Absence of conflict of interest.
Citation
Highlights
- The study’s objective was to examine the impact of an integrated drug counseling and employment intervention on employment, earnings, drug use, and HIV risk behaviors among clients in methadone maintenance treatment (MMT).
- The study was a randomized controlled trial that used surveys to compare the outcomes of MMT clients who received the integrated drug counseling and employment intervention to a control group of MMT clients who received drug counseling only.
- The study found no relationship between the integrated drug counseling and employment intervention and employment, earnings, drug use, and HIV risk behaviors.
- This study receives a low evidence rating because the authors did not ensure that the groups being compared were similar before the intervention. This means we are not confident that any estimated effects are attributable to the integrated drug counseling and employment intervention; other factors are likely to have contributed.
Intervention Examined
Integrated drug counseling and employment intervention
Features of the Intervention
Getting and staying employed can be difficult for MMT clients due to program requirements like daily dosing regimens and inflexible treatment schedules. Employment interventions are usually not included in methadone maintenance treatment (MMT) programs. Clients are often referred to other providers for employment services.
The intervention implemented interpersonal cognitive problem solving (ICPS) counseling therapy to address drug use and employment issues among MMT clients enrolled in community-based MMT programs. To be eligible, clients must be: 1) ages 18-55; 2) enrolled in MMT; 3) unemployed or underemployed; 4) able to work; and 5) interested in finding work.
Features of the Study
The study was a randomized controlled trial that recruited a total of 23 clients from 3 community-based MMT programs, two of which were in an urban setting, and one in a rural setting. The study randomly assigned participants to either the treatment group (n=12) or the control group (n=11). Among the study sample, the average age was 33 years old, 52% were female, 83% were White, and 70% participated at the urban site.
Participants were assigned to meet one of four counselors for weekly 45-minute meetings over 6 months. Participants in the treatment condition received the integrated drug counseling and employment intervention. For the treatment group, the counselor decided how many sessions were needed for each topic based on the participant's drug and work status. If the client relapsed or was in crisis, the counselor stopped the employment intervention and focused on drug counseling. Participants in the control condition received drug counseling only.
The authors use a statistical model to compare the outcomes of treatment and control group members. The primary data sources were baseline and six-month assessments measuring employment, drug use, and HIV risk behaviors using the Addiction Severity Index (ASI), the Risk Assessment Battery (RAB), the Employment Assessment Survey (EAS), and the Beck Depression Inventory (BDI).
Findings
Employment
- The study suggested there was no relationship between the integrated drug counseling and employment intervention and employment.
Earnings and wages
- The study suggested there was no relationship between the integrated drug counseling and employment intervention and average monthly earnings.
Health and safety
- The study suggested there was no relationship between the integrated drug counseling and employment intervention and drug use as well as HIV risk behaviors.
Considerations for Interpreting the Findings
Although the study is a randomized controlled trial, it has high attrition and the authors did not account for preexisting differences between the treatment and control groups. Therefore, the study is not eligible for a high causal evidence rating, the highest rating available for experimental 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 any estimated effects are attributable to the integrated drug counseling and employment intervention; other factors are likely to have contributed.