title: Increasing employment of opioid dependent outpatients: an intensive behavioral intervention.
abstract: The impact of a new, mandatory employment requirement in a community-based methadone treatment program was evaluated. All patients who had been in the methadone substitution program for at least 1 year but who were not currently employed (n = 36) were required to enhance their treatment with 20 h of employment (paid or volunteer). Patients with significant psychiatric or medical disabilities were excluded from the routine treatment requirement. Patients were informed by counseling staff that they had 2 months to secure employment. Those who did not accomplish the goal within that time period were transferred to more intensive weekly counseling (i.e. up to 8 h/week) for 10 weeks, with the enhanced counseling focusing primarily on resistance to the employment goal. Patients who remained resistant to the treatment plan were eventually started on a 21 day methadone taper until employment was verified. Seventy-five percent of the patients secured employment and maintained the position for at least 1 month. Positions were found in an average of 60 days. Most patients (78%) continued working throughout the 6-month follow-up. Those who failed to find work or maintain employment engaged in more illicit drug use. These results demonstrate that behavioral contingencies can motivate many methadone maintenance patients to obtain verified employment in the community.
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: M
authors.initials: M
authors.lastname: Kidorf
authors.forename: J R
authors.initials: JR
authors.lastname: Hollander
authors.forename: V L
authors.initials: VL
authors.lastname: King
authors.forename: R K
authors.initials: RK
authors.lastname: Brooner
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001521:Behavior Therapy / Q000379:methods / Q000592:standards*; D003042:Cocaine / Q000652:urine; D015331:Cohort Studies; D019091:Critical Pathways; D004334:Drug Administration Schedule; D004651:Employment / Q000706:statistics & numerical data; D000431:Ethanol / Q000652:urine; D005260:Female; D006801:Humans; D008297:Male; D008691:Methadone / Q000627:therapeutic use*; D009294:Narcotics / Q000627:therapeutic use* / Q000652:urine; D009293:Opioid-Related Disorders / Q000150:complications / Q000534:rehabilitation* / Q000652:urine; D010352:Patient Dropouts; D015397:Program Evaluation; D016320:Substance Abuse Treatment Centers; D016896:Treatment Outcome; D014478:Unemployment / Q000523:psychology / Q000706:statistics & numerical data
chemical_list: D009294:Narcotics; D000431:Ethanol; D003042:Cocaine; D008691:Methadone