Employment-Based Reinforcement to Motivate Drug Abstinence in the Treatment of Drug Addiction. - 1

This application is a competing continuation of a grant in which we developed and pilot
tested a computerized Therapeutic Workplace designed to train and employ adults as data
entry operators. A randomized trial is planned over 5 years to investigate the Therapeutic
Workplace business as a maintenance intervention to sustain long-term abstinence and
employment. Welfare recipients in methadone treatment, actively using cocaine, and at risk
for contracting or spreading HIV infection will participate in an initial Therapeutic
Workplace training phase. Participants (N=104) who become abstinent and skilled will be
randomly assigned to an Abstinence & Employment, or an Employment Only group. Participants
in the Abstinence & Employment group will be employed for one year in a Therapeutic
Workplace business and will have to provide drug-free urine samples to work and earn salary.
Employment Only participants will be offered employment for one year, but these participants
will not have to provide drug-free urine samples to work. This study will provide a rigorous
evaluation of the efficacy of the Therapeutic Workplace business as a long-term treatment of
cocaine addiction and unemployment; determine the benefits of requiring daily evidence of
abstinence to work; and provide information on the extent to which a Therapeutic Workplace
business can become self-sustaining. This research could provide firm scientific foundation
for the dissemination of Therapeutic Workplace businesses in the long-term treatment of
cocaine addiction and unemployment. The main hypothesis being tested is that cocaine
abstinence will be reliably maintained during the yearlong intervention evaluation period
only in the group exposed to the explicit abstinence maintenance intervention. We expect
that cocaine abstinence in the Abstinence and Employment group will be significantly greater
than cocaine abstinence in the Employment Only group.