title: The therapeutic workplace to promote treatment engagement and drug abstinence in out-of-treatment injection drug users: a randomized controlled trial.
abstract: OBJECTIVE
  Determine if employment-based reinforcement can increase methadone treatment engagement and drug abstinence in out-of-treatment injection drug users.
  
  
  METHODS
  This study was conducted from 2008 to 2012 in a therapeutic workplace in Baltimore, MD. After a 4-week induction, participants (N=98) could work and earn pay for 26 weeks and were randomly assigned to Work Reinforcement, Methadone & Work Reinforcement, and Abstinence, Methadone & Work Reinforcement conditions. Work Reinforcement participants had to work to earn pay. Methadone & Work Reinforcement and Abstinence, Methadone, & Work Reinforcement participants had to enroll in methadone treatment to work and maximize pay. Abstinence, Methadone, & Work Reinforcement participants had to provide opiate- and cocaine-negative urine samples to maximize pay.
  
  
  RESULTS
  Most participants (92%) enrolled in methadone treatment during induction. Drug abstinence increased as a graded function of the addition of the methadone and abstinence contingencies. Abstinence, Methadone & Work Reinforcement participants provided significantly more urine samples negative for opiates (75% versus 54%) and cocaine (57% versus 32%) than Work Reinforcement participants. Methadone & Work Reinforcement participants provided significantly more cocaine-negative samples than Work Reinforcement participants (55% versus 32%).
  
  
  CONCLUSIONS
  The therapeutic workplace can promote drug abstinence in out-of-treatment injection drug users. Clinical trial registration number: NCT01416584.
authors.affiliation: Johns Hopkins University School of Medicine, USA.
authors.forename: August F
authors.initials: AF
authors.lastname: Holtyn
authors.affiliation: Virginia Tech Carilion Research Institute, USA.
authors.forename: Mikhail N
authors.initials: MN
authors.lastname: Koffarnus
authors.affiliation: Johns Hopkins University School of Medicine, USA.
authors.forename: Anthony
authors.initials: A
authors.lastname: DeFulio
authors.affiliation: Johns Hopkins University School of Medicine, USA; Florida Institute of Technology, USA.
authors.forename: Sigurdur O
authors.initials: SO
authors.lastname: Sigurdsson
authors.affiliation: Johns Hopkins University School of Medicine, USA.
authors.forename: Eric C
authors.initials: EC
authors.lastname: Strain
authors.affiliation: Friends Research Institute, USA.
authors.forename: Robert P
authors.initials: RP
authors.lastname: Schwartz
authors.affiliation: Johns Hopkins University School of Medicine, USA.
authors.forename: Jeannie-Marie S
authors.initials: JM
authors.lastname: Leoutsakos
authors.affiliation: Johns Hopkins University School of Medicine, USA. Electronic address: ksilverm@jhmi.edu.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Silverman
mesh_terms: D000701:Analgesics, Opioid / Q000627:therapeutic use*; D015142:Baltimore; D019970:Cocaine-Related Disorders / Q000188:drug therapy* / Q000523:psychology* / Q000652:urine; D004651:Employment / Q000523:psychology; D015438:Health Behavior; D006784:Hospitals, Teaching; D006801:Humans; D007407:Interviews as Topic; D008691:Methadone / Q000627:therapeutic use*; D009042:Motivation; D009293:Opioid-Related Disorders / Q000188:drug therapy* / Q000523:psychology* / Q000652:urine; D012054:Reinforcement, Psychology; D015813:Substance Abuse Detection; D015819:Substance Abuse, Intravenous; D016896:Treatment Outcome; D017132:Workplace / Q000523:psychology*
chemical_list: D000701:Analgesics, Opioid; D008691:Methadone
keywords: Cocaine; Contingency management; Employment; Financial incentives; Injection drug use; Methadone; Opiate; Out-of-treatment injection drug user