A therapeutic workplace for the long-term treatment of drug addiction and unemployment: eight-year outcomes of a social business intervention

Abstract

This study evaluated the long-term effects of a therapeutic workplace social business on drug abstinence and employment. Pregnant and postpartum women (N = 40) enrolled in methadone treatment were randomly assigned to a therapeutic workplace or usual care control group. Therapeutic workplace participants could work weekdays in training and then as employees of a social business, but were required to provide drug-free urine samples to work and maintain maximum pay. Three-year outcomes were reported previously. This paper reports 4- to 8-year outcomes. During year 4 when the business was open, therapeutic workplace participants provided significantly more cocaine- and opiate-negative urine samples than controls; reported more days employed, higher employment income, and less money spent on drugs. During the 3 years after the business closed, therapeutic workplace participants only reported higher income than controls. A therapeutic workplace social business can maintain long-term abstinence and employment, but additional intervention may be required to sustain effects.

Keywords: Cocaine; Contingency management; Employment; Heroin; Incentive; Methadone; Social business.

Copyright © 2014 Elsevier Inc. All rights reserved.

Figures

Figure 1

Days in attendance in the Therapeutic Workplace across consecutive weekdays for the Therapeutic Workplace group. Each horizontal line represents the attendance results for a different individual across consecutive weekdays during the study. The numerals on the ordinates represent participant numbers. The solid portions of lines indicate that the participant attended the workplace on that day. Thin and thick portions of each line represent attendance in the training (Phase 1) and data entry business (Phase 2) portions of the intervention, respectively. Participants are arranged from those with the most attendance on the top of the figure to patients with the least attendance on the bottom. Since patients were required to provide drug-free urine samples to maintain access to the workplace, continuous solid lines also show consecutive days of abstinence. Four participants (S44, S33, S45 and S35) had offsite employment included in this figure. The open squares indicate when four of the participants left the therapeutic workplace business for competitive employment in a community workplace. Solid circles indicate when the business closed.

Figure 2

Percentage of negative urine samples for cocaine (top panels) and opiates (bottom panels) during the period while the data entry business, Hopkins Data Services, was opened (Business Open; left panels) and after the business closed (Business Closed; right panel). Data from the Business Open period were based on 30-day urine samples collected when Hopkins Data Services was opened and between months 37–48 after treatment entry. Business Closed data were based on 6-month assessments collected between months 60–96 and after Hopkins Data Services had closed. Dots represent data for individual participants and bars represent group means. Missing samples were considered positive. Because the business opened and closed on a fixed dates and participants were enrolled in the study at different dates, participants had different number of 30-day assessments during Year 4 that the business was open and different number of 6-month assessments during Years 5–8 that the business was closed.

Figure 3

Percentage of months that participants reported being employed full time during the period when the data entry business was open (Business Open; left panel) and after the business had closed (Business Closed; right panel). Business Open data were based on 30-day assessment samples collected between months 37–48 after treatment entry (Year 4), while Business Closed data were based on 6-month assessments collected between months 60–96 (Years 5–8). Dots represent data for individual participants and bars represent group means. Participants were considered unemployed if the participant did not complete an assessment (i.e., if the data were missing). Because the business opened and closed on a fixed dates and participants were enrolled in the study at different dates, participants had different number of 30-day assessments during Year 4 that the business was open and different number of 6-month assessments during Years 5–8 that the business was closed