Work-Focused Program for Substance Use Disorders
Recruiting in Palo Alto (17 mi)
Age: 18+
Sex: Any
Travel: May Be Covered
Time Reimbursement: Varies
Trial Phase: Academic
Recruiting
Sponsor: VA Office of Research and Development
Disqualifiers: Legal issues, Developmental disability, others
No Placebo Group
Approved in 1 Jurisdiction
Trial Summary
What is the purpose of this trial?To date, there are no studies of the therapeutic effects of varied work-focused programs in Veterans undergoing outpatient substance use disorder (SUD) treatment. The investigators propose a randomized clinical trial to test the effects of work-focused programs on improving sobriety and other clinical outcomes in Veterans early in the course of recovery from SUD. Veterans will be randomized to either receive or not receive referral for work-focused therapeutic programs. Primary aim is to examine effects of work-focused programs on sobriety outcomes, namely sobriety and global functioning. Secondary aim is to examine effects of work-focused programs on psychiatric symptoms, self esteem/efficacy, and quality of life.
Will I have to stop taking my current medications?
The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators or your healthcare provider.
What data supports the effectiveness of the treatment Referral to work focused program for Substance Use Disorders?
Research shows that employment is a strong predictor of positive outcomes for people with substance use disorders. Programs like Individual Placement and Support (IPS) have shown positive results in helping individuals find jobs, although the overall impact on employment is generally small.
12345Is the Work-Focused Program for Substance Use Disorders safe for humans?
The research on employment-based interventions, such as the Therapeutic Workplace and vocational rehabilitation services, does not report any specific safety concerns for humans. These programs focus on providing employment opportunities contingent on drug abstinence and have been used in various settings, including the Department of Veterans Affairs, without noted safety issues.
36789How does the Work-Focused Program for Substance Use Disorders differ from other treatments?
The Work-Focused Program for Substance Use Disorders is unique because it integrates employment-based interventions with substance use treatment, using job skills training and employment as incentives for maintaining sobriety. This approach combines vocational rehabilitation with contingency management, where participants receive rewards for abstaining from drug use, making it distinct from traditional treatments that do not typically focus on employment outcomes.
1381011Eligibility Criteria
This trial is for Veterans diagnosed with any Substance Use Disorder (SUD) such as opioids or alcohol, who are enrolled in VACHS substance use treatment and are within 30 days of detoxification. Participants must be over 18, able to consent, and not planning to relocate or likely to be incarcerated during the study.Inclusion Criteria
I am 18 years old or older.
I am able to understand and sign the consent form.
Must meet DSM-V criteria for any current Substance Use Disorder (SUD) (e.g., opioids, cocaine, marijuana, amphetamine, or alcohol)
+1 more
Exclusion Criteria
Lack of willingness to provide contact information of someone who can help us contact the participant in the event that we are unable to maintain contact directly
Involvement in a legal case that may lead to incarceration during study period
Developmental disability or medical illness that would prevent therapeutic work activity, as judged by PI or clinical staff providing this service
+1 more
Trial Timeline
Screening
Participants are screened for eligibility to participate in the trial
2-4 weeks
Treatment
Participants receive usual substance use treatment with or without referral to work-focused programs
3 months
Follow-up
Participants are monitored for sobriety and clinical outcomes after treatment
3 months
Long-term Follow-up
Participants are assessed for quality of life, self-esteem, and self-efficacy
6 months
Participant Groups
The trial is testing if work-focused programs can help improve sobriety and overall functioning in Veterans recovering from SUDs. It randomly assigns participants to either receive a referral for these programs or continue with their usual treatment without additional work focus.
2Treatment groups
Experimental Treatment
Active Control
Group I: treatment as usual plus referral to work focused programExperimental Treatment2 Interventions
usual substance use treatment plus referral to a competitive or non-competitive work-focused program
Group II: treatment as usualActive Control1 Intervention
usual substance use treatment
Find a Clinic Near You
Research Locations NearbySelect from list below to view details:
VA Connecticut Healthcare System West Haven Campus, West Haven, CTWest Haven, CT
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Who Is Running the Clinical Trial?
VA Office of Research and DevelopmentLead Sponsor
References
The effectiveness of vocational services for substance users in treatment. [2019]Employment appears frequently in the literature as an outcome criterion for substance users in treatment, and most clinicians subscribe to the belief that work plays an important role in recovery from addiction. Despite the importance attached to employment, the major standard treatment modalities have not been shown as effective in increasing client employment after treatment. The article presents a critical review and synthesis of three decades of research on the effectiveness of specialized vocational intervention for addiction treatment clients.
The role of work in substance dependency treatment: a preliminary overview. [2019]This article describes four alternative models for the role of client work in substance dependency treatment. The most common model is Work as a Positive Outcome, which conceptualizes work (employment) as a desirable outcome of treatment. The Work Infusion Model conceptualizes work as a therapeutic factor in treatment. The Contingent Sanctions Model requires clients to work to avoid undesirable consequences, such as losing treatment. The Work as Reinforcement Model offers paid work as a reward for treatment adherence. This article discusses whether either standard substance dependency treatment or vocational services within treatment programs increase client employment, whether clients want to work, and whether sufficient services are available. The empirical support for each model of client work is summarized. Critical issues that must be addressed in this area are outlined.
Special section: the most critical unresolved issues associated with contemporary vocational rehabilitation for substance users. The critical relationship between employment services and patient motivation. [2019]Several interventions and service delivery models now exist to help unemployed people in treatment for substance use disorder seek gainful employment (Platt, 1995). Some of these interventions can be conveniently offered within substance user treatment settings. One of the best known examples of these interventions is job seeking skills training and support services that help patients develop resumes, complete employment applications, learn effective networking strategies, and develop and practice effective responses to common issues and questions raised during employment interviews. A wide range of more comprehensive off-site employment programs that provide intensive vocational training and rehabilitation also exist in many communities. The growing availability of on-site services in substance user treatment programs also creates the
Introduction: new directions for vocational rehabilitation in substance user treatment: rebuilding damaged lives. [2019]If an important objective of addiction treatment is to increase patient employment, then it makes sense to locate vocational assistance within treatment programs. The purpose of this special issue is to present new research on the improvement of vocational services in addiction treatment. The volume begins with a critical review and synthesis of three decades of research on the effectiveness of specialized vocational services for addiction treatment patients. The new evaluation studies in this volume break down into those conducted in methadone treatment vs. other types of treatment settings. The volume concludes with a framework for evaluating the cost-effectiveness of vocational rehabilitation within addiction treatment. Critical issues that need resolution in this field are identified.
The Effectiveness of Interventions Intended to Improve Employment Outcomes for Persons with Substance Use Disorder: An Updated Systematic Review. [2021]Label="BACKGROUND">Employment is one of the strongest predictors of positive outcomes for persons with substance use disorder. Purpose: To conduct a systematic review of interventions intended to improve employment outcomes for persons with substance use disorder (SUD) at any stage of recovery. This is an update of a prior review published in 2004. Methods: Two bibliographic databases, PUBMED and PSYCHINFO, were searched for articles published in the period 2005-2018 that referenced employment, education, or vocational rehabilitation for people with SUD. Results: One hundred thirty-two articles were identified of which 14 met the criteria for inclusion, primarily a minimum of a quasi-experimental evaluation design. Each study was reviewed with the following format: setting (modality); subject characteristics; research procedures; results; limitations/comments. Results: Nine programs or models were represented among the 14 studies, with Individual Placement and Pupport (IPS) and its variant Customized Employment Supports (CES) having the most studies with positive results. But generally, the magnitude of any intervention effects on employment was small for all interventions; one outcome may have shown statistical significance while one or more other outcomes did not, and there was little consistency in how outcomes were measured among the studies. Conclusions/Importance: IPS/CES currently shows the most evidentiary support. But all the studies of interventions with positive outcome data should be replicated with larger samples in diverse settings.
Discounting of employment opportunities with urine drug testing requirements in opioid users enrolled in the Therapeutic Workplace. [2023]The evidence-based Therapeutic Workplace (TWP) is a promising employment-based treatment where access to work is contingent on objective evidence of abstinence from drugs. TWP is sometimes criticized for requiring individuals who use drugs to voluntarily enroll in a program requiring urine drug testing.
Growth and transformation in workplace alcoholism programming. [2019]The origins of contemporary workplace programs to provide constructive assistance to employees with alcohol problems are described. The transformation from industrial alcoholism programming to employee assistance programming is delineated in terms of a seven-component "core technology." The high degree of reported success of these programs is described with general findings from a survey of 480 private-company sites. Increasing rates of self-referral for assistance with alcohol problems are described in terms of factors facilitating such referrals. Basic research knowledge is summarized, together with a projection of new studies considered to be critical for maximizing the effectiveness of alcoholism intervention as it relates to workplace programs. Throughout the chapter the large-scale impact of workplace programming is emphasized, with an urgency for greater attention to be paid to these activities by the alcohol problem research community.
The compatibility of employment-based contingency management and vocational services at the Department of Veterans Affairs. [2020]The Department of Veterans Affairs (VA) provides vocational rehabilitation services for veterans with substance use disorders in programs such as Compensated Work Therapy (CWT). For some veterans, these services include regular monitoring and wages for work in prevocational settings. Independently of these services, the availability of a highly effective intervention for substance use disorders called contingency management (CM) has been rapidly increasing at the VA. CM involves the provision of material incentives such as prizes, vouchers, or money contingent upon verification of drug abstinence via toxicology screening. An employment-based version of CM has been demonstrated to be as effective as other forms of CM. Under this version of CM, access to paid employment or paid job training is the incentive. This employment-based CM could be used in conjunction with CWT or other vocational rehabilitation services used at the VA. The implementation of CM in such settings would increase access to CM for veterans and would be highly likely to improve substance use treatment outcomes among those receiving the service. This intervention might also improve key behavioral outcomes related to obtaining and maintaining competitive employment. VA officials in charge of employment-based treatment programs such as CWT should seriously consider integrating CM into their programs. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
Is employment-focused case management effective for patients with substance use disorders? Results from a controlled multi-site trial in Germany covering a 2-years-period after inpatient rehabilitation. [2019]Substance use disorders are associated with unemployment. An employment-focused case management (CMRE) has been conceptualised as a specific intervention to help substance use disorder patients return to competitive employment immediately after inpatient rehabilitation. This study investigated the effect of the intervention on return to work of persons with substance use disorders.
Establishing and maintaining job skills and professional behaviors in chronically unemployed drug abusers. [2019]The therapeutic workplace intervention is an employment-based drug user intervention that integrates abstinence reinforcement contingencies into an employment setting, intended for individuals manifesting chronic unemployment and drug addiction. Research on the therapeutic workplace intervention has provided a unique and rare opportunity to collect data and conduct fine-grained analyses of the training and work performance of participants. Results from a series of studies document that chronically unemployed drug users display behaviors that likely limit their success in conventional businesses. This article reviews a systematic line of research showing that targeted and intensive contingency management interventions and training programs have been effective in promoting consistent attendance and high rates of productivity and establishing job skills for employment.
Matching services to needs. Vocational services for substance abusers. [2019]Problems with employment are common among individuals with substance use disorders, yet comprehensive vocational services are not generally available to them, and vocational interventions are often not matched to their specific needs. This article describes the wide range of vocational problems found among individuals with substance use disorders and the elements of a recently funded vocational program for patients in outpatient and residential drug and alcohol treatment programs. Data are presented describing program activity and documenting program effectiveness for the first 2 years of operation of the program. Three case histories are presented to illustrate the types of services delivered and the matching of services delivered to specific, identified client needs (see Case Histories).