Discounting of employment opportunities with urine drug testing requirements in opioid users enrolled in the Therapeutic Workplace

Haily K. Traxler, Kenneth Silverman, Mikhail Koffarnus

Research output: Contribution to journalArticlepeer-review


BACKGROUND: The evidence-based Therapeutic Workplace (TWP) is a promising employment-based treatment where access to work is contingent on objective evidence of abstinence from drugs. TWP is sometimes criticized for requiring individuals who use drugs to voluntarily enroll in a program requiring urine drug testing. OBJECTIVE: This experiment was conducted to assess whether urine drug testing as a condition of employment decreases the value of employment opportunities and to what degree. METHODS: Participants were unemployed, DSM-IV opioid-dependent, and enrolled in TWP. Participants completed discounting tasks assessing preference for a hypothetical job paying a constant wage that did not require urine drug testing and a job that paid a variable wage but required drug testing. The primary outcome was 'job value' operationalized as percentage wage difference to accept a job requiring urine drug testing. RESULTS: Percent wage difference to accept a job that required urine testing was analyzed using GEE. Results revealed a significant main effect of recent drug use (χ2(1) = 10.07, p < 0.01). CONCLUSION: Most participants were willing to accept a urine drug-testing job across wages similar non-drug testing jobs. Participants reporting recent cocaine or heroin use were less likely to choose urine drug-testing employment.

Original languageEnglish
Pages (from-to)183-190
Number of pages8
JournalJournal of Vocational Rehabilitation
Issue number2
StatePublished - 2023

Bibliographical note

Funding Information:
This work was supported by National Institutes of Health (NIH) grants R01DA023864 and R01DA019497 to Kenneth Silverman. A portion of Mikhail Koffarnus’ time was supported by the fellowship T32DA007209. Haily Traxler’s time was supported by a fellowship to Haily Traxler under the Clinical and Translational Science of the National Institutes of Health award number TL1TR001997. 100% of this research was supported by federal or state money with no financial or nonfinancial support from nongovernmental sources. The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. The funding source did not have a role in writing this manuscript or in the decision to submit it for publication. All authors had full access to the data in this study and the corresponding author had final responsibility for the decision to submit these data for publication.

Publisher Copyright:
© 2023 - IOS Press. All rights reserved.


  • Contingency management
  • cocaine
  • discounting
  • heroin
  • opioid use disorder
  • therapeutic workplace

ASJC Scopus subject areas

  • Rehabilitation
  • Occupational Therapy


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