The therapeutic workplace to promote treatment engagement and drug abstinence in out-of-treatment injection drug users: A randomized controlled trial

Holtyn, August F.; Koffarnus, Mikhail N.; DeFulio, Anthony; Sigurðsson, Sigurður; Strain, Eric C.; Schwartz, Robert P.; Leoutsakos, Jeannie Marie S.; Silverman, Kenneth

doi:10.1016/j.ypmed.2014.02.021

Cited by 21 publications

(33 citation statements)

References 60 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Using data from this research effort on pregnant smokers, Heil et al (2014–in this issue) provides novel evidence on the time-course of changes in smoking once a women learns of a pregnancy that draws attention to the potential for intervening even prior to the start of prenatal care using incentives or other behavior-change strategies. Holtyn et al (2014–in this issue) report the results of a RCT on financial incentives in another vulnerable population, demonstrating how they can be used effectively to engage and increase abstinence among chronically unemployed, intravenous drug abusers. Harvey and Ogden (2014–in this issue) contribute a careful review of the literature on weight loss interventions in disadvantaged women demonstrating important gaps in meeting the needs of this vulnerable population, underscoring the potential utility of combining the financial incentives strategy discussed above with telecommunications strategies that Harvey and others have effectively utilized in weight loss interventions to meet that need.…”

Section: Behavior Change Health and Health Disparitiesmentioning

confidence: 99%

Behavior change, health, and health disparities: An introduction

Higgins

2014

Preventive Medicine

View full text Add to dashboard Cite

This Special Issue of Preventive Medicine (PM) focuses on behavior change, health, and health disparities, topics of fundamental importance to improving population health in the U.S. and other industrialized countries. While the U.S. health care system and those of other industrialized countries were developed to manage infectious disease and acute illnesses, it is chronic health conditions that most need to be understood and managed in the 21st century. The evidence is clear that personal behavior patterns like cigarette smoking and physical inactivity/obesity are critically important proximal causes of chronic disease (cardiovascular disease, site-specific cancers, type-2 diabetes) and as such behavior change will need to be a key component of their management. As the outstanding contributions to this Special Issue illustrate, substantial headway is being made in advancing knowledge including developing effective prevention and treatment strategies, with cigarette smoking being an excellent example that change is possible. That said, cigarette smoking continues to be responsible for approximately 480,000 premature deaths annually in the U.S. alone and 5 million globally. So more needs to be done, especially in economically disadvantaged populations. The same certainly applies to the challenges of the obesity epidemic, which of course is a more recent problem and understandably efforts to curtail it are in earlier stages of development.

show abstract

Section: Behavior Change Health and Health Disparitiesmentioning

confidence: 99%

Behavior change, health, and health disparities: An introduction

Higgins

2014

Preventive Medicine

View full text Add to dashboard Cite

show abstract

“…Participants have frequently been allowed to attend the Therapeutic Workplace at the beginning of Phase 1 without requiring that they provide drug-free urine samples to work or to maintain maximum pay (Donlin et al, 2008; Holtyn et al, 2014; Silverman et al, 2007). During this “induction” period, participants are invited to attend the workplace four hours every weekday, where they can earn money for working.…”

Section: Lessons From Research On the Therapeutic Workplace Interventmentioning

confidence: 99%

“…One showed positive results (Silverman, Svikis, Robles, Stitzer, & Bigelow, 2001) and one showed negative results (Knealing, Wong, Diemer, Hampton, & Silverman, 2006). One study (Holtyn, Koffarnus, DeFulio, Sigurdsson, Strain, Schwartz, & Silverman, 2014; Holtyn, Koffarnus, DeFulio, Sigurdsson, Strain, Schwartz, Leoutsakos et al, 2014), designed to promote abstinence from both opiates and cocaine in adults who were out-of-treatment and injected drugs, arranged employment-based reinforcement for participants enrolled in the Therapeutic Workplace first for enrolling in methadone treatment; then for providing urine samples every Monday, Wednesday and Friday that were negative for opiates; and then for providing urine samples that were negative for opiates and cocaine. The study showed that the sequential application of abstinence reinforcement contingencies was effective in promoting abstinence from opiates and cocaine.…”

Section: Lessons From Research On the Therapeutic Workplace Interventmentioning

confidence: 99%

“…This contingency arranges an immediate and substantial consequence for a drug-positive urine sample; however, it may also reduce attendance in the workplace (Silverman et al 2007). One study recently arranged an employment-based abstinence reinforcement contingency in which participants receive a temporary decrease in their hourly pay when they provide a drug-positive urine sample, but they are allowed to work under the reduced pay rate (Holtyn, Koffarnus, DeFulio, Sigurdsson, Strain, Schwartz, & Silverman, 2014; Holtyn, Koffarnus, DeFulio, Sigurdsson, Strain, Schwartz, Leoutsakos et al, 2014). Importantly, the more lenient employment-based abstinence reinforcement contingency was effective in promoting abstinence from opiates and cocaine and did not appear to reduce workplace attendance.…”

Section: Lessons From Research On the Therapeutic Workplace Interventmentioning

confidence: 99%

“…The two types of employment-based abstinence reinforcement contingencies have not been experimentally compared, so we do not know for certain whether either has benefits over the other. However, the recent results (Holtyn, Koffarnus, DeFulio, Sigurdsson, Strain, Schwartz, & Silverman, 2014; Holtyn, Koffarnus, DeFulio, Sigurdsson, Strain, Schwartz, Leoutsakos et al, 2014) suggest that a temporary decrease in pay for drug positive urine samples may be sufficient to promote drug abstinence and can do so without reducing attendance.…”

Section: Lessons From Research On the Therapeutic Workplace Interventmentioning

confidence: 99%

See 2 more Smart Citations

The therapeutic utility of employment in treating drug addiction: Science to application.

Silverman¹,

Holtyn²,

Morrison³

2016

Translational Issues in Psychological Science

Self Cite

View full text Add to dashboard Cite

Research on a model Therapeutic Workplace has allowed for evaluation of the use of employment in the treatment of drug addiction. Under the Therapeutic Workplace intervention, adults with histories of drug addiction are hired and paid to work. To promote drug abstinence or adherence to addiction medications, participants are required to provide drug-free urine samples or take prescribed addiction medications, respectively, to gain access to the workplace and/or to maintain their maximum rate of pay. Research has shown that the Therapeutic Workplace intervention is effective in promoting and maintaining abstinence from heroin, cocaine and alcohol and in promoting adherence to naltrexone. Three models could be used to implement and maintain employment-based reinforcement in the treatment of drug addiction: A Social Business model, a Cooperative Employer model, and a Wage Supplement model. Under all models, participants initiate abstinence in a training and abstinence initiation phase (Phase 1). Under the Social Business model, Phase 1 graduates are hired as employees in a social business and required to maintain abstinence to maintain employment and/or maximum pay. Under the Cooperative Employer model, cooperating community employers hire graduates of Phase 1 and require them to maintain abstinence to maintain employment and/or maximum pay. Under the Wage Supplement Model, graduates of Phase 1 are offered abstinence-contingent wage supplements if they maintain competitive employment in a community job. Given the severity and persistence of the problem of drug addiction and the lack of treatments that can produce lasting effects, continued development of the Therapeutic Workplace is warranted.

show abstract