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

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores how work-focused programs can aid Veterans recovering from substance use disorders (SUD) in improving sobriety and overall well-being. Participants will either continue their usual treatment or receive an additional referral to programs centered on work-related activities (employment-based interventions). The study aims to determine if these programs can enhance sobriety, mental health, self-esteem, and quality of life. Veterans who have recently received treatment for SUD and are within 30 days of detox or their last substance use might be suitable for this trial. As an unphased trial, this study provides Veterans with a unique opportunity to explore new methods to enhance their recovery journey and improve their 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 prior data suggests that work-focused programs are safe for Veterans with substance use disorders?

Research has shown that work-focused programs can be safe and helpful for people undergoing treatment for substance use disorder (SUD). For example, studies indicate that individuals in SUD recovery who secure employment tend to experience better recovery outcomes, such as maintaining sobriety and improving overall well-being. Additionally, a program called IPS, which assists people with mental health and substance use issues in finding jobs, has demonstrated promising results. Specifically, about 60% of participants in this program found work, compared to only 24% in other programs. While these findings do not directly address safety, they suggest that work-focused programs are generally well-tolerated and beneficial for people in recovery. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the work-focused program for treating substance use disorders because it incorporates employment as a crucial element of recovery. Unlike traditional treatments that primarily focus on counseling and medication, this approach adds a referral to work-focused programs, which can be either competitive or non-competitive. The idea is that gaining employment or work skills can provide structure, purpose, and self-esteem, all of which are important for maintaining long-term sobriety. This method could offer a more holistic recovery path by addressing not just the addiction itself but also the socioeconomic factors that can contribute to substance use.

What evidence suggests that this trial's work-focused programs could be effective for substance use disorders?

Research has shown that work-focused programs can aid recovery from substance use disorders (SUDs). In this trial, one group of participants will receive standard treatment plus a referral to a work-focused program. One study found that supported employment models lead to better job outcomes than other job training methods. Another review found that vocational counseling can help people secure both part-time and full-time jobs. Employment is linked to better recovery for those undergoing SUD treatment. Overall, participating in work-focused programs can improve sobriety and enhance overall well-being and life satisfaction. ^{1 2 6 7 8}

Who Is on the Research Team?

Joanna M. Fiszdon, PhD

Principal Investigator

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

Are You a Good Fit for This Trial?

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 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)

Participants will be Veterans enrolled in VACHS substance use treatment, who at time of consenting into the study are within 30 days of detoxification or last substance use as per medical record

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 for a Trial Participant

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

What Are the Treatments Tested in This Trial?

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.

How Is the Trial Designed?

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+

Published Research Related to This Trial

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]

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]

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 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]

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]

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]

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]

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]

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]

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]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC3530026/

The Effectiveness of Supported Employment in People ... The IPS model of supported employment is more effective than alternative vocational rehabilitation models at improving the competitive work outcomes of clients ...

2. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC9027488/

The Effect of Vocational Counseling Interventions for Adults ... The results of this review revealed that vocational counseling services have been highly efficacious in resulting in part-time and full-time jobs.

3. library.samhsa.gov library.samhsa.gov/sites/default/files/SAMHSA_Digital_Download/pep21-pl-guide-6.pdf

Substance Use Disorders Recovery with a Focus on ... This chapter presents the results of the evidence review which included 239 articles relating SUD to employment, education, vocational rehabilitation, recovery- ...

4. sciencedirect.com sciencedirect.com/science/article/abs/pii/S0740547217302398

Employment services and substance abuse treatment This qualitative study of over 800 participants focused on the employment experiences of consumers of substance abuse treatment programs.

5. library.samhsa.gov library.samhsa.gov/sites/default/files/pep20-02-01-019.pdf

INTEGRATING VOCATIONAL SERVICES INTO ... For people in substance use disorder (SUD) treatment, gainful employment is strongly linked to better recovery outcomes (Magura & Marshall, 2020).

6. blogs.cdc.gov blogs.cdc.gov/niosh-science-blog/2022/11/30/workplace-supported-recovery/

Workplace Supported Recovery: New NIOSH Research ... National U.S. data show2 that 70% (about 13.6 million workers) of all adults with an alcohol or illicit drug use disorder are employed, making ...

7. journals.sagepub.com journals.sagepub.com/doi/10.1177/08948453241260838

The Career Trajectories and Outcomes in Substance Use ... This scoping review provides a comprehensive overview of the reported trajectories and outcomes of individuals in recovery from substance use disorders (SUDs).

8. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC2895690/

Employment Services Utilization and Outcomes among ... Yet, employment has been one of the most difficult outcomes to improve in the drug treatment field, and substance-abusing offenders face many barriers to work.