Attendance Rates in a Workplace Predict Subsequent Outcome of Employment‐based Reinforcement of Cocaine Abstinence in Methadone Patients

Abstract

This study assessed whether attendance rates in a workplace predicted subsequent outcome of employment-based reinforcement of cocaine abstinence. Unemployed adults in Baltimore methadone programs who used cocaine (N 5 111) could work in a workplace for 4 hr every weekday and earn $10.00 per hour in vouchers for 26 weeks. During an induction period, participants provided urine samples but could work independent of their urinalysis results. After the induction period, participants had to provide urinalysis evidence of cocaine abstinence to work and maintain maximum pay. A multiple regression analysis showed that induction period attendance was independently associated with urinalysis evidence of cocaine abstinence under the employment-based abstinence reinforcement contingency. Induction period attendance may measure the reinforcing value of employment and could be used to guide the improvement of employment-based abstinence reinforcement.

Employment-based abstinence reinforcement following inpatient detoxification in HIV-positive opioid and/or cocaine-dependent patients.

“…Results did not support our primary hypothesis that contingencies placed on drug abstinence and workplace attendance (Abstinence & Work) would produce greater rates of abstinence than no abstinence contingencies. As seen in Table 2 and Figures 1 and 2, participants in this study who were randomly assigned to an Abstinence & Work contingency group were not significantly more likely to abstain from opiates and cocaine when compared to control participants, which is inconsistent with previous studies of employment-based reinforcement that have reported significant differences in drug abstinence between experimental and control groups (Donlin et al, 2008; Silverman et al, 2001; Silverman et al, 2007). …”

“…Previous contingency-based studies that require abstinence from multiple drugs have introduced those contingencies sequentially by requiring participants to achieve abstinence from their primary drug first (e.g., opiates) before introducing abstinence contingencies for secondary drugs (e.g., cocaine). This approach is supported by a meta-analysis that confirmed participants are less successful when they are required to abstain from multiple drugs simultaneously versus sequentially (e.g., Lussier et al 2006), and a previous Therapeutic Workplace study that was able to successful promote abstinence from multiple drugs when those contingencies were introduced sequentially (Donlin et al, 2008). Examination of the data in the current study suggests that the abstinence contingencies may have prevented attendance in the Abstinence & Work group.…”

Randomized Controlled Trial of Contingency Management for Stimulant Use in Community Mental Health Patients With Serious Mental Illness

“…While groups did not differ in terms psychiatric severity or homelessness, it is possible that lower functioning individuals were more likely to consistently attend study sessions when provided with reinforcement for attendance, but not when the additional contingency of abstinence was added. Others have found that treatment completion is improved after exposing patients to an initial period of non-contingent reinforcement (37). This and other approaches (e.g., providing higher value rewards, such as housing (38), or adding contingency management to evidence-based treatments for mental illness) might improve treatment retention in this population.…”

“…While the cost of delivering contingency management increases when individuals respond to the treatment (they receive more prizes), this increase is modest compared to savings in inpatient care demonstrated in this and other studies (14). While a number of innovative strategies have been explored to provide funding for contingency management reinforcers (e.g., use of donated funds/prizes, opportunities to work) (37), it is likely that contingency management will continue to be underutilized until payers provide funding for the costs of delivering this treatment. An example of this type of reform recently occurred within the Veteran's Administration where contingency management has been approved as a treatment of illicit drug use in veterans receiving intensive outpatient treatment (40).…”

Employment-based reinforcement of adherence to oral naltrexone in unemployed injection drug users: 12-month outcomes.

“…Participants earned $8.00 per hour in base pay and could earn up to $2.00 more per hour based on their productivity in the computerized training programs. Detailed descriptions of the therapeutic workplace, the web-based training programs, the staffing requirements, and the cost of the intervention can be found elsewhere (DeFulio, Donlin, Wong, & Silverman, 2009; Donlin, Knealing, Needham, Wong, & Silverman, 2008; Knealing, Roebuck, Wong, & Silverman, 2008; Silverman et al, 2007). …”