A community-based trial of vocational problem-solving to increase employment among methadone patients.

Authors: Zanis D, Coviello D, Alterman A. Appling S
Year Published 2001
Publication Journal of Substance Abuse Treatment
Volume 21
Number 1
Pages 19-26
Publisher Elsevier

Following drug use stabilization, employment has long been considered an important secondary goal for patients enrolled in methadone maintenance treatment programs. Several studies have found moderate positive correlations between increased employment, decreased substance use, and positive social functioning. Given the low rates of employment, patients desire for
employment services, and the association of employment with improved outcomes, employment interventions appear to be important to explore.


The main purposes of the study were to (a) train methadone counselors to deliver the Vocational Problem-Solving Skills (VPSS) intervention and (2) evaluate whether unemployed patients randomized to VPSS counseling would improve their employment functioning compared to patients randomized to an alternate activity.


The study was conducted at two comparable methadone treatment centers, each of which had both employed and unemployed clients.


The study sample consisted of 109 individuals receiving methadone treatment. Entrance criteria included the following: (1) Unemployed or underemployed, as working ‚under the table‚ less than 10 hours per week; (2) stabilized on methadone and enrolled in the treatment program for a minimum of 3 months; (3) expressed interest and capacity to work at least 20 hours per week; and (4) actively seeking employment as by the Bureau of Labor Statistics. Males constituted 61% of the sample, and African-Americans 61%

Data Collection

Participants were assessed by interviews at baseline, biweekly for 12 weeks, and at 6 months post-baseline. Measures included standardized measures of addiction and independent urine sampling, a vocational assessment, a treatment service review, chart review, and independent employment verification. Data analysis included descriptive statistics, a series of bivariate analyses to examine the correlation between potential predictor variables and the criterion variable (employed/not employed at least one day in the past 30 days at the 6-month follow-up point), and multinomial regression analysis.


The comparison group participated in an Interpersonal Problem Solving (IPS) intervention of similar duration and intensity as the VPSS. The goal of IPS counseling was to help patients develop improved problem-solving skills to either reduce drug use or continue abstinence from drug use. The five objectives of the IPS counseling were to: (1) reduce/eliminate illicit drug
use or maintain an abstinence plan; (2) understand the utility of social supports in recovery; (3) examine successful and unsuccessful efforts at recovery; (4) formulate realistic recovery plans; and (5) engage in planned activities.


Of the 109 participants, 101 could be located for six-month follow-up. At the point, 53 (54.6%) were considered, 19 (19.6%) were termed part-time employees (paid for working between 1 and 14 days), and 25 (25.8%) were considered full-time employees (paid for working 15 or more days in the past 30). VPSS participants were significantly more likely to be employed than the comparison group. However, enrollment in the VPSS condition did not predict employment when entered into the regression analysis with the other variables.


Although a greater percentage of patients who received the VPSS counseling program actually worked, VPSS was not predictive of employment after controlling for other factors, such as work history and motivation. Structured employment interventions may assist unemployed methadone patients in obtaining employment; however, the type of employment services provided must reflect a variety of employment needs.

URL http://www.ncbi.nlm.nih.gov/pubmed/11516923
Populations Male & Female | Hispanic or Latino | Black / African American | White / Caucasian
Outcomes Employment acquisition | Full-time employment | Part-time employment
Research Design Randomized Controlled Trials (RCTs)
Peer Reviewed Yes