Abstinence-contingent wage supplements to promote drug abstinence and employment: a randomised controlled trial.
Adult
Analgesics, Opioid
/ urine
Baltimore
Cocaine-Related Disorders
/ rehabilitation
Employment
/ statistics & numerical data
Female
Humans
Male
Methadone
/ therapeutic use
Narcotics
/ adverse effects
Opiate Substitution Treatment
Opioid-Related Disorders
/ rehabilitation
Outcome Assessment, Health Care
/ statistics & numerical data
Reinforcement, Psychology
Salaries and Fringe Benefits
employment
poverty
substance abuse
unemployment
Journal
Journal of epidemiology and community health
ISSN: 1470-2738
Titre abrégé: J Epidemiol Community Health
Pays: England
ID NLM: 7909766
Informations de publication
Date de publication:
05 2020
05 2020
Historique:
received:
08
01
2020
revised:
04
02
2020
accepted:
05
02
2020
pubmed:
23
2
2020
medline:
31
12
2020
entrez:
23
2
2020
Statut:
ppublish
Résumé
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. 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. 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. Abstinence-contingent wage supplements can promote drug abstinence and employment. ClinicalTrials.gov NCT02487745.
Sections du résumé
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.
Identifiants
pubmed: 32086373
pii: jech-2020-213761
doi: 10.1136/jech-2020-213761
pmc: PMC7259020
mid: NIHMS1590716
doi:
Substances chimiques
Analgesics, Opioid
0
Narcotics
0
Methadone
UC6VBE7V1Z
Banques de données
ClinicalTrials.gov
['NCT02487745']
Types de publication
Journal Article
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
445-452Subventions
Organisme : NIDA NIH HHS
ID : R01 DA037314
Pays : United States
Organisme : NIDA NIH HHS
ID : T32 DA007209
Pays : United States
Informations de copyright
© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.
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