Abstinence-contingent wage supplements to promote drug abstinence and employment: A randomised controlled trial

August F. Holtyn, Forrest Toegel, Shrinidhi Subramaniam, Brantley P. Jarvis, Jeannie Marie Leoutsakos, Michael Fingerhood, Kenneth Silverman

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Background Poverty, unemployment and substance abuse are inter-related problems. This study evaluated the effectiveness of abstinence-contingent wage supplements in promoting drug abstinence and employment in unemployed adults in outpatient treatment for opioid use disorder. Methods A randomised controlled trial was conducted in Baltimore, MD, from 2014 to 2019. After a 3-month abstinence initiation and training period, participants (n=91) were randomly assigned to a usual care control group that received employment services or to an abstinence-contingent wage supplement group that received employment services plus abstinence-contingent wage supplements. All participants were invited to work with an employment specialist to seek employment in a community job for 12 months. Abstinence-contingent wage supplement participants could earn training stipends for working with the employment specialist and wage supplements for working in a community job, but had to provide opiate and cocaine-negative urine samples to maximise pay. Results Abstinence-contingent wage supplement participants provided significantly more opiate and cocaine-negative urine samples than usual care control participants (65% vs 45%; OR=2.29, 95% CI 1.22 to 4.30, p=0.01) during the 12-month intervention. Abstinence-contingent wage supplement participants were significantly more likely to have obtained employment (59% vs 28%; OR=3.88, 95% CI 1.60 to 9.41, p=0.004) and lived out of poverty (61% vs 30%; OR=3.77, 95% CI 1.57 to 9.04, p=0.004) by the end of the 12-month intervention than usual care control participants. Conclusion Abstinence-contingent wage supplements can promote drug abstinence and employment. Trial registration number ClinicalTrials.gov NCT02487745.

Original languageEnglish (US)
Pages (from-to)445-452
Number of pages8
JournalJournal of epidemiology and community health
Issue number5
StatePublished - May 1 2020


  • employment
  • poverty
  • substance abuse
  • unemployment

ASJC Scopus subject areas

  • Epidemiology
  • Public Health, Environmental and Occupational Health


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