Absence of conflict of interest.
Citation
Highlights
- The study's objective was to examine the impact of a therapeutic workplace on employment, earnings and wages, and public benefits receipt.
- This study used a randomized controlled trial. The outcome data for this study came from basic assessments conducted every 30 days from 18 to 48 months after entry and more detailed assessments collected every 6 months from 18 to 96 months after entry. This paper focuses on results from the data collected from 37 to 96 months after entry. Assessments included: the Addiction Severity Index (ASI), an AIDS Risk Questionnaire, and 30-day employment history. The authors use statistical tests to compare the outcomes of treatment and control group members.
- The findings indicate that a therapeutic workplace program can help minimize barriers to employment and promote earnings and better health and safety outcomes for chronically unemployed women four years after intake. Though total income remained higher five to eight years after intake, and after the employer involved in the intervention closed, there were no significant differences on other outcomes.
- This study receives a high evidence rating. This means we are confident that the estimated effects are attributable to a therapeutic workplace, and not to other factors.
Intervention Examined
Therapeutic Workplace
Features of the Intervention
The therapeutic workplace intervention requires employees abstain from drug use to remain employed. The goal of the intervention is to encourage long-term drug abstinence.
The therapeutic workplace in this study was delivered in two phases: In the first phase, participants took part in a stipend-supported training program where they learned job skills while abstaining from drug use. Participants attended training 3 hours a day five days a week. They took drug tests each morning and, if the test was negative for opiates and cocaine, they would receive pay in the form of vouchers, exchangeable for goods and services. In the second phase, the employee was hired in a data entry position and remained employed as long as they continued to abstain from drug use. Employees were drug tested three days a week and could only work and get paid if they tested negative for opiates and cocaine.
The target of the intervention was pregnant or postpartum women who were unemployed and currently receiving methadone maintenance treatment, and who provided at least one urine sample positive for opiates or cocaine during the 6 weeks prior to screening for study enrollment. Four years after the therapeutic workplace intervention began, the business employing the participants closed.
Features of the Study
This study used a randomized controlled trial. Participants were recruited from the Center for Addiction and Pregnancy at the Johns Hopkins Bayview Medical Center in Baltimore, Maryland. Forty eligible women were randomly assigned to a treatment or control group. The treatment group took part in the therapeutic workplace intervention. The control group took part in usual care. The outcome data for this study came from basic assessments conducted every 30 days from 18 to 48 months after entry and more detailed assessments collected every 6 months from 18 to 96 months after entry. This paper focuses on results from the data collected from 37 to 96 months after entry, and examines impacts separately for the period in which the business operated (four year outcomes) and after it closed (five to eight year outcomes). Assessments included: the Addiction Severity Index (ASI), an AIDS Risk Questionnaire, and 30-day employment history. The authors use statistical tests to compare the outcomes of treatment and control group members.
Findings
Employment
- Four years after intake, treatment group participants had significantly higher rates of full-time employment (OR: 8.2), lower rates of unemployment (OR: 4.8), and more days employed (7.4 days). There were no significant differences in part-time employment. Five to eight years after intake, there were no significant differences in rates of full- or part-time employment, unemployment, or days employed.
Earnings and wages
- Four years after intake, treatment group had significantly higher employment income and higher total income. There were no significant differences in public assistance income or illegal income. Five to eight years after intake, treatment group participants had significantly higher total income. There were no significant differences in employment income, public assistance income, or illegal income.
Public benefit receipt
- Four years and five to eight years after intake, there were no differences in receipt of public assistance.
Health and safety
- Four years after intake, treatment group participants had significantly higher rates of negative urinalysis for cocaine (OR: 3.8), opiates (OR: 3.6), and both (OR: 4.6)—and higher rates of abstinence for cocaine (OR: 4.0), opiates (OR: 4.7), and both (OR: 5.5). There was no difference in rates of five measures of drug use and related illicit activities, nor in days in outpatient treatment or days of methadone use. Five to eight years after intake there were no differences in any outcome.
Considerations for Interpreting the Findings
The study authors estimated multiple impacts on outcomes related to employment, earnings, and health and safety. Performing multiple statistical tests on related outcomes makes it more likely that some impacts will be found statistically significant purely by chance and not because they reflect program effectiveness.
Causal Evidence Rating
This study receives a high evidence rating. This means we are confident that the estimated effects are attributable to a therapeutic workplace, and not to other factors.