Interventions for Unemployed Hazardous Drinkers

Despite recent improvements in the US economy, unemployment remains a significant concern, and estimates indicate that one-third of unemployed persons drink at hazardous levels, adversely impacting their health and abilities to find jobs. Reinforcement interventions are highly efficacious in reducing substance use, and they can be applied to increase job-seeking activities as well. In partnership with CT United Labor Agency, this project is designed to reduce hazardous drinking and enhance active participation in job-seeking activities among those with job loss. It will evaluate the independent and combined effects of reinforcing negative breathalyzer samples and job-seeking activities to ascertain the simplest and most cost-effective approach to improving outcomes in this population. Unemployed individuals with hazardous drinking (N = 280) will be randomly assigned to one of four conditions using a 2 x 2 design: standard care, standard care with reinforcement for submitting negative breathalyzer samples, standard care with reinforcement for job-seeking activities, or standard care plus reinforcement for both negative breathalyzer samples and job-seeking activities. Participants in all conditions will receive usual services part of CT United Labor Agency, along with a novel remote breath alcohol monitoring procedure. The study interventions will be in effect for three months, and participants will be followed for one year. Alcohol and other drug use, employment, psychiatric symptoms, and global measures of health will be assessed throughout treatment and follow-up. Reinforcing negative breathalyzer samples is expected to significantly reduce drinking, and reinforcing job-seeking activities is expected to increase re-employment rates and reduce time until job attainment. Reinforcing both negative breathalyzer samples and job-seeking activities is hypothesized to improve outcomes along both domains. The reinforcement interventions may also decrease psychiatric distress and slow progression of physical decline, common among the unemployed. If efficacious and cost-effective, results from this study may stimulate adoption of reinforcement interventions in the context of unemployment services. Reducing the adverse consequences of hazardous drinking and improving job re-entry may have pronounced benefits in a highly vulnerable segment of the US population.


Eligibility Criteria:
Inclusion Criteria:

* age 18-65 years
* not worked for pay in the formal economy for \>4 weeks
* willing to participate in a workforce training program and willing to accept either part-time or full-time work
* hazardous alcohol use defined by AUDIT scores \>8, a mean of \>2 drinks/drinking day or \>14 drinks/week in men (\>1 drink/drinking day or \>7 drinks/week in women) in the past 2 months, or submission of an alcohol positive breathalyzer (\>0.02 g/dl) or EtG positive urine sample
* English or Spanish speaking and able to read at 5th grade level
* have a valid photo ID
* willing and able to use study equipment and sign an off-campus property transfer form

Exclusion Criteria:

* have begun receiving unemployment benefits within the past 4 weeks
* worked full- or part-time \<3 months in the past 3 years in the formal or informal economy
* physiological alcohol withdrawal symptoms (score \>10 on Clinical Institute Withdrawal Assessment for Alcohol-revised)
* physiological withdrawal symptoms from an illicit drug use disorder
* serious untreated psychiatric illness
* in recovery from gambling disorder