The Therapeutic Workplace Intervention in Community Settings

Methadone is effective for heroin addiction, but many methadone patients continue to use
cocaine. High magnitude and long-duration voucher-based abstinence reinforcement, in which
participants receive vouchers exchangeable for goods and services contingent on providing
drug-free biological samples, is one of the most effective treatments for drug addiction and
can maintain cocaine abstinence over extended periods of time. Our research on a model
Therapeutic Workplace has shown that employment-based abstinence reinforcement, in which
participants must provide drug-free urine samples to access the workplace and maintain
maximum pay, can maintain cocaine abstinence and reduce drug-related HIV risk behaviors over
extended time periods. Our next challenge is to disseminate employment-based reinforcement
for the treatment of drug addiction. The investigators propose to develop, manualize, and
pilot test a community-friendly Therapeutic Workplace intervention that can be implemented
widely throughout the US and elsewhere. Methadone patients who use injection or crack
cocaine during methadone treatment will be invited to participate (N = 58) and randomly
assigned to one of two groups: Usual Care (control) group or Community Therapeutic Workplace
group. As in our prior implementations of the Therapeutic Workplace intervention, Community
Therapeutic Workplace participants will enroll in Phase 1 to initiate drug abstinence and
acquire job skills. Participants who initiate abstinence and acquire job skills in Phase 1
will be hired into community workplaces with collaborating employers in Phase 2. During
Phase 2, employment-based abstinence reinforcement contingencies will be implemented using
procedures for workplace drug and alcohol testing overseen by the US Department of
Transportation. Using this system, a national provider of Drug-Free Workplace Services will
arrange random drug testing and employment-based abstinence reinforcement contingencies in
which employees will be required to remain drug-free to maintain employment. The
investigators hypothesize that participants in the Community Therapeutic Workplace group
will provide more drug-free samples, and engage in fewer HIV-risk behaviors than
participants in the Usual Care group. The study will provide vital information on the
acceptability of the intervention to participants and employers, and provide preliminary
data on the effectiveness of the investigators procedures to maintain abstinence and promote
employment.