online appendix evidence tables. - emcdda | european monitoring

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Online Appendix – evidence tables.

Data extracted from key primary studies that informed the evidence review. Only employment outcomes are reported here. NB Individual

studies included (and summarised) in (systematic) reviews and referred to in the text are not presented.

Abbreviations RCT Randomised Controlled Study; CBA Controlled Before and After; UCBA Uncontrolled Before and After; NR data not

reported; NA Data not applicable

Residential Rehabilitation

Study detail

Participant Details Intervention Details Analyses Results

Authors: Rosenheck & Seibyl (1997) Country: USA Setting: Residential Accommodation Funding source: Veterans Administration Study design: Cross sectional Author Objectives: To examine the effectiveness of a residential work therapy programme for veterans with chronic, severe substance dependency

Total participant number: 496 Intervention number (%):496 (100) Control number (%): N/A Proportion male (%): 97% Age/Age range/mean: 40.5 Ethnicity: 51.9% White: 43.6% Black; 1.4% Hispanic, 3% other Other baseline measures: NR Groups balanced at Baseline: NR Comments: Veterans who were followed up were less likely to have been homeless when last living in the community, had higher mean Global Assessment of Functioning scones, a longer mean length of stay in the programme and were more likely to have had a mutually agreed on discharge Unit of allocation: Individual Method of recruitment: NR

Inclusion criteria: Veterans with chronic, severe substance use disorders. Exclusion criteria: NR Programme Name: Compensated Work Therapy-Transitional Residence programme. Aims: Promote responsible community-oriented behaviour, such as working at a job and paying rent, in addition to staying sober and participating in treatment. Key Components Residential support with demands for responsible behaviour. Theoretical base: NR Programme Type: Residential rehabilitation Method of Delivery: Work therapy Providers/deliverers: Trained support workers Length, duration, intensity: 6 months

Time to follow-up: 3 months after discharge Data: 1990-1994; weekly toxicology data; interviews (baseline/follow-up) Self report/validated: SR Methods used: Questionnaire/records Unit of analysis: Individual Any other process detail: Number of participants completing (%):496 (100) Reasons for non-completion: N/A

Employment outcome: Significant improvement from admission to follow-up in all domains except the three measures associated with psychiatric problems. Regression analyses showed the more psychiatric problems the less likely they were to work; the higher their global assessment functioning; if previously employed within the last 3 years and if housed within the last three months the more likely the veterans were to work. More intensive treatment was associated with improvement in health status, employment, and housing. Earnings per week, was associated with better employment outcome. Veterans worked an average of 10.6 -31.8 hours a week on the programme; they earned an average of $154.28+$63.70

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Study detail Participant Details Intervention Details Analyses Results

Authors: Slaymaker and Owen (2006) Country: USA Setting: Residential Funding source: Butler Centre for Research at Hazelden. Study design: UcBA Author Objectives: Effectiveness of a residential treatment programme in improving employment performance and reducing drug use.

Total participant number: 212 Intervention number (%): 212 (100) Control number (%): NR Proportion male %: 104 (48%) Age/Age range/mean: 41.5 Ethnicity: 96% Caucasian Other baseline measures: NR Groups balance at Baseline: NR Baseline Comments: NR Unit of allocation: Individual Method of recruitment: Approached by staff upon entering treatment

Inclusion criteria: Employed at the time of admission to substance abuse treatment and planning to return to the same job upon completion of treatment. Exclusion criteria: NR Programme Name: Residential Treatment Aims: To improve working performance and reduce absenteeism and work-related problems. To reduce drug use. Key Components: Hazelden Model Theoretical base: NR Programme Type: Residential Rehabilitation Method of Delivery: NR Providers/deliverers: Trained drugs staff Length, duration, intensity: Approx 27 days, full-time (residential)

Time to follow-up: 6 and 12 months Data: ASI (intake, 6 and 12 month follow-up); Interviews; Hazelden Questionnaire Self report/validated: SR Unit of analysis: Individual Any other process detail: NR Number of participants completing (%): 212 (100) Reasons for non-completion: NR

Employment outcome: The number of days during which participants reported having problems at work (of the past 30 days) decreased significantly from an average of 5.20 days at baseline to 0.14 days at the 12 months. Overall, 65% were retained by their original employer. The proportion of participants reporting any unplanned absence during the 12 months preceding treatment as compared with the 12 months after treatment decreased significantly from 77.7% to 29.6%. The rate of unplanned absences from work dropped significantly from an overall mean of 9.19 days in the year before treatment entry to 1.33 days in the year after treatment.

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Drugs Court

Study detail


Authors: Rossman et al., (2011) Country: USA Setting: NR Funding source: NIDA Study design: A web-based multisite cohort survey of drug courts (DC) Author Objectives: To evaluate the effects of drug courts on substance use, crime, and other outcomes (including employment).

Total participant number: 1,781 offenders Intervention number (%): 1,156 (64.9) Control number (%): 625 (35.1) Proportion male (%): NR Age/Age range/mean: NR Ethnicity: NR Other baseline measures: NR Groups balanced at Baseline: NR Comments: DC sample was better off than the comparison sample on 23 of 28 individual socioeconomic measures examined, although few differences were statistically significant. DC participants were significantly more likely than were comparison members to be enrolled in school at six months Unit of allocation: Individual Method of recruitment: Drugs Court

Inclusion criteria: DC that served adult clients and had been operational at least one year. Exclusion criteria: NR Programme Name: NR Aims: NR Key Components NR Theoretical base: NR Programme Type: Drug Court Method of Delivery: NR Providers/deliverers: NR Length, duration, intensity: NR

Time to follow-up: Follow-up: 6 & 18 months (official crime records only at 24 months). Data: 1990-1994; weekly toxicology data; interviews (baseline/follow-up) Self-report/validated: SR Methods used: NR Unit of analysis: Individual Any other process detail: Number of participants completing (%): 86% at 6 months, 83% at 18 months Reasons for non-completion: N/A

Employment outcome: At 18 months, DC participants were significantly less likely than comparison offenders to report a need for employment (27% vs. 42%), educational services (25% vs 36%, and financial assistance (28% vs. 44%). DC participants were significantly more likely than comparison members to be enrolled in school at six months (16% vs. 8%). At 18 months DC cohort were slightly more likely to be employed or in school at 18 months (66 %vs. 60 %), and averaged a higher annual income, however differences were modest in magnitude and not statistically significant. Differences in employment rates were also non-significant (p < .10).

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Authors: Webster et al., (2007) Country: USA Setting: Urban and rural drug courts, various treatment settings Funding source: NIDA Study design: RCT Author Objectives: To identify potential factors of employment in a sample of substance-using offenders; and to examine how these relate to substance use and criminal behaviour

Total participant number: 500 Intervention number (%): 250 (50) Control number (%): 250 (50) Proportion male (%): 65.4% Age/Age range/mean: 18-57 (30.5) Ethnicity: White 61.8%; African American 36.8%; Other 1.4% Other baseline measures: NR Groups balance at Baseline: Y Baseline Comments: NR Unit of allocation: Individual Method of recruitment: Contacted at the end of the court hearing by an interviewer

Inclusion criteria: Had a self-admitted drug problem; met the criteria for drug abuse from the Addiction Severity Index (ASI); consented to a urine drug test; had a non-violent criminal history; and signed an agreement of participation for the programme Exclusion criteria: NR Programme Name: Kentucky drug court programmes Aims: Use of employment factors to reduce substance use and criminal behaviour Key Components: Participants followed the 10 key components of drug court set by National Association of Drug Court Professionals. Monetary compensation. Theoretical base: NR Programme Type: Drugs court – employment -based training Method of Delivery: Manual Providers/deliverers: Trained drug treatment staff Length, duration, intensity: NR

Time to follow-up: NR Data: Employment History; Addiction Severity Index; Criminal Behaviour. Interviews Self report/validated: SR Unit of analysis: Individual Any other process detail: NR Number of participants completing (%): 500 (100) Reasons for non-completion: N/A

Employment outcome: Significant negative correlations between the employment status factor and participants’ 6-month patterns of substance use. As individuals approached a full-time work status they also tended to report less frequent cocaine, sedative methamphetamine, heroin, methadone and multiple substance use. In addition, the number of days individuals reported using illicit drugs in the 6 months before drug court was also negatively related to the employment status factor. Employment earnings were also negatively associated with participants’ 6-month substance use patterns. As earnings increased, individuals self-reported levels of marijuana, cocaine and multiple substance use decreased. The number of times participants reported using drugs in the 6 months before drug court decreased as well. Individuals’ 6-month pattern of methamphetamine use was the only substance use outcome significantly related to employment stability

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Supported Housing

Study detail


Authors Kerrigan et al., (2000) Country: USA Setting: Outpatient treatment facility Funding source: NR Study design: UCBA Author Objectives: To examine the factors that influence employment rates of veterans with severe alcohol and other substance use disorders

Total participant number: 529 Intervention number (%): 529 (100) Control number (%): 0 Proportion male %: NR Age/Age range/mean: 43 Ethnicity: NR Other baseline measures: NR Groups balance at Baseline: NR Comments: NR Unit of allocation: individual - Veterans treatment services Method of recruitment: NR

Inclusion criteria: Veterans Exclusion criteria: NR Programme Name: Veterans Industries Programme Aims: Vocational rehabilitation and housing support Key Components: Therapeutic workplace Theoretical base: NR Programme Type: Housing support and workplace therapy Method of Delivery: Workplace Providers/deliverers: Private sector Employers Length, duration, intensity: NR

Time to follow-up: NR Data: NR Self report/validated: NR Methods used: NR Unit of analysis: Individual Any other process detail: NR Number of participants completing (%):68% Reasons for non-completion: NR

Employment outcome: The rate of employment among patients who completed the hospitalization programme was 41 %, compared to 6 % among those who did not. A total of 170 patients (32%) received supportive housing, and of those, 82 (48%) obtained gainful employment. This rate was significantly higher than the rate of employment among participants who did not receive supportive housing. Of the 138 patients who participated in work therapy (26%), 62 (45%) obtained employment, a rate significantly higher than for those who did not. Stepwise logistic regression identified regular discharge, supported housing, and work therapy as significant predictors of employment

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Vocational Training

Study Participant Details Intervention details Analyses Results

Authors Appel et al., (2000) Country: USA Setting: Methadone clinics Funding source: NR - presumed New York State Office of Alcoholism and Substance Abuse Services Study design: CBA Author Objectives: Effectiveness of a vocational training programme

Total participant number: 691 Intervention number (%): 333 (48.2) Control number (%): 358 (51.8) Proportion male %: 454 (66.7%) Age/Age range/mean: 33 Ethnicity: 57.6% Non-white; 42.4% White Other baseline measures: NR Groups balance at Baseline: Y Comments: NR Unit of allocation: Individual Method of recruitment: Existing clients

Inclusion criteria: NR Exclusion criteria: NR Programme Name: vocational rehabilitation counselling Aims: No formal role- regulated patient participation in pre-employment groups and other vocational activities. Key Components: NR Theoretical base: NR Programme Type: Vocational Training Method of Delivery: NR Providers/deliverers: Trained vocational counsellors Length, duration, intensity: NR

Time to follow-up: 16 months, but 7 months for control site Data: Interviews, client records Self report/validated: SR Methods used: NR Unit of analysis: Individual Any other process detail: NR Number of participants completing (%):NR Reasons for non-completion: NR

Employment outcome: Involvement in vocational and employment activities increased from 53 to 56% in the intervention site, but decreased from 45 to 43% in the control site. However, this change was not significant. Regression analysis indicated that in those clients who were unemployed at study entry, being involved in the programme for a greater length of time, being younger, or being enrolled at the intervention site were significant predictors of finding employment.

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Study detail

Participant Details Intervention Details Analyses

Results

Authors: Butler et al., (2004) Country: USA Setting: NR Funding source: NIDA Study design: RCT Author Objectives: Effectiveness of a vocational training programme

Total participant number: 194 Intervention number (%): 97 (50) Control number (%): 97 (50) Proportion male %: 64.4% Age/Age range/mean: 36.9 (9.8) Ethnicity: 55.7% white; Other baseline measures: Receipt of psychological and/or drug treatment; education; marital status Groups balance at Baseline: Yes Comments: Unit if allocation: individual Method of recruitment: Drug treatment services

Inclusion criteria: NR Exclusion criteria: NR Programme Name: Working it Out CD ROM Aims: To investigate the relationship between employment and drug use amongst low income females Key Components: N/A Theoretical base: N/A Programme Type: Vocational training Method of Delivery: CD-ROM Providers/deliverers: CD-ROM Length, duration, intensity: Studied over 2 years

Time to follow-up: 6 months Data: Questionnaire Self report/validated: SR Methods used: NR Unit of analysis: Individual Any other process detail: NR Number of participants completing (%): 6 months post baseline Reasons for non-completion: Missing; prison

Employment outcome: All subjects reported a decrease in employment related problems; no significant intervention effects. Younger clients showed a greater reduction in employment problems than older clients.

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Authors: Coviello et al., (2004) Country: USA Setting: drug treatment service Funding source: NIDA Study design: RCT Author Objectives: Effectiveness of a vocational training programme

Total participant number: 109 Intervention number(%): 62 (56.9) Control number (%): 47 (43.1) Proportion male %: 61 Age/Age range/mean: 44 Ethnicity: 60% Black Other baseline measures: Groups balance at Baseline: NR Comments: Unit of allocation: Individual Method of recruitment: Recruited form community methadone clinics

Inclusion criteria: Not employed, interested and able to work, and stabilized in methadone treatment Exclusion criteria: NR Programme Name: Vocational problem solving skills Aims Effectiveness of Vocational Problem Solving Skills (VPSS) intervention on job seeking motivation and action steps Key Components: The basis is that a client will think through his/her own problems and select a range of action-oriented steps that could be helpful in reaching a realistic goal Theoretical base: NR Programme Type: Vocational Training Method of Delivery: NR Providers/deliverers: Treatment worker Length, duration, intensity: 10 sessions

Time to follow-up: 6 months post-baseline Data: Questionnaire and interview Self report/validated: Both Methods used: NR Unit of analysis: Individual Any other process detail: NR Number of participants completing (%): 93.5% Reasons for non-completion: NR

Employment outcome: No effect of the VPSS intervention on clients’ motivation to work. Clients who were highly motivated at baseline continued to be highly motivated throughout the intervention, regardless of group assignment. Clients in the VPSS group talked to their counsellors about jobs more often than control clients.

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Authors Dennis et al., (1993) Country: USA Setting: Methadone clinics Funding source: NIDA Study design: RCT Author Objectives: Effectiveness of a vocational training programme

Total participant number: 249 Intervention number (%):124 (49.8) Control number (%):125 (50.2) Proportion male %: 60 Age/Age range/mean: 35 Ethnicity: 58% White Other baseline measures: NR Groups balance at Baseline: NR Comments: Control group more likely to be employed at baseline. Unit of allocation: Individual Method of recruitment: 2 Clients recommended by each treatment worker, random sample of other clients

Inclusion criteria: NR Exclusion criteria: NR Programme Name: The Training and Employment Programme Aims: To provide needs assessment, a vocational action plan, skills development, and a budget for any identified training needs Key Components standardised needs assessment, community resource directory, counsellor training, on-site vocational specialists, case management to access additional community resources, motivational workshops, and additional financial resources to address gaps in the current service system Theoretical base: Vocational Training Programme Type: NR Method of Delivery: NR Providers/deliverers: Trained counsellors Length, duration, intensity: NR

Time to follow-up: 3, and 6-12 months Data: Interviews, monitoring data Self report/validated: SR Methods used: NR Unit of analysis: Individual Any other process detail: NR Number of participants completing (%):69.6% control; 76.6% intervention Reasons for non-completion: NR

Employment outcome: Site dependent, but intervention subjects received significantly more classes/ education; referrals to job skills sessions; vocational assessments, job skills services and job support services. Site specific changes, but overall the intervention had no significant effect on employment rates

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Study detail


Authors: Foley et al., (2010) Country: USA Setting: Drug treatment centre Funding source: NIDA Study design: RCT Author Objectives: Effectiveness of a job seekers workshop

Total participant number: 102 Intervention number(%):53 (52.0) Control number (%):49 (48.0) Proportion male %: 80% Age/Age range/mean: 36.3 (10.5) Ethnicity: 100% indigenous American Other baseline measures: Groups balance at Baseline: NR Comments: Unit of allocation: individual Method of recruitment: Recruited from drug treatment centre

Inclusion criteria: Drug and/or alcohol dependent individuals who were 18 years of age or older, enrolled at NCI for at least 10 days, categorised as either unemployed (i.e., not having worked at all for the month prior to study recruitment) or underemployed (i.e., having worked no more than 20 hours/week in any given week during the past month), and interested in obtaining a job Exclusion criteria: NR Programme Name: Job seekers workshop (JSW) Aims: Effectiveness of JSW vs. job interviewing video Key Components: Job skills training, in particular interview preparation Theoretical base: NR Programme Type: Vocational Training Method of Delivery: Mixture of lectures, videos, skills training sessions Providers/deliverers: Trained treatment providers Length, duration, intensity: 3 sessions of 4 hours each

Time to follow-up: Up to 6 months Data: Questionnaire Self report/validated: SR Methods used: NR Unit of analysis: Individual Any other process detail: NR Number of participants completing (%): NR Reasons for non-completion: NR

Employment outcome: Analysis revealed no significant effects of JSW. Regression analysis did not reveal any statistically significant effect of group membership (JSW and JIV) on time to employment, defined as either a new taxed job or enrolment in a job-training programme, during the three months after randomisation. At 6-month follow-up, the Cox regression procedure did not detect any significant between- group difference in time to employment. A significant difference was found on enrolment in a training programme, with more participants who were involved in the JIV intervention enrolled in a training programme than in the JSW intervention. No significant differences between groups in work hours or total work and training hours were found. No significant differences between the two interventions (JSW vs. JIV) at 3- or 6-month follow-up.

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Authors: French et al., (2002) Country: USA Setting: Residential Funding source: CSAT, NIDA Study design: RCT Author Objectives: Cost effectiveness of specialist residential rehabilitation for pregnant women

Total participant number: 85 Intervention number(%):44 (51.8) Control number (%):41 (48.2) Proportion male %: 0 Age/Age range/mean: 33.21 Ethnicity: 54% white Other baseline measures: Groups balance at Baseline: Y Comments: Unit of allocation: Individual Method of recruitment: Self-referral or through CJ system

Inclusion criteria: At least 18 years of age, pregnant at the time of admission or have given birth within the past 18 years, and enter treatment at 1 of the 12 participating programme sites Exclusion criteria: NR Programme Name: Pregnant and Parenting Women’s Living Centres (PPWLCs), Aims: comprehensive drug treatment Key Components: comprehensive, gender-sensitive approach, focused on treating addicted mothers and their children. Specialty treatment consisted of a comprehensive set of “wrap around” services on site such as case management, alcohol and other drug treatment, child care, transportation, medical treatment, room and board, education/job skills training, parenting skills training, aftercare planning, and family counselling. Theoretical base: NR Programme Type: Vocational Training Method of Delivery: NR Providers/deliverers: Drug treatment providers Length, duration, intensity: up to 12 months

Time to follow-up: + 6 months Data: Questionnaire Self report/validated: both Methods used: NR Unit of analysis: Individual Any other process detail: Cost-benefit analysis conducted Number of participants completing (%): 56 Reasons for non-completion: NR

Employment outcome: Economic analysis showed a significant time x treatment cost benefit of speciality but not standard treatment on Employment measures (ASI, income received from employment). There was no significant different between programme types

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Authors: Karuntzoz et al., (1994) Country: USA Setting: Buffalo - Hospital-based; Pittsburgh, San Jose – freestanding clinics; Milwaukee (discontinued so withdrawn from study) Funding source: NIDA Study design: RCT Author Objectives: To evaluate the effectiveness of standard methadone treatment and standard treatment plus an experimental training programme (TEP)

Total participant number: 250 Intervention number 124 (49.6) Control number %): 126 (50.4) Proportion male %: 50 Age/Age range/mean: 18-64 Ethnicity: African-American 26.7%; Caucasian 56.7%; Hispanic 15.8%; Other 0.8% Other baseline measures: Groups balance at Baseline: N Baseline Comments: Employment status differed significantly during the week before admission to treatment for males and females, with females less likely to be employed. Unit of allocation: Individual Method of recruitment: Four existing methadone treatment programmes clients recommended by counsellors as likely to benefit from participation in TEP & remaining clients

Inclusion criteria: Voluntary participation in TEP; range of clients in terms of vocational readiness and motivation, attending methadone clinic Exclusion criteria: NR Programme Name: Experimental Training Programme (TEP) Aims: To increase employment opportunities and compare the difference between genders in vocational needs and outcomes Key Components Employment training, skills development, take home privileges - 10% for Pittsburgh (employed only) and Buffalo, 50% of clients - Santa Clara Theoretical base: NR Programme Type: Vocational Training Method of Delivery: Counselling, training, maintenance, manual Providers/deliverers: Methadone treatment staff; vocational specialists Length, duration, intensity: NR

Time to follow-up: 6 & 12 months Data: Interviews; urine tests Self report/validated: Both Unit of analysis: Individual Any other process detail: NR Number of participants completing (%):NR Reasons for non-completion: NR

Employment outcome: There were differences in job placement after 6 months. There was a positive effect overall for the TEP condition defined by an increase in the level of services received producing positive effects for both genders. No specific employment outcome. In both TEP and standard groups more females than males were referred to classes, educational services or job training. More males than females within each condition received help with job search

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Study detail


Authors: Kemp et al., (2004) Country: USA Setting: Community Funding source: NIDA Study design: UCBA Author Objectives: To assess whether employment services help offenders in drug treatment programmes gain employment.

Total participant number: 245 Intervention number(%):106 (43.3); 46 (18.7); 18 (7.3); 21 (8.6) Control number (%): 54 (22.0) Proportion male %: NR Age/Age range/mean: NR Ethnicity: NR Other baseline measures: NR Groups balance at Baseline: NR Comments: NR Unit of allocation: Group Method of recruitment: Self-referral or through CJ system

Inclusion criteria: Parolees Exclusion criteria: NR Programme Name: Helping Offenders to Work Aims: Programme consisted of 4 different targeted strategies to help recipients gain skills and employment Key Components: Job skills development and supported work; Life skills development; Job training; Welfare to work Theoretical base: NR Programme Type: Vocational Training Method of Delivery: Workshops and counselling Providers/deliverers: Vocational specialists Length, duration, intensity: NR

Time to follow-up: +12 months post admission Data: Records analysis Self report/validated: Both Methods used: NR Unit of analysis: Group Any other process detail: NR Number of participants completing (%):77.9% Reasons for non-completion: NR

Employment outcome: Skills development and supported work - 54.2% employed, mean wage $6.64; Life skills development - 58.1% employed, $7.00; Job training - 59.0% employed, $13.00; Welfare to work - 46.2%, $6.50

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Authors Kidorf et al., (2004) Country: USA Setting: Drug treatment services + competitive workplace Funding source: NIDA Study design: Cross sectional study Author Objectives: Effectiveness of vocational training

Total participant number: 228 Intervention number (%): 228 (100%) Control number (%):0 Proportion male %: 54% Age/Age range/mean: 37.4 (8.5) Ethnicity: 47% African American Other baseline measures: Groups balance at Baseline: NR Comments Unit of allocation: individual Method of recruitment: Assessment at methadone treatment centres:

Inclusion criteria: Methadone maintained clients in treatment for >1 year and judged able to work Exclusion criteria: NR Programme Name: Motivated Stepped Care Aims: To reintroduce methadone clients back into competitive employment Key Components Participants required to secure (part time) employment within 2 months. If not, then they receive counselling focusing on gaining employment. Subsequent failure to find employment results in tapering down of methadone dose and automatic treatment discharge. Incentives for job finding (e.g. more take-home medicines) Theoretical base: Stepped care, motivational, behavioural reinforcement Programme Type: Vocational Training Method of Delivery: Counsellors (individual/group) Providers/deliverers: Specially trained drug treatment staff Length, duration, intensity: Dependent upon client circumstances

Time to follow-up: NR - audit of employment data taken in Aug/Sept 2002 Data: Official records Self report/validated: NA Methods used: Unit of analysis: Individual Any other process detail: Number of participants completing (%):100% Reasons for non-completion: NA

Employment outcome: Of the 228 participants, 70% had full time employment, 19% part time, 4% school volunteers. 92% were paying tax (i.e. 8% 'cash in hand'). 72% of positions were in manual labour. In 110 clients who were unemployed at the time of treatment entry, 84% were employed at follow up. Unemployed clients were 6.9 times more likely to be referred to Steps 2 (low intensity counselling) or 3 (intensive counselling) for drug use in the past year than employed patients

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Authors Leukefeld et al., (2007) Country: USA Setting: Therapeutic workplace Funding source: NIDA Study design: RCT Author Objectives: Effectiveness of vocational training

Total participant number: 500 Intervention number (%): low = 120 (24); high = 118 (24) Control number (%): 239 (48) Proportion male %: 32 Age/Age range/mean: C = 31.3; L = 28.4; H = 31.3 Ethnicity: NR Other baseline measures: Groups balance at Baseline: NR Comments: NR Unit of allocation: individual Method of recruitment: Drug court attendees

Inclusion criteria: Participant must have: (a) had a self-admitted drug problem; (b) met criteria for drug abuse from the Addiction Severity Index (ASI); (c) consented to a urine drug test; (d) a non-violent criminal history; and (e) signed an agreement to participate in the programme Exclusion criteria: NR Programme Name: Enhanced employment Aims: Skills training in drug court attendees; categorised according to low or high intensity intervention Key Components: Skills development, employment readiness, social/workplace skills Theoretical base: NR Programme Type: Vocational Training Method of Delivery: NR Providers/deliverers: NR Length, duration, intensity: 11 individual sessions and 24 group sessions over 15 weeks

Time to follow-up: 12 months Data: Questionnaire; interview Self report/validated: SR Methods used: NR Unit of analysis: Individual Any other process detail: NR Number of participants completing (%):96% Reasons for non-completion: Death

Employment outcome: There was a significant association between intervention level and pattern of employment in the past year with participants in the high upgrading group reporting more full-time employment than the low upgrading group & no intervention groups. Fewer participants were unemployed in the HUG. The percentage of participants reporting part-time employment ranged from 12 to 16%. Participants differed in the number of days worked at a legitimate job in both the past year and in the past 30 days. Participants in HUG reported working more days in the past and in the previous 30 days than either the LUG or NI group. Participants in NI worked more days than those in the low intervention group. Participants in the HUG reported more income in the past year (than those in the LUG.

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Study detail


Authors Lidz et al., (2004) Country: USA Setting: Methadone clinics Funding source: NIDA Study design: RCT Author Objectives: Effectiveness of vocational training

Total participant number: 417 Intervention number (%): VPS 167 (40.0); JSW 68 (16.3); VPS + JSW 66 (15.8) Control number (%): NA Proportion male %: 60.7% Age/Age range/mean: 40.71 (7.37) Ethnicity: 50.5% white; 36.7% black Other baseline measures: Groups balance at Baseline: Y Comments: NR Unit of allocation: Individual Method of recruitment: Enrolled from methadone clinics

Inclusion criteria: NR Exclusion criteria: NR Programme Name: Vocational Problem-Solving, Job Seekers Workshop, Aims: VPS = promote job readiness; JSW = improving job seeking and interviewing skills Key Components: Didactic intervention, video feedback, Theoretical base: Interpersonal problem solving theory; cognitive behavioural theory Programme Type: Vocational Training Method of Delivery: NR Providers/deliverers: NR Length, duration, intensity: VPS 10 sessions x 1.5 hrs; JSW 5 sessions x 2.5hrs

Time to follow-up: +6 and +12 months Data: Questionnaire; interview Self report/validated: SR Methods used: NR Unit of analysis: Individual Any other process detail: NR Number of participants completing (%): 65.5% Reasons for non-completion: NR

Employment outcome: All three groups show substantial increases in mean days worked from baseline to 6-month follow-up. The VPS and JSW groups showed further increases in mean days worked at the 12 month f-up, while the VPS and JSW group shows a decrease from the 6-month level. Differences in mean days of employment among groups by ANOVA did not approach significance. Those who attended 50% or more of their assigned training sessions did not have significantly more days employed at 6-month or 12-month follow-up than subjects who attended less than 50% of sessions or subjects who attended no sessions.

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Authors Magura et al., (2007) Country: USA Setting: Methadone treatment service Funding source: NIDA Study design: RCT Author Objectives: Effectiveness of vocational training

Total participant number: 168 Intervention number (%): 78 (46.4) Control number (%):90 (53.6) Proportion male %: 58% Age/Age range/mean: 44.8 (8.5) Ethnicity: African American 43%; Hispanic 32%; 25% white Other baseline measures: Groups balance at Baseline: No Comments: Significantly more Hispanic subjects in control group at baseline Unit of allocation: individual Method of recruitment: Self referral or referred by drug treatment worker

Inclusion criteria: Unemployed, stabilised on methadone, negative urine analysis for cocaine and other opiates over previous 4 weeks, absence of serious illness, informed consent Exclusion criteria: NR Programme Name: Customised Employment Supports Aims: Promote vocational skills and reduction in non-vocational barriers (e.g. Low self-efficacy) Key Components Individualised interventions based on programme theory Theoretical base: Unspecified theory, not a manual approach Programme Type: Vocational Training Method of Delivery: Outreach, office appointments Providers/deliverers: Trained vocational counsellors Length, duration, intensity: NR, each counsellor had an average caseload of approximately 15 clients

Time to follow-up: +6, +12 months Data: Interviews, diaries, employer documentation Self report/validated: SR Methods used: NR Unit of analysis: Individual Any other process detail: NR Number of participants completing (%):168 (91%) Reasons for non-completion: Ineligible, died, or received no counselling due to counsellor unavailability

Employment outcome: Over the course of the study, 41% of intervention vs. 25.5% of standard vocational counselling participants had paid employment (full or part time) during both follow-up periods. However there was no difference in mean income during the study period. Regression analysis showed that having prior paid employment, full intervention and receiving the intervention vs. control were significant predictors of having any paid employment at follow up.

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Authors McLennan et al., (2003) Country: USA Setting: Drug treatment services Funding source: Robert Wood Johnson Foundation. Study design: UCBA Author Objectives: To evaluate the

effectiveness of a multiservice

intervention designed to move female

substance users from welfare to

sobriety and self-sufficiency

Total participant number: 529 Intervention number (%): 100% Control number (%):0 Proportion male %: 0 Age/Age range/mean: 32 Ethnicity: 38% white; 48% black Other baseline measures: Groups balanced at Baseline: NR Comments: NR Unit of allocation: Individual Method of recruitment: NR:

Inclusion criteria: Women with substance use problem, on welfare and had not worked in the previous month Exclusion criteria: NR Programme Name: Caseworks for Families Aims: Assist recipients of welfare to achieve stable employment and self-sufficiency by overcoming substance abuse and other major barriers to work. Key Components Intervention at each site were focused on substance abuse, employment (including work readiness, vocational training, and basic education), domestic violence, and parenting training. Theoretical base: Multiple risk factors and multiagency working Programme Type: Vocational Training Method of Delivery: N/A Providers/deliverers: Drug treatment workers Length, duration, intensity: NR

Time to follow-up: +6, +12 months Data: Questionnaire, Urine analyses Self report/validated: Both Methods used: Unit of analysis: Individual Any other process detail: NR Number of participants completing (%): 69.2% Reasons for non-completion: More days in CWF treatment and fewer days of school or vocational training predicted a greater likelihood of completing the study follow-ups.

Employment outcome: There were significant improvements on the employment composite score and on all seven of the additional measures in this area. On the four employment measures, there was significant change from baseline to 6 months and then again from 6 months to 12 months. For example, the percentage of participants employed at least half time rose from 6% at baseline to 20.4% at 6 months and to 29.9% at 12 months, and dollars paid for work rose from $42 at baseline to $127 at 6 months and to $240 at 12 months. Conversely, measures of welfare utilization did not change significantly between baseline and 6 months, but they did improve from 6 to 12 months. For example, the percentage of participants receiving TANF actually increased from 72.7% to 74.6% between baseline and 6 months but then decreased to 58.4% at 12 months.

19

Study detail


Authors: Reif et al., (2004) Country: USA Setting: Treatment services Funding source: SAMHSA Study design: Secondary analysis of nationally representative treatment utility survey Author Objectives: To examine the influence of employment counselling on substance users

Total participant number: 297 Intervention number: 124 (41.8) Control number: 173 (58.2) Proportion male %: 75 Age/Age range/mean: 34 Ethnicity: 65% white; 28% black Other baseline measures: A mean of 1.1 ancillary treatment services Groups balanced at Baseline: NR Comments: NR Unit of allocation: individual Describe: Clients in treatment who did or did not receive employment counselling Method of recruitment: Survey data

Inclusion criteria: Clients with an identified need for employment counselling Exclusion criteria: NR Programme Name: NR Aims: To improve client employment and employability skills Key Components: Not specifically mentioned as clients different treatment facilities Theoretical base: NR Programme Type: Vocational training Method of Delivery: NR Providers/deliverers: Drug treatment workers Length, duration, intensity: NR

Data: Interview, urine analyses Self report/validated: Both Methods used: NR Unit of analysis: Individual Any other process detail: NR Time to follow-up: 12-months Number of participants completing (%): 77 Reasons for non-completion: NR

Employment outcome: Intervention clients were more likely to be employed at follow up

20


Authors: Reif & Rittter (2004) Country: USA Setting: Treatment centre Funding source: NIAAA; The Robert Wood Johnson Foundation grant; SAMHSA Study design: Secondary analysis of survey data: subsample of adult clients who anticipated in the SAMHSA - focus on employment counselling. Author Objectives: To examine the impact of employment counselling on treatment participation, post-discharge abstinence and employment compared to those who meet this need but do not receive employment counselling.

Total participant number: 297 Intervention number (%): 124 (received employment counselling) Control number (%):173 Proportion male %: 73.3% Age/Age range/mean: 34 Ethnicity: White 64.6%; Black 27.9%; Hispanic 16.1%; Other 7.5% Other baseline measures: Groups balance at Baseline: NR Baseline Comments: NR Unit of allocation: Individual Method of Recruitment: NR

Inclusion criteria: Non-methadone clients discharged from residential treatment and identified with a need for employment counselling Exclusion criteria: Residential clients and outpatient methadone clients Programme Name: Employment Counselling Aims: Drug abstinence, treatment participation and employment skills/outcome. Key Components: Not mentioned as clients were at different treatment facilities Theoretical base: NR Programme Type: Vocational Training and Employment Counselling Method of Delivery: Counselling (group & individual); employment counselling, skills for life education. Providers/deliverers: Trained drugs staff Length, duration, intensity: 22 outpatient visits over an average of 18 weeks (129 days)

Time to follow-up: 1 year Data: Interviews Self report/validated: SR Unit of analysis: Individual Any other process detail: NR Number of participants completing (%):50% (3 months); 20% 6 months; remainder maximum duration. Reasons for non-completion: Difficulties making contact with clients once discharged. Adult clients discharged from 143 outpatient non-methadone substance user treatment facilities; only discharged outpatient non-methadone clients who participated in Phase III follow-up.

Employment outcome: Individuals who received employment counselling have better treatment participation and outcomes than clients who met this need and did not. Characteristics that impacted upon employment: Married or common law at admission, homelessness at admission and Hispanic approached significance. Follow-up: 72% of clients were employed at some point since discharge. The employment counselling group were three times more likely to be employed at any time after discharge than clients with unmet need. Characteristics post discharge: female, age and low history of psychological problems

21


Authors: Schottenfield et al., (1992) Country: USA Setting: Therapeutic Community Funding source: NR Study design: Cross-sectional (case histories) Author Objectives: Effectiveness of vocational programmes for a range of vocational problems found among individuals with substance use disorders and the elements of a recently funded vocational programme for patients in outpatient and residential drug and alcohol treatment programmes. Present programme effectiveness for the first 2 years of operation of the programme.

Total participant number: 223 Intervention number: 223 (100) Control number %): 0 Proportion male %: NR Age/Age range/mean: NR Ethnicity: NR Other baseline measures: NR Groups balanced at Baseline: N Baseline Comments: NR 52% of subjects were low SES, 48% were high SES, and 88% were heroin users with 74% reporting I.V. use. Depression and hepatitis C were the most common medical co-morbidities and 39% reported prior psychiatric treatment. 61% of patients reported prior legal problems with 35% having been incarcerated. Unit of allocation: individual Method of recruitment: NR

Inclusion criteria: NR Exclusion criteria: NR Programme Name: Vocational Intervention Aims: To use employment-based training as an essential element of successful drug reduction/abstinence. Key Components: Vocational Counselling, job-seeking skills, job development, substance abuse treatment and discharge. Theoretical base: NR Programme Type: Vocational Training (therapeutic community) Method of Delivery: Manual Providers/deliverers: Trained drugs staff Length, duration, intensity: 12-18 months

Time to follow-up: Continuous Data: vocational assessment (employment/ educational history, goals, prior difficulties, motivation/ interest in finding a job, barriers to employment and employment maintenance). Psychological/substance abuse history. Self report/validated: Both Unit of analysis: Individual Any other process detail: NR Number of participants completing (%):110 (63) Reasons for non-completion: Non-completers were more likely to have an arrest history

Employment outcome: 120 of the 172 initially unemployed clients were successfully placed in either full-time or part-time employment. The average wage of those who gained employment was $7.60 per hour. 25 were employed at the time of completion of the programme and continued with vocational follow-up.

22


Authors: Shepard & Reif (2004) Country: USA Setting: NR Funding source: Substance Abuse and Mental Health Services Administration (SAMHSA) Study design: Secondary analysis using data from the Alcohol and Drug Services Study ADSS. Author Objectives: Effectiveness of vocational training

Total participant number: 1802 (sampled treatment records) Intervention number: 175 (9.7) Control number %): 1627 (90.3) Proportion male %: 78.7 Age/Age range/mean: 34.2 Ethnicity: Hispanic/Latino 14.5%; White 71.5%; Other 4.0% Other baseline measures: The clients who received VR differed significantly from clients who did not on several background characteristics. Those who received VR were less likely to be Hispanic, white, to have alcohol as their primary substance, and to have ever worked a full-time job. Groups balanced at Baseline: N Baseline Comments: NR Unit of allocation: Individual Method of recruitment: NR

Inclusion criteria: outpatient non-methadone treatment Exclusion criteria: In receipt of methadone treatment Programme Name: Vocational rehabilitation/ employment counselling Aims: To compare clients who received VR to clients who did not receive VR by characteristics. To improve employment skills and encourage abstinence Key Components: NR Theoretical base: NR Programme Type: Vocational Training Method of Delivery: NR Providers/deliverers: ADSS Length, duration, intensity: NR

Time to follow-up: NR Data: Interviews, self-report, urine samples Self report/validated: Both Unit of analysis: Individual Any other process detail: NR Number of participants completing (%):NR Reasons for non-completion: NR

Employment outcome: Out of all clients discharged from outpatient non-methadone treatment, just under 10% received VR. These clients were significantly less likely to have had a full-time job in the year prior to admission to substance user treatment. Alternatively, they were more likely to be unemployed throughout the year prior to admission than those who did not receive VR. Clients who received VR were slightly more likely to have income below $20,000 and less likely to have incomes above $20,000 compared to clients who did not receive VR.

23


Authors: Sung (2001) Country: USA Setting: NR Funding source: NR Study design: Secondary analysis of client records Author Objectives: To show the outcome of Drug Treatment Alternative-to-Prison (DTAP)

Total participant number: 406 (different subsamples of the entire DTAP population were examined throughout this study Intervention number 406 (100) Control number %): NR Proportion male %: 84% Age/Age range/mean: 18 – 58 (32) Ethnicity: 60% Hispanic; 35% African-Americans; 5% White Other baseline measures: NR Groups balance at Baseline: NR Baseline Comments: NR Unit of allocation: individual Method of recruitment: NR

Inclusion criteria: N/A Exclusion criteria: N/A Programme Name: Drug Treatment Alternative-to-Prison (DTAP) Aims: To illustrate how meaningful employment reduces drug use and criminal recidivism rates Key Components: Vocational, training, Job skills Theoretical base: NR Programme Type: Vocational training Method of Delivery: NR Providers/deliverers: NR Length, duration, intensity: NR

Time to follow-up: NR Data: Interviews; available DTAP data Self report/validated: SR Unit of analysis: Individual Any other process detail: NR Number of participants completing (%): 406 (100) Reasons for non-completion: N/A

Employment outcome: Mixed results emerged from the analysis of the 243 graduates who did not have either a high school diploma or a GED before treatment; of 80% that participated only 13% passed. For in-treatment vocational training, of 319 participants 63% participated and 49% completed. Of DTAP graduates, 52% met with the job developer for employment counselling, and 40% were placed on jobs with the assistance of the DTAP job developer. 4% (4) of the 93 graduates with available data accepted employment offers from participating members of the business advisory council. Results from data analysis show that improved employment rates prevented post-treatment recidivism among DTAP graduates – their earnings ranged from minimum wages to $34,000 per year.

24


Authors Zanis et al., (2001) Country: USA Setting: methadone clinic Funding source: NIDA Study design: RCT Author Objectives: Compare interventions aimed to increase employment opportunities

Total participant number: 109 Intervention number (%):62 VPSS Control number (%):47 IPS Proportion male %: 61%; 60% Age/Age range/mean: 43.5; 43.5 Ethnicity: 37, 38 % White; 61, 62% Black; 2% Hispanic Other baseline measures: NR Groups balance at Baseline: Y Comments: Similar baseline demographics except patients in the VPSS condition were more likely than control patients to have a valid driver’s license. Unit if allocation: individual Method of recruitment: NR

Inclusion criteria: voluntary participation; unemployed or underemployed (< 10 hours pw); stabilised on methadone and enrolled in the MMTP for a min of 3 months; expressed interest and capacity to work at least 20 hours per week; actively seeking employment Exclusion criteria: NR Programme Name: Vocational Problem-Solving Skills (VPSS) Aims: To analyse the effectiveness of VPSS in assisting unemployed methadone patients obtain employment. Key Components cognitive based intervention to help patients understand how to overcome current barriers to and to set realistic vocational goals. Theoretical base: cognitive theory Programme Type: Vocational Training Method of Delivery: workshop sessions following manual Providers/deliverers: trained methadone counsellors Length, duration, intensity: 10 30 to 60 minutes individual counselling sessions and skills sessions for 12-week period

Time to follow-up: 6-months Data: Interviews and urine samples Self report/validated: both Methods used: NR Unit of analysis: Individual Any other process detail: NR Number of participants completing (%): 93 Reasons for non-completion: lack of motivation, lack of available jobs and ill health

Employment outcome: Based on the Yates adjusted chi-square statistic the employment rate difference between conditions was statistically significant. However, there was no difference in employment functioning between the two intervention groups at the 6-month follow-up when controlling for baseline differences.

25

Contingency management


Authors: Budney et al., (2000) Country: USA Setting: Outpatient drug treatment facility Funding source: NIDA Study design: RCT Author Objectives: NR

Total participant number: 60 Intervention number (%): 20 (33.3) Control number: 20; 20 (33.3; 33.3) Proportion male %: 83 Age/Age range/mean: 32 (8.5) Ethnicity: 100% white Other baseline measures: Receipt of psychological and/or drug treatment; education; marital status Groups balance at Baseline: Y Comments: NR Unit of allocation: Individual Method of recruitment: Advertisements and referrals

Inclusion criteria: be at Men seeking treatment for cannabis dependence, use of cannabis in previous 30 days Exclusion criteria: current dependence on alcohol or any other drug except nicotine, active psychosis or other severe psychiatric or medical disorder that would impede participation in outpatient counselling, or a legal problem for which incarceration was imminent. Programme Name: motivational enhancement (M), M plus behavioural coping skills therapy (MBT), or MET Details plus voucher-based incentives MBTV). Aims: To test the effects of the addition of voucher based incentives to coping skills and motivational enhancement. Key Components: motivational enhancement; + behavioural coping skills therapy; + voucher programme (drug free urine = cash voucher) Theoretical base: Motivational interviewing Programme Type: Contingency management Method of Delivery: Manual-based, delivered by therapists Providers/deliverers: Therapists Length, duration, intensity: 14 weeks

Data: Questionnaire; urine testing Self report/validated: both Methods used: NR Unit of analysis: Individual Any other process detail: NR Time to follow-up: Immediately post treatment. Number of participants completing (%): 45-65% Reasons for non-completion: NR Data: Questionnaire; urine testing Self report/validated: both Methods used: NR Unit of analysis: Individual Any other process detail: NR Time to follow-up: Immediately post treatment. Number of participants completing (%): 45-65% Reasons for non-completion: NR

Employment outcome: No between group differences, although subjects receiving motivational enhancement alone showed significant increase in ASI employment scores

26


Authors: DeFulio & Silverman (2011) Country: USA Setting: A non-profit data entry business Funding source: NIDA Study design: RCT Author Objectives: Long term effectiveness of employment-based reinforcement of cocaine abstinence after discontinuation of the intervention

Total participant number: 51 Intervention number 24 (47) Control number (%): 27 (52.9) Proportion male %: 23 Age/Age range/mean: 43 Ethnicity: 88% Black Other baseline measures: NR Groups balance at Baseline: NR Baseline Comments: NR Unit of allocation: Individual Method of recruitment: Already enrolled on a work-place treatment programme

Inclusion criteria: Unemployed welfare recipients who persistently used cocaine while in methadone treatment Exclusion criteria: NR Programme Name: Contingency Management Aims: To reduce long-term cocaine use and maintain employment. Key Components Required to provide cocaine- and opiate-negative urine samples to work and maintain maximum rate of pay. Participants earned a base pay of $8.00 per hour in vouchers and could earn approximately $2.00 per hour in vouchers based on productivity on the training programmes, in phase two this went up to $10 & $4 and pay cheques rather than vouchers. Theoretical base: NR Programme Type: Contingency Management Method of Delivery: Work placement Providers/deliverers: Methadone treatment staff Length, duration, intensity: 30 months: Phase 1: 6 months; Phase 2: 1 year

Time to follow-up: 6 and 12 months after the end of phase 2, which was 24 and 30 months after enrolment in phase 1, respectively. Data: Urine samples, breath samples and self-reports Self report/validated: Both Unit of analysis: Individual Any other process detail: NR Number of participants completing (%): 51 (100) Reasons for non-completion: N/A

Employment outcome: At follow-up more participants reported earning some money from employment compared to intake; 40% earned money from employment during the year after employment in the therapeutic workplace. A lower percentage of study participants were on welfare or living in poverty during the year of follow-up compared to study intake and participants’ social, employment, economic and legal conditions were similar in the two groups across all phases of the study.

27

Study detail


Authors: Donlin et al, (2008)

Country: USA

Setting: Simulated workplace.

Funding source: NIDA

Study design: CBA

Author Objectives: To assess

whether attendance rates predict

subsequent outcome of

employment- based reinforcement

for cocaine abstinence.

Total participant number: 319

Intervention number(%): 222

(69.6)

Control number (%): 97 (30.4)

Proportion male %: 22.5

Age/Age range/mean: 43 (6.4)

Ethnicity: 92.8% Black

Other baseline measures: NR

Groups balance at Baseline: NR

Comments: NR

Unit of allocation: Individual

Method of recruitment: Referrals

from methadone clinics

Inclusion criteria: Individuals

indicating that they were 18 years of

age or older, were unemployed,

used cocaine or crack within the last

30 days, were receiving welfare

benefits, and were enrolled in

methadone maintenance in

Baltimore

Exclusion criteria: NR

Programme Name: Employment-

based reinforcement of cocaine

abstinence.

Aims: Reinforce abstinence,

increase employment

Key Components: Provision of

employment dependent upon

cocaine-negative urine samples

Theoretical base: NR

Programme Type: Contingency

management

Method of Delivery: Workplace

activities

Providers/deliverers: University

staff

Length, duration, intensity: 6

month employment

Time to follow-up: 6 months

Data: Urinalysis, questionnaire

Self report/validated: Both

Methods used:

Unit of analysis: Individual

Any other process detail: NR

Number of participants

completing (%): 111 (100)

Reasons for non-completion: NA

Employment outcome:

The percentage of minutes worked

in the induction period was

significantly correlated with the

percentage of cocaine-negative

urine samples in the intervention

period.

28

Study detail


Authors: De Fulio et al., (2009) (follow up to Donlin et al., (2008) Country: USA Setting: A non-profit data entry business. Funding source: NIDA Study design: RCT Author Objectives: NR

Total participant number: 51 Intervention number(%): 27 (52.9) Control number (%): 24 (47.1) Proportion male %: 23 Age/Age range/mean: 43 Ethnicity: 88% Black Other baseline measures: NR Groups balance at Baseline: NR Comments: NR Unit of allocation: Individual Method of recruitment: referrals

from methadone clinics

Inclusion criteria: Unemployed welfare recipients who used cocaine persistently while enrolled in methadone treatment in Baltimore. Exclusion criteria: NR Programme Name: Employment-based contingency management Aims: To test the effectiveness of employment only vs. abstinence-contingency employment Key Components: Access to employment was contingent upon provision of drug-free urine samples under routine and then random drug testing. Theoretical base: N/A Programme Type: Contingency management Method of Delivery: work placement Providers/deliverers: University staff Length, duration, intensity: 1 year

employment

Data: Questionnaires, interviews, urinalysis Self report/validated: Both Methods used: NR Unit of analysis: Individual Any other process detail: Time to follow-up: 1 year Number of participants completing (%): 89%; 95% Reasons for non-completion: Death of 1 participant

Employment outcome: The abstinence-contingent

employment and employment-only

groups attended the work-place at

similar rates and most participants in

both groups were retained

throughout the year of phase 2.

Participants in both groups earned

similar hourly wages on average and

showed similar levels of accuracy in

data entry. The abstinence

contingent employment group had a

higher mean rate of work output than

the employment-only group, but this

difference was not significant.

29

Study detail


Authors: Drebing et al (2005) Country: USA Setting: Workplace Funding source: New England Mental Illness Research Education and Clinical Centre Study design: RCT Author Objectives: Effectiveness of contingency management

Total participant number: 19 Intervention number(%): 11 (58) Control number (%): 8 (42) Proportion male %: 100 Age/Age range/mean: 46 (56) Ethnicity: 79% white Other baseline measures: NR Groups balance at Baseline: Y Comments: N/A Unit of allocation: Individual Method of recruitment: NR

Inclusion criteria: Dual diagnosis veterans. Potential to return to competitive supported employment within 6 months Exclusion criteria: Veterans over the age of 55; chronic medical problems Programme Name: Compensated work therapy programme Aims: To evaluate the efficacy of adding contingency management techniques to vocational rehabilitation (VR) to improve treatment outcome as measured by entry into competitive employment. Key Components: Contingency management Theoretical base: NR Programme Type: Contingency management Method of Delivery: workplace activities Providers/deliverers: Workplace staff Length, duration, intensity: 4 months

Time to follow-up: 4 months Data: Questionnaire; Urinalysis Self report/validated: Both Methods used: NR Unit of analysis: Individual Any other process detail: NR Number of participants completing (%): NR Reasons for non-completion: NR

Employment outcome: When time to first events (résumé completion, first job interview, first job, first positive screen) was examined, participation in the enhanced incentives condition was associated with shorter time to résumé completion and first job interview. Scores on the Job Search Behaviours Scale at Week 16 were significantly higher for the enhanced incentives group. Total wages for the enhanced incentives group were significantly greater than for the CWT-only group. No difference in weeks of competitive employment, or hours worked.

30

Study detail


Authors: Drebing et al., (2007)

follow up to Drebing et al., (2005)

Country: USA

Setting: Workplace

Funding source: Veterans

Administration Rehabilitation

Research and Development Service

Study design: RCT

Author Objectives: NR

Total participant number: 100

Intervention number(%):50 (50)

Control number (%):50 (50)

Proportion male %: 99

Age/Age range/mean: 46.3

Ethnicity: 95% white

Other baseline measures: NR

Groups balance at Baseline: Y

Comments: N/A

Unit of allocation: Individual

Method of recruitment: NR

Inclusion criteria: Dual diagnosis

veterans. Potential to return to

competitive supported employment

within 6 months

Exclusion criteria: Veterans over

the age of 55; chronic medical

problems

Programme Name: Compensated

Work Therapy (VR) + contingency

management

Aims: Efficacy of the addition of

Contingency management to

vocational rehabilitation

Key Components: Payments for

provision of negative-urine samples

Theoretical base: NR

Programme Type: Contingency

management

Method of Delivery: Workplace,

with vocational counselling

Providers/deliverers: Workplace

staff

Length, duration, intensity: 36

weeks of weekday working

Time to follow-up: 9 months

Data: Questionnaire; Urinalysis

Self report/validated: Both

Methods used: NR

Unit of analysis: Individual

Any other process detail: NR

Number of participants

completing (%): 88% at + 9 months

Reasons for non-completion: NR

Employment outcome:

Participation in the VR + CM

condition was associated with a

significantly shorter time to entry into

competitive employment. While a

greater percentage of the VR + CM

group was employed at each month,

the differences were statistically

significant only for follow up months

2, 7, and 9.

Participants in the VR + CM group

completed 39% more job-search

tasks than those in the VR-only

group and The VR + CM group had

a statistically significant higher

completion rate on 5 of the 15 tasks.

Participants who relapsed at any

point during the study were not

significantly different from those who

remained abstinent in terms of

whether they entered competitive

employment or how quickly they

entered employment.

31


Authors: Room (1998) Country: USA Setting: work placement Funding source: Alcohol Research Group Study design: Secondary analysis - observational data Author Objectives: To assess how intervening with substance users can improve their employment and employment-related skills

Total participant number: NR Intervention number NR Control number %): NR Proportion male %: NR Age/Age range/mean: NR Ethnicity: NR Other baseline measures: NR Groups balanced at Baseline: NR Baseline Comments: NR Unit of allocation: individual Method of recruitment: NR

Inclusion criteria: NR Exclusion criteria: NR Programme Name: Social Model Programme Aims: To reduce substance use and improve employment opportunities Key Components: voucher reinforcement; contingency management of punctuality and reliable attendance Theoretical base: NR Programme Type: Vocational Training Method of Delivery: Various Providers/deliverers: Various Length, duration, intensity: Various

Time to follow-up: 1 year Data: qualitative (some quantitative) Self report/validated: SR Unit of analysis: Individual Any other process detail: NR NR Number of participants completing (%): NR Reasons for non-completion: NR

Employment outcome: Social model programs 1 and 2 have produced improvements of 34% and 28% respectively, in ASI employment scores from baseline to follow-up. ASI scores also show decreases in employment problems among social model clients.

32


Authors: Silverman et al., (2007) Country: USA Setting: Centre for Learning and Health, a treatment-research unit at the Johns Hopkins Bay View Medical Centre Funding source: NIDA Study design: RCT Author Objectives: To consider if employment-based abstinence reinforcement increases cocaine abstinence in adults who inject drugs and use cocaine during methadone treatment.

Total participant number: 56 Intervention number Abstinence and work 28 (50%) Control number %): Work only 28(50%) Proportion male %: NR Age/Age range/mean: 43.9 (6.5); 47.5 (5.8) Ethnicity: Black/white/other 92.9; 7.1; 0% Work only: 89.3; 7.1; 3.6% Other baseline measures: NR Groups balance at Baseline: NR Baseline Comments: NR Unit of allocation: Individual Method of recruitment: Fliers and letters were distributed to 11 Baltimore methadone programmes Research staff also visited the methadone treatment programs to describe the study to methadone treatment staff (e.g., counsellors).

Inclusion criteria: 18 years or older, unemployed, injected heroin or cocaine, used cocaine or crack in the past 30 days, currently enrolled in methadone maintenance treatment. Required to pass a written quiz and read 80% of the consent forms correctly and met DSM criteria for cocaine, opioid and alcohol dependence. Exclusion criteria: Unable to read consent form/failed written quiz (2%). If reported current suicidal ideation or hallucinations. Programme Name: Work-based abstinence Aims: To reduce substance use through an abstinence work-based programme Key Components job-skills training and monetary Vouchers – urine must be negative to enter workplace. Theoretical base: NR Programme Type: Contingency management Method of Delivery: Work placement Providers/deliverers: Methadone treatment staff (counsellors) Length, duration, intensity: 4 hours every weekday for 8 weeks (first stage); 26 weeks (2nd stage) 10 - 12, 1-3pm

Time to follow-up: 6 months Data: Interview; urine and breath samples, the VEA, the RAB, and the TSR. Also a modified Therapeutic Workplace Satisfaction Questionnaire. Self report/validated: Both Unit of analysis: Individual Any other process detail: NR Number of participants completing (%): 56 Reasons for non-completion: N/A

Employment outcome: Abstinence-and-work and work-only participants attended the workplace at high rates during baseline (85% and 82% of days, respectively). Work-only participants continued high rates of attendance throughout the intervention. Attendance by abstinence-and work participants decreased during the intervention when the cocaine urinalysis contingency was arranged, although most participants continued to attend intermittently.

33


Authors Silverman et al., (2002) Country: USA Setting: Therapeutic Workplace; University Funding source: NIDA Study design: RCT Author Objectives: To evaluate the effectiveness of a therapeutic workplace on treatment outcomes including drug abstinence and employment.

Total participant number: 40 Intervention number (%): 20 (50) Control number (%): 20 (50) Proportion male %: 0 Age/Age range/mean: 31.9 (2.5); 31.6(4.8) Ethnicity: 85%; 80% black; 20%; 15% white Other baseline measures: Groups balance at Baseline: Yes Comments: Unit of allocation: individual Method of recruitment: NR

Inclusion criteria: pregnant or post-partum Exclusion criteria: NR Programme Name: Therapeutic workplace Aims: To initiate abstinence and to establish basic academic and job skills Key Components: Workplace, participation dependent upon providing negative urine samples Theoretical base: NR Programme Type: Contingency management Method of Delivery: Supported Employment Providers/deliverers: Trained drugs staff Length, duration, intensity: 3 hours per day, 5 days per week, 6 month

Time to follow-up: regular assessment over 24 weeks Data: Urine analysis; workplace performance Self report/validated: V Methods used: NR Unit of analysis: Individual Any other process detail: NR Number of participants completing (%): 21 Reasons for non-completion: Failure to comply with CAP rules, non-attendance of workplace (12; 9) Incarceration (2)

Employment outcome: On average, 45% of participants attended the workplace per day. 20 participants assigned to the Therapeutic Workplace earned $706 in base pay, $239 in professional demeanour pay, and $68 for meeting daily learning aims. In total, participants' voucher earnings averaged $1,013. 40% of all Therapeutic Workplace participants maintained high rates of attendance throughout most of the 24 weeks.

34


Authors: Silverman et al., (2002) Country: USA Setting: Therapeutic workplace/ Research unit Funding source: NIDA Study design: CBA Author Objectives: Effectiveness of supported employment

Total participant number: 40 Intervention number 20 (50%) Control number %): Usual Care 20 (50%) Proportion male %: 0% Age/Age range/mean: 18-50 Ethnicity: NR Other baseline measures: Groups balance at Baseline: NR Baseline Comments: Unit of allocation: individual Method of recruitment: Centre for Addiction and Pregnancy (CAP) patients

Inclusion criteria: CAP patients, Age 18-50, unemployed, currently receiving methadone maintenance treatment and provided at least one urine sample positive for opiates or cocaine during the 6 weeks prior to being reviewed for screening. Exclusion criteria: considered at risk for suicide or had a psychiatric disorder that might disrupt their workplace functioning or limit their ability to provide informed consent Programme Name: Long-term effects of therapeutic workplace Aims: Decreased drug use and improved employment prospects Key Components Urine samples necessary each day - if negative allowed to work. Voucher reinforcement contingencies were arranged primarily to promote abstinence and to maintain workplace attendance. Voucher incentives for good performance and professional demeanour Theoretical base: NR Programme Type: Contingency management Method of Delivery: Workplace Providers/deliverers: Trained drugs staff Length, duration, intensity: 3 hrs per day, 5 days a wk. Up to 3 years; re-enrolled every six months

Time to follow-up: 3-years Data: 1996-1998; assessment every 30 days for both groups (starting 18 months after treatment entry). Urine samples (initially 3 times per week), questionnaires, interviews, ASI Self report/validated: Both Unit of analysis: Individual Any other process detail: NR Number of participants completing (%): NR Reasons for non-completion: NR

Employment outcome: 12 (60%) of the participants maintained periods of sustained attendance (i.e., interrupted by no more than occasional brief absences) of 6 months or more Three (15%) of the participants initiated their longest period of sustained workplace attendance after their initial invitation to attend the Therapeutic Workplace. On average, participants attended the workplace on 43% of the 780 weekdays in the 3-year period. At the end of the 3-year period, 9 of the 20 participants were attending the workplace consistently. On average, participants earned $53.67 per week in vouchers. Most of the earnings were derived from base pay ($42.89 per week, on average); the remainder was earned from professional demeanour ($7.96 per week, on average) and performance (meeting learning aims, data entry productivity pay, and typing; $2.81 per week, on average) pay.

35


Authors: Silverman et al., (2009) Country: USA Setting: Therapeutic workplace Funding source: NIDA Study design: Secondary analysis - review of 2 studies Phase 1-2 (Silverman 2001; 2002) Author Objectives: To review the success of TWP on employment and abstinence.

Total participant number: 40 (phase 1) 20 (phase 2) Intervention number NR Control number %): NR Proportion male %: 0 Age/Age range/mean: 18+ Ethnicity: NR Other baseline measures: Groups balance at Baseline: NR Baseline Comments: NR Unit of allocation: individual Method of recruitment: Enrolled in a methadone treatment programme in Baltimore,

Inclusion criteria: Pregnant and recently postpartum methadone patients. Currently enrolled in a methadone treatment programme in Baltimore, unemployed, child younger than 18 years old, income that would make them eligible for welfare. Reported using crack cocaine in the 30 days prior to intake, provided a cocaine-positive urine sample at the screening interview Exclusion criteria: NR Programme Name: Therapeutic workplace intervention Aims: Heroin and cocaine abstinence. To train and employ participants as data entry operators. Behaviour modification. Key Components To monitor attendance and completion of work shifts Theoretical base: NR Programme Type: Contingency management Method of Delivery: Individual counselling, data-entry training, daily methadone, trainee manual, voucher reinforcement Providers/deliverers: Methadone treatment staff (counsellors); a doctoral-level psychologist with training in behaviour analysis and behavioural pharmacology supervised the programme. Length, duration, intensity Phase 1: 4 hours every weekday for 6 months. Phase 2: 6 -8 hours per day, 5 days per week for 6 months

Time to follow-up: 3 years Data: Monthly assessments, urine and breath samples Self report/validated: Both Unit of analysis: Individual Any other process detail: Initiate sustained abstinence, establish needed job skills, and promote good work habits and professional demeanour. In Phase 2, abstinent and skilled patients are hired into a therapeutic workplace business where they perform real jobs and are paid in standard pay cheques Number of participants completing (%): 19 (Phase 2) Reasons for non-completion: unable to function

Employment outcome: Trainees completed tasks and maintained at least 2 consecutive weeks of abstinence, consistent attendance, punctuality and professional behaviour - hired as a data entry operator in Phase 2: maintained an overall accuracy of 99.6% and entered data at a rate of 2,515 characters per hour.

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Authors: Wong et al., (2004) Country: USA Setting: Therapeutic workplace (TWP) Funding source: NIDA Study design: Secondary analysis of sub sample used in RCT of Silverman 2001; 2002 Author Objectives: To evaluate a contingency management intervention

Total participant number: 4 Intervention number (%): 4 (100) Control number (%): 0 Proportion male %: 0 Age/Age range/mean: 29 – 32 (31) Ethnicity: NR Other baseline measures: NR Groups balance at Baseline: Y Baseline Comments: Unit of allocation: individual Method of recruitment: From therapeutic workplace intervention

Inclusion criteria: Employed as data entry operators in a TWP data entry business Exclusion criteria: NR Programme Name: Contingency Management Aims: To promote consistent and reliable attendance Key Components: Not allowed to work if positive urine sample or late. Earnings - vouchers. Reward system - vouchers, base rate of $5.25, bonus $5 for each batch completed minus $0.08 for every error. Theoretical base: NR Programme Type: Contingency Management Method of Delivery: NR Providers/deliverers: Methadone treatment staff (counsellors) Length, duration, intensity: 6 hrs per day, 5 days a week

Time to follow-up: NR Data: Urine samples; interviews Self report/validated: Both Unit of analysis: Individual Any other process detail: NR Number of participants completing (%): 4 (100) Reasons for non-completion: N/A

Employment outcome: Operators arrived at work on time a greater percentage of days during the contingency management condition compared with the first and second baseline conditions. The average number of minutes that operators were late for work each workday was significantly less during the intervention condition compared with the first and second baseline conditions Overall, operators completed a greater percentage of work shifts during the contingency management intervention condition compared with either baseline conditions. In addition operators worked significantly more minutes per day during the intervention condition compared with either baseline conditions On average operators earned 66.5% and 61.5% of the available base pay during the first and second baseline conditions, respectively. In contrast, operators on average earned 87.8% of available base pay during the contingency management condition.

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Authors: Wong et al., (2004) Country: USA Setting: Therapeutic workplace (TWP) Funding source: NIDA Study design: Secondary analysis of sub sample used in RCT of Silverman 2001; 2002 Author Objectives: Effectiveness of TWP with contingency management on attendance & abstinence

Total participant number: 5 Intervention number (%): 5 (100) Control number %): NR Proportion male %: 0 Age/Age range/mean: 18+ Ethnicity: NR Other baseline measures: Groups balance at Baseline: Y Baseline Comments: Unit of analyses: individual Method of recruitment: recruited from existing TWP sample

Inclusion criteria: already employed as data entry operators in the TWP Exclusion criteria: NR Programme Name: TWP with Contingency management Aims: To maintain therapeutic work-place attendance & improve treatment outcome. Key Components To monitor attendance and completion of work shifts Theoretical base: NR Programme Type: contingency management intervention Method of Delivery: Providers/deliverers: Methadone treatment staff (counsellors) Length, duration, intensity: 6h per day, 5 days per week. The initial baseline condition lasted for 80 consecutive workdays, followed by a contingency management period that lasted for 72 consecutive workdays, followed by a second baseline condition that lasted 148 consecutive workdays.

Time to follow-up: NR Data: Monitoring workplace punctuality, attendance and completion Self report/validated: SR Unit of analysis: Individual Any other process detail: Number of participants completing (%):5 (100) Reasons for non-completion: N/A

Employment outcome: Contingency management intervention significantly increased the mean percentage of days that operators completed work shifts. Post-hoc comparisons showed that the percentage of days that operators completed work shifts increased significantly during implementation of the contingency management intervention and then significantly decreased when the intervention was discontinued.

38

Supported Employment


Authors: Beimers et al., 2010 Country: USA Setting: Community Mental Health Services, Ohio Funding source: NR Study design: UCBA Author Objectives: To evaluate the effectiveness of supported employment services and examine the factors associated with entry into employment amongst substance users with mental illness

Total participant number: 113 Intervention number (%): 113 (100) Control number (%): NA Proportion male %: 66.4 Age/Age range/mean: 38.9 Ethnicity: Black 29.2%; White 66.4%; Other 4.4% Other baseline measures: NR Groups balance at Baseline: NA Baseline Comments: Most common mental illness was schizophrenia followed by bipolar disorder and depression. Four out of five had previous employment experience. The drug use scale had a lower mean and the community function and empowerment scale had higher means for those who entered employment than those who did not. 31.9% of individuals perceived themselves of having a disability that prohibited employment. Unit of allocation: Individual Method of recruitment: Sample drawn from integrated dual disorder treatment (IDDT) programmes at four mental health centres across Ohio

Inclusion criteria: Diagnosis of co-occurring substance use and mental disorders, receiving IDDT, interested in employment and willing to be referred for supported employment services, consented to participation Exclusion criteria: Employed at baseline Programme Name: Supported Employment Services Aims: To improve access to employment for substance users with a co-occurring mental illness. Key Components Addressing employment barriers, training for employment and job search skills Theoretical base: NR Programme Type: Supported Employment Method of Delivery: Counselling, training Providers/deliverers: treatment staff, supported employment staff, case managers Length, duration, intensity: Data collected on a monthly basis for 12 months

Time to follow-up: On-going over 12 months Data: Consumer and provider questionnaires, administrative records, forms designed specifically for project Self report/validated: SR Unit of analysis: Individual Any other process detail: NR Number of participants completing (%): NR Reasons for non-completion: NR

Employment outcome: 46.9% entered competitive employment during the 12-month study period, 66% of these individuals entered employment within the first 3-months. The average length of employment was 4.3 months; however 43% were employed for 2 months or less. Non-white, higher consumer empowerment, higher supported employment service use and lower financial status predicted employment entry.

39

Study detail


Authors Kerrigan et al., (2004) Country: USA Setting: Outpatient treatment facility Funding source: NR Study design: UCBA Author Objectives: NR

Total participant number: 80 Intervention number (%): 80 (100) Control number (%): 0 Proportion male : 98% Age/Age range/mean: 45 Ethnicity: 63% African American; 29% White Other baseline measures: NR Groups balance at Baseline: NR Comments: NR

Inclusion criteria: Veterans Exclusion criteria: NR Programme Name: Veterans Industries Programme Aims: Therapeutic work-for pay programme in which the VA contracts with private industry and federal agencies for work to be performed by veterans. Key Components: Supported housing and employment Theoretical base: NR Programme Type: Supported employment Method of Delivery: TW Providers/deliverers: Private sector Employers Length, duration, intensity: 3 months

Time to follow-up: >3 months Data: NR Self report/validated: NR Methods used: NR Unit of analysis: Individual Any other process detail: NR Number of participants completing (%): 72 (90%) Reasons for non-completion: NR

Employment outcome: 43 of the 80 veterans (54%) obtained competitive employment. The majority of jobs were in entry-level service positions including housekeeping, building maintenance, security, shipping, and receiving. A follow-up conducted 3 months after discharge from Veterans Industries indicated that 60% maintained competitive employment.

40


Authors Knealing et al., (2006) Country: USA Setting: Community Funding source: NIDA Study design: RCT Author Objectives: Effectiveness of therapeutic workplace programme

Total participant number: 47 Intervention number (%): 22 (46.8) Control number (%): 25 (53.2) Proportion male %: 14; 8 Age/Age range/mean: 37.1; 36.1 Ethnicity: 82%; 88% Black Other baseline measures: NR Groups balance at Baseline: Y Comments: NR Unit of analysis: Individual Method of recruitment: Methadone maintenance clinics

Inclusion criteria: resident in Baltimore city, >18 years, in methadone treatment, unemployed, met DSM–IV criteria for cocaine dependence, provided a urine sample that tested cocaine positive at the full screening interview, reported smoking crack cocaine, had at least one child <18 years (to help ensure welfare eligibility), and had an income within limits that allowed for welfare benefits (Temporary Cash Assistance [TCA) in Maryland Exclusion criteria: Considered at imminent risk of suicide or had a psychiatric disorder that could disrupt the workplace functioning or limit their ability to give informed consent (e.g., diagnosis of schizophrenia). Programme Name: Therapeutic Workplace Aims: Designed to provide training under simulated work conditions to prepare participants for entry-level office jobs and to promote and sustain long-term abstinence from drug use. Key Components: Therapeutic workplace + contingency management for attendance and drug free samples Theoretical base: NR Programme Type: Supported Employment Method of Delivery: Work placement Providers/deliverers: University Length, duration, intensity: Weekdays for 9 months

Time to follow-up: every 30 days for 9 months Data: Questionnaire; Urinalysis Self report/validated: Both Methods used: NR Unit of analysis: Individual Any other process detail: NR Number of participants completing (%): Only 7 of the 22 participants initiated consistent periods of abstinence and workplace attendance Reasons for non-completion: Failure to attend or provide urine sample (thus self-exclusion from workplace)

Employment outcome: Rates of full-time employment (>20 of past 30 days; assessed on the basis of ASI interviews) were universally low at intake, throughout the treatment period, and at the follow-up time point. Rates of part-time employment (>20 of past 30 days), although higher than for full-time employment, was consistently low across time for both groups of participants, and there were no significant differences between groups at any of the time points. A higher percentage of Therapeutic Workplace participants than usual care control participants had “any employment” (defined as having full-time, part-time, or Therapeutic Workplace employment) during treatment. That difference was marginally significant on the basis of the GEE analysis. This difference was not maintained at the follow-up time point, when employment within the Therapeutic Workplace was no longer available.

41

Employee Assistance Programmes


Authors: Jordan et al., (2008) Country: USA Setting: Four Kaiser Permanente’s Addiction Medicine programme (KPAM) outpatient programmes in Southern California: Fontana, San Diego, West Los Angeles and Carson (LA). Funding source: NR Study design: RCT Author Objectives: To evaluate the economic benefit of chemical dependency treatment to employers

Total participant number: 498 Intervention number (%): 189 (38) Control number (%): 309 (62) Proportion male %: 69.8; 71.8 Age/Age range/mean: 42.9; 41.5 Ethnicity: White 63%, 57.3%; African American 15.3%, 14.6%; Latino 13.2%, 20.1%; Other 8.5%, 8.1% Other baseline measures: NR Groups balance at Baseline: Y Baseline Comments: NR Unit of allocation: individual Method of recruitment: NR

Inclusion criteria: Employed patients Exclusion criteria: NR Programme Name: Chemical Dependency Treatment Aims: To improve work performance Key Components: Chemical dependency services; group sessions on anger management, prevention etc. job skills and other workshops. Theoretical base: NR Programme Type: Employee Assistance Method of Delivery: Group sessions, one-to-one counselling. Providers/deliverers: Addiction medicine physician specialists Length, duration, intensity: 1-2 months up to 1 year.

Time to follow-up: 30 - 60 day assessments Data: Assessment data from the Substance Abuse Treatment Support System (SATSS scales), assessments before 30 days after treatment. Employment measure; abbreviated ASI Self report/validated: SR Unit of analysis: Individual Any other process detail: NR Number of participants completing (%): Average 60% one location; 30% at another location (does not specify). Reasons for non-completion: Completion rates lower for update than for intake assessment due to drop out & lack of time, unavailability of a SATSS computer and failure to remind participants to arrive early or to stay after their treatment session when update due.

Employment outcome: Reported absence decreased from 58.5% at admission to 26.9%, lateness for work from 37.3% - 20.4%, less productivity from 19.7 - 14.9 and conflict from18.1 -11.8 with 30-60 days treatment. Similar decreases were reported at 61+ days with 66% reduction in absenteeism. 70% of patients had improved workplace performance after 1 month of treatment.

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Anti discrimination policy

Study detail


Authors: Baldwin et al., (2010) Country: USA Setting: Competitive workplace Funding source: NIDA Study design: Cross sectional Author Objectives: To determine if there were significant differences in employment outcomes for individuals with former substance use disorders, and if so, this was attributed to employer discrimination

Total participant number: 43,093 Intervention number (%): NR Control number (%):NR Proportion male %: NR Age/Age range/mean: 18–64 Ethnicity: NR Other baseline measures: Differences between age and income Groups balance at Baseline: NR Baseline Comments: NR Unit if allocation: Individual Method of recruitment: NR

Inclusion criteria: Former and non-former drug users; employed Exclusion criteria: NR Programme Name: NR Aims: To consider employment outcomes for former substance users Key Components: NR Theoretical base: NR Programme Type: Disability Discrimination Acts Method of Delivery: N/A Providers/deliverers: N/A Length, duration, intensity: N/A

Time to follow-up: N/A Data: Interviews Self report/validated: SR Unit of analysis: Individual Any other process detail: NR Number of participants completing (%): 81% Reasons for non-completion: Failure to complete the surveys

Employment outcome: No significant differences in employment rates, however significant difference in rates of full-time employment and job loss within 12 months (9% vs. 7% for former alcohol disorders; 13% vs. 7% for former drug disorders). Those more susceptible to job loss were individuals with co-morbid medical disorders, a high school education only, within the youngest or oldest age groups and individuals within the lowest income bracket.

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Welfare (benefits)


Authors: Brucker (2004) Country: USA Setting: Community Funding source: NR Study design: Cross sectional Author Objectives: To determine the employment status of welfare to work recipients

Total participant number: 329 recipients of disability benefits out of 11076 survey respondents Intervention number(%): NA Control number (%): Proportion male %: 59 Age/Age range/mean: 46.5% under 25 Ethnicity: 59.3% white Other baseline measures: NR Groups balance at Baseline: NR Comments: NR Unit of allocation: Individual Method of recruitment: NR

Inclusion criteria: Respondents in a subset of the combined 2002 and 2003 National Survey of Drug Use and Health Exclusion criteria: NR Programme Name: Disability allowance (Welfare) Aims: Comparison of treatment and employment outcomes in individuals with substance use disorders who receive disability benefit vs. those that do not Key Components: employment-based Theoretical base: N/A Programme Type: Welfare to work Method of Delivery: NR Providers/deliverers: NR Length, duration, intensity: NR

Data: Questionnaire Self report/validated: SR Methods used: NR Unit of analysis: Individual Any other process detail: NR Time to follow-up: Cross sectional Number of participants completing (%): NR Reasons for non-completion: NR

Employment outcome: Treatment attendance was not significantly associated with employment status in disability beneficiaries. Younger and better education clients were more likely to report employment in the previous week

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Authors: Schmidt (2007) Country: USA Setting: Welfare Offices/ adjacent private locations; for follow up: homes, jails, prisons, treatment facilities, shelters, and parks (homeless population) Funding source: NIDA Study design: Cross sectional, longitudinal survey Author Objectives: To examine

how substance use impacts the

ability for mothers to move from

welfare to work and to remain

economically independent

Total participant number: 419 Intervention number NA Control number (%): NA Proportion male %: 10% Age/Age range/mean: 29.2 Ethnicity: White/Caucasian 29.2%; Black/African-American 38.1%; Latino/Hispanic 19%; Other 13.7% Other baseline measures: NR Groups balance at Baseline: NR Baseline Comments: Not all were substance users Unit of allocation: individual Method of recruitment: NR

Inclusion criteria: In receipt of welfare (TANF) Exclusion criteria: non-welfare Programme Name: Welfare to work Aims: To determine how substance use impacts the ability to move from welfare to work and to remain economically independent after welfare Key Components Comparison of substance users with non-substance users Theoretical base: NR Programme Type: Welfare to work Method of Delivery: NR Providers/deliverers: NR Length, duration, intensity: NR

Time to follow-up: annually over 4 years Data: The Welfare Client Longitudinal Study (WCLS); Interviews (face to face/telephone) Self report/validated: SR Unit of analysis: Individual Any other process detail: Number of participants completing (%):402 (96%) Reasons for non-completion: 2% refusal; 2 % died

Employment outcome: Older age was associated with leaving welfare; no work history in the previous 12 months was negatively related to welfare as was having >3 children. No relationship between substance use and hazard of exiting welfare. No significant differences in the quality or stability of the jobs obtained by women with a substance use related problem as compared to those without. By 24-month follow-up most were no longer in employment. Regression analyses showed that a high school diploma have a significant effect on decreasing the hazard of returning to welfare. Those with less work history in the last 12 months were more likely to re-enter welfare.

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