Absence of conflict of interest.
Citation
Highlights
- The study’s objective was to examine the impact of chemical dependency treatment and additional vocational services on employment and earnings outcomes. This profile focuses on the comparison between clients who completed both the substance use and vocational service components of the intervention and those who did not. The authors investigated similar research questions for another contrast, the profile of which can be found here.
- The authors used a nonexperimental design to compare the outcomes of participants who received chemical dependency and additional vocational services and eligible participants who did not receive either program. Using data from state case management records, the authors conducted statistical models to examine differences between the groups.
- The study found a statistically significant relationship between receiving chemical dependency treatment and additional vocational services and the increased average number of months employed and monthly earnings in the 4.5 years following treatment.
- This study receives a low evidence rating. This means we are not confident that the estimated effects are attributable to chemical dependency treatment and additional vocational services; other factors are likely to have contributed.
Intervention Examined
Chemical Dependency Treatment and Additional Vocational Services under the Alcohol and Drug Addiction Treatment and Support Act (ADATSA)
Features of the Intervention
Passed in 1987, Washington state implemented the Alcohol and Drug Addiction Treatment and Support Act (ADATSA) to support goals of alcohol and drug abstinence through chemical dependency treatments. Additional goals of the treatment program include coping skills, social skills, and vocational skills. The Washington State Division of Alcohol and Substance Abuse (DASA) administered the chemical dependency program for eligible participants, including six months of treatment (including vocational skills) programming and financial support for any two-year period. Clients were also eligible to receive additional vocational services from three pilot programs: The Vocational Opportunity Training Education Program (VOTE), Rapid Rehabilitation Resolution (RRR), and the ADATSA Cooperative Employment Program (ACEP). The program was designed to serve adults with addictions to alcohol or other drugs. To receive treatment, clients were required to be low-income and unemployable due to their addiction.
Features of the Study
The nonexperimental study compared the outcomes of clients that received chemical dependency treatment and additional vocational services and clients that were eligible for treatment but did not participate. In a four-and-a-half-year follow-up study, study authors examined employment and earning outcomes for approximately 1,146 clients eligible to receive ADATSA chemical dependency treatment and additional vocational services. Participants were often unmarried, white, male, justice-involved, had some level of substance abuse history, physical/mental/emotional problems, and/or homeless. The primary data sources for this study came from a combination of case records from ADATSA clients assessed in 1989 and case records from all ADATSA clients who received additional vocational services from VOTE, RRR, and ACEP. Data was collected for the two years prior to treatment and four and a half years following treatment. The authors used statistical models to compare the outcomes of clients in treatment and control groups. In the statistical models, study authors controlled for gender, race, age, marital status, education, recent employment, and seasonal labor variables.
Findings
Earnings and wages
- The study found a significant positive relationship between receiving ADATSA chemical dependency treatment and additional vocational services and average monthly earnings in the 4.5 years following treatment in comparison to participants that did not receive treatment.
Employment
- The study found a significant positive relationship between receiving ADATSA chemical dependency treatment and additional vocational services and employment rates and number of months employed in the 4.5 years following treatment in comparison to participants that did not receive treatment.
Considerations for Interpreting the Findings
While the study authors statistically controlled for pre-treatment characteristics such as sex, race, age, marital status, education, and recent employment, they did not control for baseline outcomes greater than one year before program participation as required by the protocol. Also, the authors acknowledged that self-selection mechanisms were not accounted for. Self-selection mechanisms in this context include the differences in motivation for eligible participants to pursue chemical dependency treatment and additional vocational services when compared to the participants that completed chemical dependency treatment only. Individuals who self-selected into the program could differ in observable and unobservable ways, affecting the observed outcomes. Therefore, the study is not eligible for a moderate causal evidence rating, the highest rating available for nonexperimental designs.
Causal Evidence Rating
The quality of causal evidence presented in this report is low because the authors did not ensure that the groups being compared were similar before the intervention. This means we are not confident that the estimated effects are attributable to chemical dependency treatment and additional vocational services; other factors are likely to have contributed.