Abstinence-contingent wage supplements to promote drug abstinence and employment: a randomised controlled trial

• Published in: Journal of epidemiology and community health (1979) 2020-05, Vol.74 (5), p.445-452
• Main Authors: Holtyn, August F, Toegel, Forrest, Subramaniam, Shrinidhi, Jarvis, Brantley P, Leoutsakos, Jeannie-Marie, Fingerhood, Michael, Silverman, Kenneth
• Format: Article
• Language: English
• Subjects: Abstinence; Adult; Analgesics, Opioid - urine; Baltimore; Business models; Clinical trials; Cocaine; Cocaine-Related Disorders - rehabilitation; Cocaine-Related Disorders - urine; Drug abuse; Drug addiction; Drug use; Employers; Employment; Employment - statistics & numerical data; Female; Heroin; Humans; Intervention; Low income groups; Male; Methadone - therapeutic use; Narcotics; Narcotics - adverse effects; Narcotics - therapeutic use; Opiate Substitution Treatment; Opioid-Related Disorders - rehabilitation; Opioid-Related Disorders - urine; Opioids; Outcome Assessment, Health Care - statistics & numerical data; Poverty; Reinforcement, Psychology; Salaries and Fringe Benefits; Schedules; Substance use disorder; Training; Urine
• ISSN: 0143-005X; 1470-2738; 1470-2738
• DOI: 10.1136/jech-2020-213761

BackgroundPoverty, unemployment and substance abuse are inter-related problems. This study evaluated the effectiveness of abstinence-contingent wage supplements in promoting drug abstinence and employment in unemployed adults in outpatient treatment for opioid use disorder.MethodsA randomised controlled trial was conducted in Baltimore, MD, from 2014 to 2019. After a 3-month abstinence initiation and training period, participants (n=91) were randomly assigned to a usual care control group that received employment services or to an abstinence-contingent wage supplement group that received employment services plus abstinence-contingent wage supplements. All participants were invited to work with an employment specialist to seek employment in a community job for 12 months. Abstinence-contingent wage supplement participants could earn training stipends for working with the employment specialist and wage supplements for working in a community job, but had to provide opiate and cocaine-negative urine samples to maximise pay.ResultsAbstinence-contingent wage supplement participants provided significantly more opiate and cocaine-negative urine samples than usual care control participants (65% vs 45%; OR=2.29, 95% CI 1.22 to 4.30, p=0.01) during the 12-month intervention. Abstinence-contingent wage supplement participants were significantly more likely to have obtained employment (59% vs 28%; OR=3.88, 95% CI 1.60 to 9.41, p=0.004) and lived out of poverty (61% vs 30%; OR=3.77, 95% CI 1.57 to 9.04, p=0.004) by the end of the 12-month intervention than usual care control participants.ConclusionAbstinence-contingent wage supplements can promote drug abstinence and employment.Trial registration numberClinicalTrials.gov NCT02487745.