Background Community Reinforcement and Family Training (CRAFT) assists family members with a treatment-resistant loved-one. The most consistent outcome of CRAFT is increased treatment entry of the identified treatment-resistant person (IP). This led us to question whether all six components of CRAFT are necessary. Methods In a randomized clinical trial, 115 concerned significant others (CSOs) of an IP received 12–14 sessions of the full CRAFT intervention, 4–6 sessions focused on Treatment Entry Training (TEnT), or 12–14 sessions of Alanon/Nar-Anon Facilitation (ANF). We monitored treatment entry, attendance, and substance use of the IP and the CSO’s mood and functioning. Data were collected at baseline and 4-, 6-, and 9- months post-baseline. Results We found significant reductions in time to treatment entry (X2(2)=8.89, p=.01) and greater treatment entry rates for CRAFT (62%; OR=2.7, 95% CI=1.1–6.9) and TEnT (63%; OR=2.9, 95% CI=1.2–7.5) compared to ANF (37%), but CRAFT and TEnT did not differ significantly from each other (OR=1.1, 95% CI=0.4–2.7). No between-group differences in IP drug use were reported by CSOs, but days of drug use decreased over time for all groups (F(3, 277)=13.47, p<.0001). Similarly, CSO mood and functioning did not differ between the three conditions, but improved over time (p<.0001 for all significant measures). Conclusions We replicated the results of previous trials demonstrating that CRAFT produces greater treatment entry rates than ANF and found similar treatment entry rates for CRAFT and TEnT. This suggests that treatment entry training is sufficient for producing the best established outcome of CRAFT.

This study empirically examined opinions of treatment providers regarding Contingency Management (CM) programs while controlling for experience with a specific efficacious CM program. In addition to empirically describing provider opinions, we examined whether the opinions of providers at the sites that implemented the CM program were more positive than those of matched providers at sites that did not implement it. Participants from 7 CM treatment sites (n = 76) and 7 matched non-participating sites (n = 69) within the same nodes of NIDA's Clinical Trials Network completed the Provider Survey of Incentives (PSI), which assesses positive and negative beliefs about incentive programs. An intent-to-treat analysis found no differences in the PSI summary scores of providers in CM program vs. matched sites, but correcting for experience with tangible incentives showed significant differences, with providers from CM sites reporting more positive opinions than those from matched sites. Some differences were found in opinions regarding costs of incentives and these generally indicated that participants from CM sites were more likely to see the costs as worthwhile. The results from the study suggest that exposing community treatment providers to incentive programs may itself be an effective strategy in prompting the dissemination of CM interventions.

Contingency management (CM) for drug abstinence has been applied to individuals independently even when delivered in groups. We developed a group CM intervention in which the behavior of a single, randomly selected, anonymous individual determined reinforcement delivery for the entire group. We also compared contingencies placed only on cocaine abstinence (CA) versus one of four behaviors (CA, treatment attendance, group CM attendance, and methadone compliance) selected randomly at each drawing. Two groups were formed with 22 cocaine-dependent community-based methadone patients and exposed to both CA and multiple behavior (MB) conditions in a reversal design counterbalanced across groups for exposure order. The group CM intervention proved feasible and safe. The MB condition improved group CM meeting attendance relative to the CA condition.

This study assesses the frequency that users of illicit drugs display unprofessional behaviors in an employment setting. This research was conducted in the Therapeutic Workplace, a model employment-based treatment program for chronically unemployed adults with long-histories of illicit drug use. Unemployed adults in methadone treatment, who were opiate and cocaine dependent, showed signs of injection drug use, and recently used cocaine were hired to work for 4 hours every weekday for 7 months. Results show that while the overall incidence of many undesirable behaviors is low, a small percentage of participants had serious workplace behavior problems that might limit their success in community workplaces. This study suggests that unprofessional behavior in the workplace could contribute to chronic unemployment in this population. KeywordsEmployment; Heroin Addiction; Cocaine Addiction; Contingency management; Reinforcement; Vocation rehabilitation Chronic unemployment is a serious problem among individuals with long histories of illicit drug use, and has been associated with continued drug use, poor treatment outcome, and criminal activity (Platt, 1995). A recent review showed that employment interventions for unemployed adults who have histories of drug addiction have had mixed effects. Some interventions had little or no effect in increasing employment (e.g., Coviello et al. 2004;Hall et al. 1981b;Butler et al. 2004;Lidz et al. 2004); others increased the percentage of individuals who obtained paid employment (e.g., Hall et al. 1981a;Staines et al. 2004). Most evaluations of employment interventions reviewed examined whether individuals exposed to the employment interventions obtained a job. However, little research has been conducted to examine the extent to which program participants maintain employment over extended periods of time. The information that is available on longer-term outcomes suggests that many intervention graduates who obtain employment do not reliably maintain their employment over time (e.g., Platt et al. 1993;Kemp et al. 2004; Dickinson and Maynard, 1981 NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptEvaluations of the few intensive programs that provide job skills training and supported employment show that many participants fail even to maintain their supported employment jobs and many who obtain competitive employment fail to maintain those jobs overtime (e.g., Dickinson and Maynard, 1981;Kemp et al. 2004). One of the most extensive and informative studies of employment interventions for illicit drugs users evaluated the effects of an intensive supported work intervention in 1,433 adults who were unemployed and who had been in substance use treatment within 6 months of enrollment in the study (Dickinson and Maynard, 1981). Participants were randomly assigned to receive the supported employment intervention or to a control condition. Supported employment participants could work in supported jobs for between 12 and 18 months. The supported jobs provid...