Combining stepped-care approaches with behavioral reinforcement to motivate employment in opioid-dependent outpatients
Combining stepped-care approaches with behavioral reinforcement to motivate employment in opioid-dependent outpatients
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DOI：
10.1081/ja-200034591
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发表时间：
2004-01-01
影响因子：
2
通讯作者：
Brooner, RK
中科院分区：
文献类型：
--
作者：
Kidorf, M;Neufeld, K;Brooner, RK
就业与接受美沙酮治疗的阿片依赖门诊患者的治疗结果改善有关(例如，Platt，1995)。阿片依赖者通常失业接受治疗，尽管海洛因使用量减少，但许多人仍处于失业状态。需要更多的干预措施来激励求职行为和结果。这篇文章报道了一种有希望的方法来减少在寻求治疗的阿片类药物依赖患者中普遍存在的长期失业--一种结合了多种行为强化以激励患者参与和遵守治疗计划的“阶梯式护理”服务提供干预。这种治疗方法(激励阶梯式护理--MSC；Brooner和Kidorf(2002))经过改进和修改，以激励和支持阿片类药物依赖患者的一系列积极治疗行为和结果(Kidorf等人)。1999年)，包括求职和求职。在治疗一年后失业的患者被系统地推进到更密集的每周咨询步骤，并一直留在那里，直到找到工作。尽管在最高护理步骤(步骤3，每周咨询9小时)接受了至少4周的咨询，但仍处于失业状态的人开始使用美沙酮，为出院做准备，这在获得工作后是可逆的。本文描述了MSC方法，并介绍了被判断为有工作能力的患者的就业率(n=228)。对2002年8月至9月期间的医疗和账单记录的审查显示，这些患者中的绝大多数人(93%)都是受雇的，通常是全职职位。就业与因吸毒而进入每周更高强度的咨询活动的频率较低相关。此外，就业稳定性和功能改善的多个指数，包括工作月数、工作时间和年化工资，都与更好的药物使用结果有关。这些数据表明，MSC干预是激励和支持慢性重度物质使用障碍患者求职和就业的有效平台。
Employment is associated with improved treatment outcome for opioid-dependent outpatients receiving methadone (e.g., Platt, 1995). Opioid-dependent individuals typically enter treatment unemployed and many remain unemployed despite reductions in heroin use. Additional interventions are needed to motivate employment seeking behaviors and outcome. This article reports on a promising approach to reduce the chronic unemployment commonplace in treatment-seeking, opioid-dependent patients-a "stepped care" service delivery intervention that incorporates multiple behavioral reinforcements to motivate patient participation in and adherence to the treatment plan. This therapeutic approach (Motivated Stepped Care-MSC; Brooner and Kidorf (2002) was refined and modified to motivate and support a range of positive treatment behaviors and outcomes in patients with opioid-dependence (Kidorf et al. 1999), including job-seeking and acquisition. Patients who are unemployed after one year of treatment are systematically advanced to more intensive steps of weekly counseling and remain there until employment is attained. Those who remain unemployed despite exposure to at least 4 weeks of counseling at the highest step of care (Step 3, which is 9 h weekly of counseling) are started on a methadone taper in preparation for discharge, which is reversible upon attaining a job. This article describes the MSC approach and presents rates of employment for patients who were judged capable of working (n = 228). A review of medical and billing records during August-September 2002 revealed that the great majority of these patients were employed (93%), usually in full-time positions. Employment was associated with less frequent advancement to higher intensities of weekly counseling because of drug use. Further, multiple indices of improved employment stability and functioning, including months of work, hours of work, and annualized salary, were associated with better drug use outcomes. These data suggest that the MSC intervention is an effective platform for motivating and supporting both job seeking and employment in patients with chronic and severe substance use disorder.