Methadone treatment patients, have had poorer employment outcomes than other substance users. Employment may enhance clinical outcomes for this group by reducing rates of relapse, criminality, and parole violation. Work is also associated with lower rates of drug use during treatment, as well as longer retention in treatment. Substance users have been eliminated and federal welfare reform legislation. Substance users in treatment must achieve work readiness in specific time frames. Traditional vocational services for substance users, including methadone treatment patients, have had limited positive results. Innovative vocational interventions or programs are needed to assist this group with employment.
The hypothesis of this study was that patients assigned to the experimental Customized Employment Support model condition would have better employment outcomes
than those assigned to a control condition who received standard vocational counseling.
The study was implemented at two sites in Manhattan. One is a free-standing methadone clinic operated by Greenwich House, a nonprofit social services agency. The other methadone clinic is operated by Harlem Hospital but is located separately from the hospital.
The data was collected from May 2001 through April 2005. The efficacy sample for the analysis consisted of 168 patients who completed follow-up interviews. *(Note this is a follow up to the study by Staines, Blankertz, Magura et al 2004) The sample was 58% male, 75% minority group, average age 45 years, and in methadone treatment for an average of five years.
The study collected data on patient employment and behaviors from the following sources: personal interviews, vocational activities log and employment documentation. Employment measures drew on and integrated information from these sources. The major employment outcome was the attainment of a paid job.
To provide a single overall index of vocational outcomes, they were combined into a four-level, ordinal measure of highest level of vocational attainment:
1. Attained a competitive job (highest).
2. Attained an informal job.
3. Performed constructive activity other than paid employment.
4. None of the above (lowest).
CES counselors left during the study period. Patients who received no counseling (N=24) were excluded from this sample. The interview follow up rate for follow up at 12 months was 91%. The main analytical technique was multiple logistic regression with statistical significance set at p < .05 (2-tailed). Vocational intervention condition was introduced into the analysis as an indicator variable (CES=1, standard=0). The statistical control for period of intervention, as described above, is also an indicator variable (earlier cases = 1, later cases = 0). All analyses of employment outcomes included the baseline measure of the outcome variable as a covariate. Since the study had no dollar measure of earnings prior to baseline, work in the prior 6-month period was used as the covariate in the analysis of earnings as an outcome. Patient baseline variables were examined to determine whether any were significantly associated with both an employment outcome and vocational intervention assignment (CES vs. standard counseling); none were. Thus, none of these variables was a potential confounder in the regression analysis. Work in the pre-study period was included as a covariate in the multivariate analysis, however, to enable the potential independent effect of the CES intervention on employment outcomes to be determined.
The intervention, the Customized Employment Supports (CES) model, is designed to help patients overcome these employment barriers and attain paid work as soon as possible. The model assigns CES counselors small caseloads so that, using intensive interventions, they can engage patients and enhance their self-efficacy. Methods used to help patients increase their self-efficacy include role modeling, persuasion, and minimizing emotional arousal.
Participants were randomized into intervention and control groups.
The results supported the hypothesis for two measures of employment; i.e., the Customized Employment Support group was significantly more likely than the control group to obtain both any paid employment and informal paid employment. However, there were no significant differences for competitive employment or total earnings.
Vocational rehabilitation services for unemployed methadone patients can be improved by implementing a Customized Employment Support model.