Absence of conflict of interest.
Citation
Highlights
- The study’s objective was to examine the impact of abstinence-contingent wage supplements on post-intervention employment for adults in opioid treatment.
- The study was a randomized controlled trial that used data from self-reported assessments to compare the outcomes of a treatment group of unemployed adults in opioid treatment who could receive abstinence-contingent wage supplements to a control group of unemployed adults in opioid treatment who received usual care.
- The study did not find any statistically significant effects of abstinence-contingent wage supplements on post-intervention employment.
- This study receives a high evidence rating. This means we would be confident that any estimated effects are attributable to abstinence-contingent wage supplements, and not to other factors. However, the study did not find statistically significant effects.
Intervention Examined
Abstinence-contingent wage supplements
Features of the Intervention
Abstinence-contingent wage supplements, which are designed to target individuals in poverty with substance use disorders, combine both employment opportunities and abstinence reinforcement. Participants earned stipends if they worked with employment specialists and engaged in job-seeking behaviors for up to 20 hours per week. When employed, participants could earn abstinence-continent wage supplements for all verified hours they worked for up to 40 hours per week. To earn the maximum amount of wage supplements, participants had to provide opiate- and cocaine-negative urine samples on a schedule that was initially routine, which then moved to a random drug-testing schedule.
Features of the Study
The study used a randomized controlled trial to examine the impact of abstinence-contingent wage supplements. The study was conducted at the Center for Learning and Health on the Johns Hopkins Bayview Campus in Baltimore, Maryland, USA. During Phase 1 of the program, which took place over a 90-day period, participants considered eligible for the study if they were unemployed adults aged 18 and above who were either enrolled in or eligible for opioid treatment, had opioid-positive urine samples, expressed a desire to find employment, and resided in or near Baltimore City. Phase 1 participants who attended a therapeutic workplace at least 10 out of the final 20 days in Phase 1 were invited to participate in Phase 2. More than half of all participants were male, more than half were black, more than three-quarters were unmarried, more than three-quarters were previously incarcerated, two-thirds had completed high school or had a GED, and nearly all were living in poverty.
During Phase 2, a total of 91 individuals were randomized with 44 participants assigned to the treatment group and 47 assigned to the control group. Both groups could work with an employment specialist to seek employment in community jobs during Phase 2, which lasted 12 months. The treatment group could also earn training stipends for working with the employment specialist and wage supplements for working in a community job, but participants had to provide opiate and cocaine-negative urine samples to maximize their stipends.
The study used data from self-assessments collected at intake, at the end of Phase 1, monthly during Phase 2, and every 3 months during post-intervention. The authors used a statistical model to compare the outcomes of treatment and control group members.
Findings
Employment
- The study did not find any statistically significant effects of abstinence-contingent wage supplements on post-intervention employment among unemployed adults in opioid treatment.
Causal Evidence Rating
The quality of causal evidence presented in this report is high because it was based on a well-implemented randomized controlled trial. This means we would be confident that any estimated effects would be attributable to abstinence-contingent wage supplements and not to other factors. However, the study did not find statistically significant effects.