title: A randomized clinical trial of a Therapeutic Workplace for chronically unemployed, homeless, alcohol-dependent adults.
abstract: OBJECTIVE
  To assess the efficacy of the Therapeutic Workplace, a substance abuse intervention that promotes abstinence while simultaneously addressing the issues of poverty and lack of job skills, in promoting abstinence from alcohol among homeless alcoholics.
  
  
  METHODS
  Participants (n = 124) were randomly assigned to conditions either requiring abstinence from alcohol to engage in paid job skills training (Contingent Paid Training group), offering paid job skills training with no abstinence contingencies (Paid Training group) or offering unpaid job skill training with no abstinence contingencies (Unpaid Training group).
  
  
  RESULTS
  Participants in the Contingent Paid Training group had significantly fewer positive (blood alcohol level ≥ 0.004 g/dl) breath samples than the Paid Training group in both randomly scheduled breath samples collected in the community and breath samples collected during monthly assessments. The breath sample results from the Unpaid Training group were similar in absolute terms to the Contingent Paid Training group, which may have been influenced by a lower breath sample collection rate in this group and fewer reported drinks per day consumed at intake.
  
  
  CONCLUSIONS
  Overall, the results support the utility of the Therapeutic Workplace intervention to promote abstinence from alcohol among homeless alcoholics, and support paid training as a way of increasing engagement in training programs.
authors.affiliation: Center for Learning and Health, Johns Hopkins University School of Medicine, MFL W142, 5200 Eastern Ave., Baltimore, MD 21224, USA. ksilverm@jhmi.edu
authors.forename: Mikhail N
authors.initials: MN
authors.lastname: Koffarnus
authors.forename: Conrad J
authors.initials: CJ
authors.lastname: Wong
authors.forename: Karly
authors.initials: K
authors.lastname: Diemer
authors.forename: Mick
authors.initials: M
authors.lastname: Needham
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Hampton
authors.forename: Michael
authors.initials: M
authors.lastname: Fingerhood
authors.forename: Dace S
authors.initials: DS
authors.lastname: Svikis
authors.forename: George E
authors.initials: GE
authors.lastname: Bigelow
authors.forename: Kenneth
authors.initials: K
authors.lastname: Silverman
mesh_terms: D000328:Adult; D057229:Alcoholics / Q000523:psychology*; D000437:Alcoholism / Q000534:rehabilitation* / Q000628:therapy; D001521:Behavior Therapy / Q000379:methods*; D001944:Breath Tests; D004526:Efficiency; D005260:Female; D006678:HIV; D006703:Ill-Housed Persons; D006801:Humans; D007406:Interview, Psychological; D008297:Male; D009042:Motivation; D012201:Reward; D040242:Risk Reduction Behavior; D013663:Teaching / Q000379:methods; D013695:Temperance / Q000523:psychology*; D016896:Treatment Outcome; D014478:Unemployment; D014830:Vocational Guidance; D017132:Workplace