The Long-Term Treatment of Drug Addiction and Unemployment

Drug addiction is as a chronic relapsing disorder. High magnitude and long-duration
voucher-based abstinence reinforcement is one of the most effective treatments for drug
addiction and can maintain drug abstinence over extended periods of time, but practical
methods of implementing these interventions are needed. Workplaces could be ideal and
practical vehicles for arranging and maintaining abstinence reinforcement over long time
periods. The investigator's research on a model Therapeutic Workplace has shown that
employment-based abstinence reinforcement, in which participants must provide drug-free urine
samples to maintain maximum pay, can maintain drug abstinence. Now what is needed is the
development of effective and economically sound methods to arrange long-term exposure to
employment-based abstinence reinforcement. The present study will evaluate the effectiveness
and economic benefits of a Wage Supplement Model of arranging long-term exposure to
employment-based abstinence reinforcement. Under this model, successful Therapeutic Workplace
participants are offered abstinence-contingent wage supplements if they obtain and maintain
competitive employment. Governments have used wage supplements effectively to increase
employment in welfare recipients. The Wage Supplement Model harnesses the power of wage
supplements to promote employment, while simultaneously using the wage supplements to
reinforce drug abstinence. The intervention will combine the Therapeutic Workplace,
Individual Placement and Support (IPS) supported employment, and abstinence-contingent wage
supplements. IPS is a supported employment intervention that has been proven effective in
promoting employment in adults with severe mental illness. Under this model, participants
will be exposed to the Therapeutic Workplace to initiate drug abstinence and establish job
skills. To promote employment and prevent relapse to drug use, participants will receive IPS
Plus Abstinence-Contingent Wage Supplements. A randomized trial will evaluate the
effectiveness and economic benefits of the Abstinence-Contingent Wage Supplement Model in
promoting employment and sustaining abstinence in heroin users. Participants will be enrolled
in the Therapeutic Workplace for 3 months and then randomly assigned to an IPS Only group or
an IPS Plus Abstinence-Contingent Wage Supplement group for one year. IPS Only participants
will receive the IPS intervention. IPS Plus Abstinence-Contingent Wage Supplement
participants will receive the IPS intervention and abstinence-contingent wage supplements.
Drug use while participants are employed in community jobs will be monitored by American
Substance Abuse Professionals, Inc. (ASAP®), a leading provider of workplace substance abuse
services in the U.S. This novel intervention could be an effective and economically sound way
to promote long-term abstinence and employment.

Inclusion Criteria:

- report heroin use

Exclusion Criteria:

- report current suicidal or homicidal ideation;

- have a severe psychiatric disorder