A Therapeutic Workplace for Alcohol Dependence
Condition: Alcohol Dependence
MeSH terms: Alcoholism
Study type: Interventional
Phase: Phase 2

Summary: 
      The purpose of this study is to determine whether the Therapeutic Workplace is effective in
      increasing and maintaining long-term drug abstinence in homeless, alcohol dependent adults.
    

Detailed description: 
      Few populations are beset with the constellation of economic, social and health problems that
      afflict homeless individuals. At the heart of much of this misfortune are staggering rates of
      alcoholism and drug addiction. While it is not clear whether substance abuse is a cause,
      consequence, or simply a correlate of homelessness, there is no question that substance abuse
      is among the most common and most serious problems facing the homeless. Given their unique
      set of serious and chronic problems, the Institute of Medicine has identified the homeless as
      a group of people in need of specialized substance abuse interventions. Prior research has
      shown that the Therapeutic Workplace intervention is effective in the treatment of
      chronically unemployed heroin and cocaine dependent individuals. The intervention integrates
      abstinence reinforcement contingencies of proven efficacy into a model supported work
      program. Under this intervention, patients are paid to perform data entry jobs in the
      Therapeutic Workplace. Those lacking needed skills are given intensive training in basic
      academic and job skills. To reinforce abstinence from alcohol and drugs, patients are
      required to provide an alcohol-free breath sample and drug-free urine sample to gain entrance
      to the workplace each day. In this way, patients can work and earn salary only when they
      abstain from alcohol and drugs. Patients are paid in vouchers instead of cash to reduce the
      chance they will use their earnings to purchase alcohol or drugs.

      A randomized trial was conducted to evaluate the efficacy of this intervention in homeless,
      alcohol-dependent adults who completed an inpatient alcohol detoxification. After the
      detoxification, 124 participants were invited to attend the workplace for 6 months. They were
      randomly assigned to one of three groups that differed in the requirements for voucher
      reinforcement. One group received the full therapeutic workplace intervention in which
      vouchers were contingent on both abstinence and work (Abstinence and Work group). A second
      group was paid for work, but did not have to provide an alcohol-free breath sample or
      drug-free urine sample to gain access to the workplace; their vouchers were contingent on
      work only (Work-Only group). A third group was invited to attend the therapeutic workplace
      but received no vouchers for work performed or abstinence achieved during treatment (No
      Voucher group).
    

Intervention name(s): Contingency management
Intervention type(s): Behavioral
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: contingency management; reinforcement; employment; Therapeutic Workplace