Abuse Treat Prev Policy 2021; 16:40. [PMID: 33947412 PMCID: PMC8097930 DOI: 10.1186/s13011-021-00377-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Resilience, referring to the inherent ability to naturally recover in the face of adverse conditions, is an essential concept in discussions of substance use disorder (SUD) recovery. This study's objective was to shed light on resilience and related factors that affect relapse risk in patients with SUDs. METHOD Fifty-two patients with SUDs were given a self-administrated questionnaire from February to April 2015 consisting of question items for sociodemographic characteristics, relapse risk (Stimulant Relapse Risk Scale), and resilience (Bidimensional Resilience Scale). Scale scores were tested for associations with subject attributes, after which resilience's effects on relapse risk were analyzed using correlation and multiple regression (forced-entry) analyses. RESULTS Stimulants were the most common substance related to SUD (n = 26, 21.7%; multiple answers). Bivariate correlation showed that higher acquired resilience was significantly associated with a lower relapse risk (r = - 0.314, P < 0.01). Reduced relapse risk was significantly associated with current employment (Std. β = - 0.446, P < 0.05). CONCLUSION Our findings demonstrate the necessity of recovery support to enhance acquired resistance in patients with SUDs to prevent relapses. Reinforcing employment support services and encouraging patients to continue treatment were suggested as potentially effective measures to enhance resilience in individuals with SUDs on their road to recovery.
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Affiliation(s)
- Ayako Yamashita
- Faculty of Medicine, School of Health Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan.
| | - Shin-Ichi Yoshioka
- Faculty of Medicine, School of Health Science, Tottori University, Yonago, Japan
| | - Yuki Yajima
- Department of Nursing, Faculty of Human Health Sciences, Niimi University, Niimi, Japan
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Roberts E, Doidge JC, Harron KL, Hotopf M, Knight J, White M, Eastwood B, Drummond C. National administrative record linkage between specialist community drug and alcohol treatment data (the National Drug Treatment Monitoring System (NDTMS)) and inpatient hospitalisation data (Hospital Episode Statistics (HES)) in England: design, method and evaluation. BMJ Open 2020; 10:e043540. [PMID: 33243818 PMCID: PMC7692978 DOI: 10.1136/bmjopen-2020-043540] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The creation and evaluation of a national record linkage between substance misuse treatment, and inpatient hospitalisation data in England. DESIGN A deterministic record linkage using personal identifiers to link the National Drug Treatment Monitoring System (NDTMS) curated by Public Health England (PHE), and Hospital Episode Statistics (HES) Admitted Patient Care curated by National Health Service (NHS) Digital. SETTING AND PARTICIPANTS Adults accessing substance misuse treatment in England between 1 April 2018 and 31 March 2019 (n=268 251) were linked to inpatient hospitalisation records available since 1 April 1997. OUTCOME MEASURES Using a gold-standard subset, linked using NHS number, we report the overall linkage sensitivity and precision. Predictors for linkage error were identified, and inverse probability weighting was used to interrogate any potential impact on the analysis of length of hospital stay. RESULTS 79.7% (n=213 814) people were linked to at least one HES record, with an estimated overall sensitivity of between 82.5% and 83.3%, and a precision of between 90.3% and 96.4%. Individuals were more likely to link if they were women, white and aged between 46 and 60. Linked individuals were more likely to have an average length of hospital stay ≥5 days if they were men, older, had no fixed residential address or had problematic opioid use. These associations did not change substantially after probability weighting, suggesting they were not affected by bias from linkage error. CONCLUSIONS Linkage between substance misuse treatment and hospitalisation records offers a powerful new tool to evaluate the impact of treatment on substance related harm in England. While linkage error can produce misleading results, linkage bias appears to have little effect on the association between substance misuse treatment and length of hospital admission. As subsequent analyses are conducted, potential biases associated with the linkage process should be considered in the interpretation of any findings.
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Affiliation(s)
- Emmert Roberts
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience King's College London, London, United Kingdom
- Deaprtment of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience King's College London, London, United Kingdom
- South London and the Maudsley NHS Foundation Trust, London, United Kingdom
- Public Health England, London, United Kingdom
| | - James C Doidge
- Intensive Care National Audit & Research Centre, London, United Kingdom
| | - Katie L Harron
- Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Matthew Hotopf
- Deaprtment of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience King's College London, London, United Kingdom
- South London and the Maudsley NHS Foundation Trust, London, United Kingdom
| | | | | | | | - Colin Drummond
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience King's College London, London, United Kingdom
- South London and the Maudsley NHS Foundation Trust, London, United Kingdom
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