The therapeutic workplace to promote treatment engagement and drug abstinence in out-of-treatment injection drug users: A randomized controlled trial

August F. Holtyn, Mikhail N. Koffarnus, Anthony DeFulio, Sigurdur O. Sigurdsson, Eric C. Strain, Robert P. Schwartz, Jeannie Marie S. Leoutsakos, Kenneth Silverman

Research output: Contribution to journalArticlepeer-review

21 Scopus citations

Abstract

Objective: Determine if employment-based reinforcement can increase methadone treatment engagement and drug abstinence in out-of-treatment injection drug users. Method: This study was conducted from 2008 to 2012 in a therapeutic workplace in Baltimore, MD. After a 4-week induction, participants (N. =. 98) could work and earn pay for 26. weeks and were randomly assigned to Work Reinforcement, Methadone & Work Reinforcement, and Abstinence, Methadone & Work Reinforcement conditions. Work Reinforcement participants had to work to earn pay. Methadone & Work Reinforcement and Abstinence, Methadone, & Work Reinforcement participants had to enroll in methadone treatment to work and maximize pay. Abstinence, Methadone, & Work Reinforcement participants had to provide opiate- and cocaine-negative urine samples to maximize pay. Results: Most participants (92%) enrolled in methadone treatment during induction. Drug abstinence increased as a graded function of the addition of the methadone and abstinence contingencies. Abstinence, Methadone & Work Reinforcement participants provided significantly more urine samples negative for opiates (75% versus 54%) and cocaine (57% versus 32%) than Work Reinforcement participants. Methadone & Work Reinforcement participants provided significantly more cocaine-negative samples than Work Reinforcement participants (55% versus 32%). Conclusion: The therapeutic workplace can promote drug abstinence in out-of-treatment injection drug users.

Original languageEnglish
Pages (from-to)62-70
Number of pages9
JournalPreventive Medicine
Volume68
DOIs
StatePublished - Nov 1 2014

Bibliographical note

Funding Information:
This research was supported by grants R01DA023864, K24DA023186, and T32DA07209 from the National Institute on Drug Abuse (NIDA). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute on Drug Abuse or the National Institutes of Health. The authors wish to thank Jeanne Harrison for her assistance with data management and study coordination, Jackie Hampton for participant recruitment and assessment, and David Pierce for his help with data analyses.

Publisher Copyright:
© 2014 Elsevier Inc.

Keywords

  • Cocaine
  • Contingency management
  • Employment
  • Financial incentives
  • Injection drug use
  • Methadone
  • Opiate
  • Out-of-treatment injection drug user

ASJC Scopus subject areas

  • Epidemiology
  • Public Health, Environmental and Occupational Health

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