Abstinence-Contingent Wage Supplements for Long-Term Treatment of Drug Addiction

 描述(申请人提供)：吸毒成瘾是一种慢性复吸障碍。大规模和长期的凭单戒毒强化是治疗药物成瘾最有效的方法之一，可以在较长一段时间内保持戒除可卡因，但需要执行这些干预措施的实际方法。工作场所可能是安排和长期维持禁欲强化的理想和实用的工具。我们对一个示范治疗工作场所的研究表明，以就业为基础的戒断强化，参与者必须提供无毒的尿样以维持最高工资，可以维持可卡因戒断。现在，我们需要开发有效且经济合理的方法，安排长期接触以就业为基础的禁欲强化。我们建议评估一种工资补充模式的有效性和经济效益，该模式安排长期接触以就业为基础的禁欲强化。在这一模式下，如果成功的治疗工作场所参与者获得并保持有竞争力的工作，他们将获得视禁欲而定的工资补充。各国政府有效地利用工资补贴来增加福利接受者的就业。工资补贴模式利用工资补贴的力量来促进就业，同时利用工资补贴来加强戒毒。干预将结合治疗工作场所，个人安置和支持(IPS)支持的就业，以及禁欲条件下的工资补充。IPS是一种支持性就业干预措施，已被证明在促进患有严重精神疾病的成年人就业方面有效。在这一模式下，参与者将接触到治疗工作场所，以启动药物戒断并建立工作技能。为了促进就业和防止再次吸毒，参与者将获得IPS Plus戒酒补贴。一项随机试验将评估戒除条件工资补充模式在促进低收入失业注射吸毒者在阿片类激动剂治疗期间继续使用可卡因的就业和维持戒除可卡因方面的有效性和经济效益(N=120)。参与者将在治疗工作场所登记3个月，然后随机分配到仅接受IPS治疗的小组或为期一年的IPS加戒酒条件工资补充组。仅IPS参与者将接受IPS干预。IPS Plus节制工资补贴参与者将获得IPS干预和节欲补贴。参与者受雇于社区工作时的药物使用情况将由美国领先的工作场所药物滥用服务提供商美国药物滥用专业人员公司(ASAP(R))监测。这种新颖的干预措施可能是促进注射吸毒者长期戒除可卡因和就业的一种有效且经济合理的方式。注射吸毒者是一个因贫困、失业和注射吸毒者而面临许多不良后果风险的人群。

 DESCRIPTION (provided by applicant): Drug addiction is a chronic relapsing disorder. High magnitude and long-duration voucher-based abstinence reinforcement is one of the most effective treatments for drug addiction and can maintain cocaine abstinence over extended periods of time, but practical methods of implementing these interventions are needed. Workplaces could be ideal and practical vehicles for arranging and maintaining abstinence reinforcement over long time periods. Our research on a model Therapeutic Workplace has shown that employment-based abstinence reinforcement, in which participants must provide drug-free urine samples to maintain maximum pay, can maintain cocaine abstinence. Now we need to develop effective and economically sound methods to arrange long-term exposure to employment-based abstinence reinforcement. We are proposing evaluate the effectiveness and economic benefits of a Wage Supplement Model of arranging long-term exposure to employment-based abstinence reinforcement. Under this model, successful Therapeutic Workplace participants are offered abstinence-contingent wage supplements if they obtain and maintain competitive employment. Governments have used wage supplements effectively to increase employment in welfare recipients. The Wage Supplement Model harnesses the power of wage supplements to promote employment, while simultaneously using the wage supplements to reinforce drug abstinence. The intervention will combine the Therapeutic Workplace, Individual Placement and Support (IPS) supported employment, and abstinence- contingent wage supplements. IPS is a supported employment intervention that has been proven effective in promoting employment in adults with severe mental illness. Under this model, participants will be exposed to the Therapeutic Workplace to initiate drug abstinence and establish job skills. To promote employment and prevent relapse to drug use, participants will receive IPS Plus Abstinence-Contingent Wage Supplements. A randomized trial will evaluate the effectiveness and economic benefits of the Abstinence-Contingent Wage Supplement Model in promoting employment and sustaining cocaine abstinence in low-income unemployed injection drug users who continue to use cocaine during opioid agonist treatment (N=120). Participants will be enrolled in the Therapeutic Workplace for 3 months and then randomly assigned to an IPS Only group or an IPS Plus Abstinence-Contingent Wage Supplement group for one year. IPS Only participants will receive the IPS intervention. IPS Plus Abstinence-Contingent Wage Supplement participants will receive the IPS intervention and abstinence-contingent wage supplements. Drug use while participants are employed in community jobs will be monitored by American Substance Abuse Professionals, Inc. (ASAP(r)), a leading provider of workplace substance abuse services in the U.S. This novel intervention could be an effective and economically sound way to promote long-term cocaine abstinence and employment in injection drug users, a population at risk for many adverse outcomes because of their poverty, unemployment and injection drug use.