Reinforcing productivity in a job-skills training program for unemployed substance-abusing adults.

Subramaniam, Shrinidhi; Everly, Jeffrey J.; Silverman, Kenneth

doi:10.1037/bar0000077

Cited by 8 publications

(9 citation statements)

References 35 publications

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“…This is consistent with prior studies demonstrating the utility of incentives in promoting attendance and performance in job skills training programmes for unemployed adults with substance use disorders 40. Those studies have shown that unemployed adults will attend a job skills training programme primarily when offered incentives for attendance36 41 42; and they will work on training programmes, but primarily when offered incentives based on their performance on the training programmes 43 44…”

Section: Discussionsupporting

confidence: 87%

Abstinence-contingent wage supplements to promote drug abstinence and employment: a randomised controlled trial

Holtyn

Toegel

Subramaniam

et al. 2020

J Epidemiol Community Health

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BackgroundPoverty, unemployment and substance abuse are inter-related problems. This study evaluated the effectiveness of abstinence-contingent wage supplements in promoting drug abstinence and employment in unemployed adults in outpatient treatment for opioid use disorder.MethodsA randomised controlled trial was conducted in Baltimore, MD, from 2014 to 2019. After a 3-month abstinence initiation and training period, participants (n=91) were randomly assigned to a usual care control group that received employment services or to an abstinence-contingent wage supplement group that received employment services plus abstinence-contingent wage supplements. All participants were invited to work with an employment specialist to seek employment in a community job for 12 months. Abstinence-contingent wage supplement participants could earn training stipends for working with the employment specialist and wage supplements for working in a community job, but had to provide opiate and cocaine-negative urine samples to maximise pay.ResultsAbstinence-contingent wage supplement participants provided significantly more opiate and cocaine-negative urine samples than usual care control participants (65% vs 45%; OR=2.29, 95% CI 1.22 to 4.30, p=0.01) during the 12-month intervention. Abstinence-contingent wage supplement participants were significantly more likely to have obtained employment (59% vs 28%; OR=3.88, 95% CI 1.60 to 9.41, p=0.004) and lived out of poverty (61% vs 30%; OR=3.77, 95% CI 1.57 to 9.04, p=0.004) by the end of the 12-month intervention than usual care control participants.ConclusionAbstinence-contingent wage supplements can promote drug abstinence and employment.Trial registration numberClinicalTrials.gov NCT02487745.

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Section: Discussionsupporting

confidence: 87%

Abstinence-contingent wage supplements to promote drug abstinence and employment: a randomised controlled trial

Holtyn

Toegel

Subramaniam

et al. 2020

J Epidemiol Community Health

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“…They suggested that the external work requirement, in particular, helped them to feel "productive" and develop job skills that would help them build a new life outside of the treatment facility, which, in turn, helped motivate their continued engagement. Securing and maintaining employment has long been a challenge for people with a history of substance use disorder, leading some treatment programs to integrate vocational training and support [51][52][53][54] ; while the results of these programs have been mixed, 52,53 our findings indicate that working outside of the facility during long-term treatment can provide additional benefits, including motivating clients to remain engaged with their treatment.…”

Section: Discussionmentioning

confidence: 85%

Motivations for Treatment Engagement in a Residential Substance Use Disorder Treatment Program: A Qualitative Study

Dillon

Kedia

Isehunwa³

et al. 2020

Subst�Abuse

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Aims: The aim of this study was to explore perspectives on motivations for treatment engagement from substance use disorder (SUD) clients in a long-term residential rehabilitation program. Design and Methods: A convenience sample of 30 clients who were enrolled in a year-long SUD treatment program at a residential rehabilitation facility took part in in-depth interviews. Interview transcripts were analyzed using the directed content analysis approach. Results: Participant accounts indicated that their treatment engagement was motivated by factors that aligned with the six primary constructs of the Health Belief Model: (i) perceived susceptibility (eg, believing that their substance use required intervention and that they were prone to relapse), (ii) perceived severity (eg, substance use negatively impacted their health and harmed their close relationships), (iii) perceived benefits (eg, opportunities for a better life, reconnecting with family members and close friends, & avoiding legal consequences), (iv) perceived barriers (eg, the length of the treatment program), (v) cues to actions (eg, decisive moments, elements of the treatment program, & faith and spirituality), and (vi) self-efficacy in remaining abstinent (eg, treatment program provided them with skills and experiences to maintain long-term sobriety). Discussion: Our analysis indicates that participants’ treatment engagement was linked to their beliefs regarding the severity of their substance use disorder, their treatment program’s ability to help them avoid future relapse, and their own capability to act upon the strategies and resources provided by the treatment program. A theoretical understanding of these aspects can contribute to the future planning of precision interventions.

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“…Participants worked significantly more and completed more training steps when they could earn stipends for training performance than when they only earned base pay. Another study replicated those results (Subramaniam, Everly, & Silverman, 2017).…”

Section: Systematic Investigations Of Incentives For Skill Development In Low-income Adultsmentioning

confidence: 54%

“…Our research has shown that special contingencies may be required and effective to promote training and work behaviors. In particular, our participants will attend our training program, but primarily when offered financial incentives for attendance (Koffarnus et al, 2011;Koffarnus et al, 2013b;Silverman et al, 1996a); they will work on training programs, but primarily when offered some portion of their pay contingent on performance on training programs (Koffarnus et al, 2013a;Subramaniam et al, 2017); they will work with an employment specialist to look for employment, but primarily when offered stipends for working with the employment specialist (Silverman et al, 2018); and as employees in a therapeutic workplace business, they will arrive to work on time and work complete work shifts, but primarily when special contingencies are arranged to promote punctuality and complete work shifts (Wong et al, 2004a(Wong et al, , 2004b. This research has demonstrated both the limitations of the adults who have participated in the therapeutic workplace and potential reinforcement contingencies that could be effective in promoting skill development and employment in this population.…”

Section: Remaining Challenges To Address Poverty and Drug Addictionmentioning

confidence: 99%

The Utility of Operant Conditioning to Address Poverty and Drug Addiction

2019

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Poverty is associated with poor health. This article reviews research on proximal and distal operant interventions to address drug addiction and poverty. Proximal interventions promote health behaviors directly. Abstinence reinforcement, a common proximal intervention for the treatment of drug addiction, can be effective. Manipulating familiar parameters of operant conditioning can improve the effectiveness of abstinence reinforcement. Increasing reinforcement magnitude can increase the proportion of individuals that respond to abstinence reinforcement, arranging long-term exposure to abstinence reinforcement can prevent relapse, and arranging abstinence reinforcement sequentially across drugs can promote abstinence from multiple drugs. Distal interventions reduce risk factors that underlie poor health and may have an indirect beneficial effect on health. In the case of poverty, distal interventions seek to move people out of poverty. The therapeutic workplace includes both proximal and distal interventions to treat drug addiction and poverty. In the therapeutic workplace, participants earn stipends or wages to work. The therapeutic workplace uses employment-based reinforcement in which participants are required to provide drug-free urine samples or take scheduled doses of addiction medications to work and/or maintain maximum pay. The therapeutic workplace has two phases, a training and an employment phase. Special contingencies appear required to promote skill development during the training phase, employment-based reinforcement can promote abstinence from heroin and cocaine and adherence to naltrexone, and the therapeutic workplace can increase employment. Behavior analysts are well-suited to address both poverty and drug addiction using operant interventions like the therapeutic workplace.

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Reinforcing productivity in a job-skills training program for unemployed substance-abusing adults.

Cited by 8 publications

References 35 publications

Abstinence-contingent wage supplements to promote drug abstinence and employment: a randomised controlled trial

Abstinence-contingent wage supplements to promote drug abstinence and employment: a randomised controlled trial

Motivations for Treatment Engagement in a Residential Substance Use Disorder Treatment Program: A Qualitative Study

The Utility of Operant Conditioning to Address Poverty and Drug Addiction

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