Work-Focused Program for Substance Use Disorders

Overseen By Joanna M Fiszdon, PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: VA Office of Research and Development

Disqualifiers: Legal issues, Developmental disability, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Approved in 1 Jurisdiction This treatment is already approved in other countries

Compensation: Varies

Number of Visits: Unknown

Duration: 3 months

140 Participants Needed

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. ^{1 2 3 4 5}

Is 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. ^{3 6 7 8 9}

How 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. ^{1 3 8 10 11}

Research Team

Joanna M. Fiszdon, PhD

Principal Investigator

VA Connecticut Healthcare System West Haven Campus, West Haven, CT

Eligibility 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)

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

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

Treatment Details

Interventions

• Referral to work focused program

Trial Overview 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.

Participant Groups

Group I: treatment as usual plus referral to work focused program Experimental Treatment 2 Interventions

usual substance use treatment plus referral to a competitive or non-competitive work-focused program

Group II: treatment as usual Active Control 1 Intervention

usual substance use treatment

Who Is Running the Clinical Trial?

VA Office of Research and Development

Lead Sponsor

Trials

1,691

Recruited

3,759,000+

Findings from Research

Employment is often viewed as a crucial factor in the recovery process for individuals undergoing addiction treatment, yet standard treatment methods have not effectively improved employment outcomes for these clients.

A comprehensive review of three decades of research highlights the potential benefits of specialized vocational interventions tailored for addiction treatment clients, suggesting that these approaches may be more effective in enhancing employment opportunities post-treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effectiveness of vocational services for substance users in treatment. Magura, S., Staines, GL., Blankertz, L., et al.[2019]

The article presents four models for integrating work into substance dependency treatment, with the most common being Work as a Positive Outcome, which views employment as a key goal of treatment.

The effectiveness of these models in increasing client employment and their desirability among clients is discussed, highlighting the need for sufficient vocational services within treatment programs.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The role of work in substance dependency treatment: a preliminary overview. Magura, S.[2019]

Job seeking skills training and support services integrated within substance use disorder treatment programs can effectively assist unemployed individuals in finding employment by teaching essential skills like resume writing and interview techniques.

Comprehensive off-site employment programs that offer intensive vocational training and rehabilitation are also available, providing additional resources for individuals in recovery to secure gainful employment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Special section: the most critical unresolved issues associated with contemporary vocational rehabilitation for substance users. The critical relationship between employment services and patient motivation. Kidorf, M., Brooner, RK.[2019]

Integrating vocational assistance into addiction treatment programs can significantly enhance patient employment outcomes, as highlighted by a comprehensive review of three decades of research.

The new studies presented differentiate the effectiveness of vocational services in methadone treatment settings compared to other treatment types, emphasizing the need for tailored approaches in vocational rehabilitation for addiction patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Introduction: new directions for vocational rehabilitation in substance user treatment: rebuilding damaged lives. Magura, S., Staines, GL.[2019]

The systematic review identified 14 studies focused on improving employment outcomes for individuals with substance use disorder, with Individual Placement and Support (IPS) and Customized Employment Supports (CES) showing the most positive results.

Despite some positive findings, the overall impact of interventions on employment outcomes was small, highlighting the need for further research with larger sample sizes and consistent outcome measurements.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Effectiveness of Interventions Intended to Improve Employment Outcomes for Persons with Substance Use Disorder: An Updated Systematic Review. Magura, S., Marshall, T.[2021]

In a study involving unemployed individuals with opioid dependence enrolled in a Therapeutic Workplace program, most participants were willing to accept jobs that required urine drug testing, indicating that the requirement did not significantly decrease the perceived value of employment opportunities.

However, those who reported recent cocaine or heroin use were less likely to choose jobs that required drug testing, suggesting that recent substance use may influence job acceptance in the context of drug testing requirements.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Discounting of employment opportunities with urine drug testing requirements in opioid users enrolled in the Therapeutic Workplace. Traxler, HK., Silverman, K., Koffarnus, M.[2023]

Workplace programs for assisting employees with alcohol problems have evolved significantly, moving from industrial alcoholism programming to more comprehensive employee assistance programs, which are based on a seven-component 'core technology.'

A survey of 480 private-company sites indicates a high success rate for these programs, with increasing self-referrals for assistance, highlighting the need for further research to enhance the effectiveness of workplace alcoholism interventions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Growth and transformation in workplace alcoholism programming. Roman, PM.[2019]

Contingency management (CM) is an effective intervention for substance use disorders that provides incentives for drug abstinence, and its employment-based version has shown similar effectiveness to traditional CM methods.

Integrating employment-based CM into existing vocational rehabilitation services like Compensated Work Therapy (CWT) at the VA could enhance treatment outcomes for veterans with substance use disorders and support their efforts to secure and maintain competitive employment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The compatibility of employment-based contingency management and vocational services at the Department of Veterans Affairs. Cosottile, DW., DeFulio, A.[2020]

The employment-focused case management intervention (CMRE) did not significantly improve the return to competitive employment rates for substance use disorder patients compared to standard care, with 35.6% in the CMRE group and 41.2% in the control group employed after 24 months.

However, CMRE was more effective in connecting patients with services from the Federal Employment Agency or Job Centres immediately after discharge, indicating a potential benefit in support services despite not improving overall employment outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

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. Saal, S., Forschner, L., Kemmann, D., et al.[2019]

The therapeutic workplace intervention effectively combines employment with abstinence reinforcement, helping chronically unemployed drug users improve their work performance and job skills.

Research shows that targeted contingency management and training programs within this intervention lead to better attendance and productivity among participants, addressing behaviors that hinder their success in traditional job settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Establishing and maintaining job skills and professional behaviors in chronically unemployed drug abusers. Wong, CJ., Silverman, K.[2019]

Individuals with substance use disorders often face significant employment challenges, and existing vocational services are typically not tailored to their specific needs.

A newly funded vocational program for patients in drug and alcohol treatment has been operational for 2 years, showing effectiveness in addressing these challenges through personalized services, as illustrated by three case histories.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Matching services to needs. Vocational services for substance abusers. Schottenfeld, RS., Pascale, R., Sokolowski, S.[2019]

References

1. England pubmed.ncbi.nlm.nih.gov

The effectiveness of vocational services for substance users in treatment. [2019]

2. England pubmed.ncbi.nlm.nih.gov

The role of work in substance dependency treatment: a preliminary overview. [2019]

3. England pubmed.ncbi.nlm.nih.gov

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]

4. England pubmed.ncbi.nlm.nih.gov

Introduction: new directions for vocational rehabilitation in substance user treatment: rebuilding damaged lives. [2019]

5. England pubmed.ncbi.nlm.nih.gov

The Effectiveness of Interventions Intended to Improve Employment Outcomes for Persons with Substance Use Disorder: An Updated Systematic Review. [2021]

6. Netherlands pubmed.ncbi.nlm.nih.gov

Discounting of employment opportunities with urine drug testing requirements in opioid users enrolled in the Therapeutic Workplace. [2023]

7. United States pubmed.ncbi.nlm.nih.gov

Growth and transformation in workplace alcoholism programming. [2019]

8. United States pubmed.ncbi.nlm.nih.gov

The compatibility of employment-based contingency management and vocational services at the Department of Veterans Affairs. [2020]

9. England pubmed.ncbi.nlm.nih.gov

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]

10. England pubmed.ncbi.nlm.nih.gov

Establishing and maintaining job skills and professional behaviors in chronically unemployed drug abusers. [2019]

11. United States pubmed.ncbi.nlm.nih.gov

Matching services to needs. Vocational services for substance abusers. [2019]