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 journalArticle

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

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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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