The effect evaluation of Individual Placement and Support (IPS) for patients with substance use disorders: study protocol for a randomized controlled trial of IPS versus enhanced self-help

Abstract

Background Employment is associated with better outcomes of substance use treatment and protects against relapse after treatment completion. Unemployment rates are high for people with substance use disorders (SUD) who undergo treatment, with Norwegian estimates ranging from 81 to 91%. Evidence-based vocational models are lacking for patients in SUD treatment but exist for patients with psychosis in terms of Individual Placement and Support (IPS). The aim of the IPS for substance use disorders (IPS-SUD) trial is to investigate the effect of IPS in a SUD population. Methods/design The IPS-SUD trial is a randomized controlled trial (RCT) comparing IPS to an enhanced control intervention. The study is a seven-site, two-arm, pragmatic, parallel-group, superiority RCT. Participants are randomly assigned (1:1) to receive either IPS plus treatment as usual (TAU) or to receive a self-help guide book and 12-h workshop plus 1-h individual vocational guidance plus TAU. Aiming to recruit 200 participants, we will be able to detect a 20% difference in the main outcome of employment with 90% power. We will make assessments at inclusion and at 6- and 12-month follow-ups and obtain outcome data on employment from national mandatory registries. The primary outcome will be at least 1 day of competitive employment during the 18-month follow-up period. Secondary employment outcomes will capture the pattern and extent of employment in terms of total time worked (days/hours), time to first employment, number of different jobs, duration of the longest employment, and sustained employment. Secondary non-employment outcomes will be substance use, mental distress, and quality of life measured by validated instruments at 6, 12, and 18 months follow-up assessments. To be eligible, participants must be between 18 and 65 years, currently unemployed and in treatment for SUD. Discussion The IPS-SUD trial will provide evidence for the use of IPS in a SUD population. Findings from the study will have implications for service delivery. Trial registration ClinicalTrials.gov NCT04289415. Registered on February 28, 2020

The effect of employment support integrated in substance use treatment: A health economic cost-effectiveness simulation of three different interventions

“…A Norwegian five-year prospective study of drug users found that 45% were imprisoned at least once during the study period, with a mean duration of 65 incarcerated days ( Gjersing & Bretteville-Jensen, 2021 ). We know that treatment, including opioid maintenance treatment for persons with opioid dependency, is associated with reductions in criminal behaviour and convictions ( Gossop et al, 2005 ; Lind et al, 2005 ; Soyka et al, 2012 ). The average cost per inmate per day in Norway is €318 ( Aebi & Tiago, 2021 ).…”

“…The impact of employment on substance use, mental health and quality of life is of utmost importance for those involved. These outcomes will be made available through our ongoing RCT (Rognli et al, 2021).…”

“…The other trial takes place in Norway, with inclusion completed and results expected in 2024. Details of the Norwegian trial are presented in a protocol paper (Rognli et al, 2021).…”

What does Dame Carol Black’s review of drug and alcohol misuse services mean for probation services?

“…Nonetheless, it is reasonable to assume that more intensive support is required for a cohort characterised by mental health problems, a history of trauma and the stigma of criminalisation. The review notes that a randomised control trial is underway for Individual Placement and Support (IPS) for the substance misuse population in England (Rognli et al, 2021). A recent systematic review of the IPS initiative found that such programmes improve employment rates, hours worked and wages earned for people with drug and alcohol problems (Harrison et al, 2020).…”

Arbeidsrettet behandling ved alvorlig psykisk lidelse i spesialisthelsetjenesten

“…Det er imidlertid ikke knyttet forskning til noen av disse tiltakene, og det finnes ingen rapporter eller evalueringer om IPS og rus. En pågående RCT ved Oslo universitetssykehus avsluttet inklusjon av deltakere i juni 2022, og vil vaere et viktig bidrag til den internasjonale litteraturen om IPS og rus (Rognli et al, 2021).…”