French MT, Zarkin GA, Hubbard RL, Rachal JV

1: Am J Drug Alcohol Abuse. 1993;19(1):19-33.Links

The effects of time in drug abuse treatment and employment on posttreatment drug use and criminal activity.

French MT, Zarkin GA, Hubbard RL, Rachal JV.

Health and Human Resource Economics, Research Triangle Institute, Research Triangle Park, North Carolina27709.

The impact of length of stay in drug abuse treatment on follow-up drug use and criminal behavior has important clinical and policy implications. In this paper we use longitudinal data from the Treatment Outcome Prospective Study to estimate the simultaneous effects of time in treatment and employment outcomes--weeks worked and total earnings--on posttreatment drug use and criminal activity. The drug use/criminal activity variables include four indexes measuring the severity of use, drug-related problems, predatory illegal acts, and overall criminal behavior. The results show that time in treatment had a negative and statistically significant impact on these outcome variables for every modality with residential clients experiencing the largest relative impact. The time-in-treatment effect was robust even when employment outcomes were modeled jointly with drug use and criminal activity outcomes. These findings highlight the importance of length of stay in treatment in the recovery and rehabilitation of drug abusers.

PMID: 8382448 [PubMed - indexed for MEDLIN

1: Subst Use Misuse. 2007;42(7):1109-26.Links

Employment and work among drug court clients: 12-month outcomes.

Leukefeld C, Webster JM, Staton-Tindall M, Duvall J.

Center on Drug and Alcohol Research, University of Kentucky, Lexington, Kentucky40506-0350, USA.

Employment contributes to drug abuse treatment success and is an important treatment outcome (Institute of Medicine, 1990). However, few tailored employment interventions are available. This project developed an employment intervention focused on obtaining, maintaining, and upgrading employment. The current study, approved by an IRB, uses 12-month outcomes to examine intervention dosage effects. Participants were 500 clients who entered two Kentucky drug court programs between March 2000 and November 2002. Measures included demographics, drug/alcohol use, criminality, employment, and education measures from the Addiction Severity Index (McLellan, Luborsky, Woody, and O'Brien, 1980) as well as specific employment measures. To examine the intervention, the number of intervention upgrading sessions attended was divided by the number of possible upgrading sessions. Session attendance percentages were then used to median split into a low upgrading group and a high upgrading group and were compared with the no intervention group. These three groups were used in a series of ANOVA and chi-square analyses to examine differences at 12-month follow-up. When employment, legal work, illegal work, and employment problems were examined for one year and 30 days at follow-up, there were significant effects for jobs in the past year, days worked at a legitimate job in both the past year as well as 30 days, and income from a legitimate job in the past year. Participants in the high upgrade group received maximum employment benefits. Since legal earnings increased and illegal earnings decreased, drug-user treatment programs and practitioners should assess and refer clients to employment interventions. Tailored employment interventions should be tested to keep drug users in treatment and to increase treatment outcome. The study's limitations are noted and future needed research is suggested.

PMID: 17668328 [PubMed - indexed for MEDLINE]

1: Subst Use Misuse. 2007;42(7):1187-205.Links

Measuring employment among substance-using offenders.

Webster JM, Staton-Tindall M, Duvall JL, Garrity TF, Leukefeld CG.

Center on Drug and Alcohol Research, University of Kentucky, Lexington, Kentucky40536-0086, USA.

Employment has been identified as an important predictor of drug abuse treatment outcome; however, employment has been measured in a variety of different ways in the drug abuse literature and typically with community samples. The present IRB-approved study used factor analysis to identify commonalities among several employment measures collected from a sample of drug court offenders who entered one of two Kentucky drug courts between March 2000 and November 2002. Measures included demographics, employment, substance use, and criminality. The factor analysis produced four employment factors: status, earnings, duration, and stability. These factors had different correlation patterns with substance use and criminality. Study limitations are noted.

PMID: 17668332 [PubMed - indexed for MEDLINE

1: J Subst Abuse Treat.2002 Dec;23(4):261-71.Links

The effect of treatment completion and length of stay on employment and crime in outpatient drug-free treatment.

Zarkin GA, Dunlap LJ, Bray JW, Wechsberg WM.

RTI, 3040 Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC27709, USA.

Length of stay in treatment has been found to be a significant predictor of positive post-treatment outcomes, such as decreases in unemployment and crime. However, length of stay may be an incomplete predictor of successful treatment. Surprisingly, few studies have examined whether completing treatment in addition to length of stay is an important factor in explaining positive treatment outcomes. The objective of our study is to examine the effect that treatment completion and length of stay have on post-treatment employment and crime for patients in outpatient drug-free treatment, the largest treatment modality in the United States. We use conditional logit and multiple regression models with program-level indicator variables (fixed effects) to estimate the effect of treatment completion and length of stay on employment and crime controlling for drug use severity, previous treatment history, and other patient demographics. Data are from the National Treatment Improvement Evaluation Study and include 986 adults enrolled in outpatient drug-free programs across the United States. We find that treatment completion and length of stay are significantly related to post-treatment employment. Holding length of stay constant, the occurrence of employment at follow-up among patients who complete their planned treatment is almost 2 times that of patients who do not complete treatment. However, treatment completion did not have a statistically significant effect on the probability of post-treatment crime. Although our results are mixed, these findings suggest that greater attention should be placed on evaluating the importance of both length of stay and treatment completion in treatment outcome studies.

PMID: 12495788 [PubMed - indexed for MEDLIN

1: Arch Gen Psychiatry.2001 May;58(5):503-8.Links

A 33-year follow-up of narcotics addicts.

Hser YI, Hoffman V, Grella CE, Anglin MD.

UCLADrugAbuseResearchCenter, 1640 S Sepulveda Blvd, Suite 200, Los Angeles, CA90025, USA.

BACKGROUND: This study examined longitudinal patterns of heroin use, other substance use, health, mental health, employment, criminal involvement, and mortality among heroin addicts. METHODS: The sample was composed of 581 male heroin addicts admitted to the California Civil Addict Program (CAP) during the years 1962 through 1964; CAP was a compulsory drug treatment program for heroin-dependent criminal offenders. This 33-year follow-up study updates information previously obtained from admission records and 2 face-to-face interviews conducted in 1974-1975 and 1985-1986; in 1996-1997, at the latest follow-up, 284 were dead and 242 were interviewed. RESULTS: In 1996-1997, the mean age of the 242 interviewed subjects was 57.4 years. Age, disability, years since first heroin use, and heavy alcohol use were significant correlates of mortality. Of the 242 interviewed subjects, 20.7% tested positive for heroin (with additional 9.5% urine refusal and 14.0% incarceration, for whom urinalyses were unavailable), 66.9% reported tobacco use, 22.1% were daily alcohol drinkers, and many reported illicit drug use (eg, past-year heroin use was 40.5%; marijuana, 35.5%; cocaine, 19.4%; crack, 10.3%; amphetamine, 11.6%). The group also reported high rates of health problems, mental health problems, and criminal justice system involvement. Long-term heroin abstinence was associated with less criminality, morbidity, psychological distress, and higher employment. CONCLUSIONS: While the number of deaths increased steadily over time, heroin use patterns were remarkably stable for the group as a whole. For some, heroin addiction has been a lifelong condition associated with severe health and social consequences.

PMID: 11343531 [PubMed - indexed for MEDLINE

1: J Appl Psychol. 2001 Apr;86(2):337-50.Links

Prospective relationships between drug problems and work adjustment in a community sample of adults.

Galaif ER, Newcomb MD, Carmona JV.

Department of Psychology, University of California, Los Angeles90025, USA.

The prospective relationships between drug problems and work adjustment (e.g., job instability, job satisfaction) were examined in a community sample of 470 adults. Polydrug problems (alcohol, marijuana, and cocaine problem drug use) were both predictors and consequences of work adjustment. In partial support of the impaired functioning theory, polydrug problems predicted reduced job satisfaction 4 years later. Supporting the work-related strain theory, early job instability predicted polydrug problems 4 years later. In support of the theory of general deviance, low social conformity predicted later job instability. Finally, supporting social support theory, early support for drug problems reduced polydrug problems and increased job satisfaction 4 years later.

PMID: 11393445 [PubMed - indexed for MEDLIN

1: J Behav Health Serv Res. 2009 Apr;36(2):267-82. Epub 2008 Nov 21.Links

Longitudinal effects of LAAM and methadone maintenance on heroin addict behavior.

Anglin MD, Conner BT, Annon JJ, Longshore D.

Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, DavidGeffenSchool of Medicine, UCLA, 1640 S. Sepulveda Blvd., Ste. 200, Los Angeles, CA90025, USA.

Levo-alpha-acetylmethadol maintenance (LAAM) was compared to methadone maintenance (MM) on the behavioral performance of 315 heroin addicts before, during, and after 12 months of fully subsidized treatment. Assessments of drug use, criminal behavior, HIV risk behaviors, and employment and residential status were obtained at treatment intake and at 6, 12, and 18 months after admission. Treatment retention and in-treatment suppression of heroin use were significantly better for the LAAM group than for the MM group. Improvements were also noted during treatment in criminal behavior, criminal justice involvement, and employment status, and there were reductions in injection HIV risk and number of sexual partners. Most significant effects were primarily related to active participation in maintenance treatment. Under subsidized treatment, retention rates were two to four times that of similar clients in local community programs during the same period. LAAM was a useful and a potentially important addition to treatment options for opiate addiction, conferring greater retention and opiate suppression benefits. Its removal from application provides a historical lesson concerning the introduction of new medications into addiction health services.

PMID: 19023658 [PubMed - in process

1: Am J Drug Alcohol Abuse. 2001 Feb;27(1):137-46.Links

Correlates of employment: a cohort study.

Sterling RC, Gottheil E, Glassman SD, Weinstein SP, Serota RD, Lundy A.

Department of Psychiatry and Human Behavior, JeffersonMedicalCollege, ThomasJeffersonUniversity, Philadelphia, Pennsylvania19146, USA.

Employment is often viewed as a potent indicator of substance abuse treatment outcome. This study was conducted to determine if personality and/or demographic characteristics of a cohort of unemployed substance dependent persons presenting for addiction treatment might predict employment 9 months postadmission. By using stepwise discriminant function analysis, seven variables predictive of employment were identified. The positive value of employment was clearly documented. Those who gained employment were functioning better with regard to social and drug-use parameters than those who did not.

1: Int J Addict. 1990 Jan;25(1):53-63.Links

The influence of prolonged stable methadone maintenance treatment on mortality and employment: an 8-year follow-up.

Segest E, Mygind O, Bay H.

Office of the Commissioner of Health, Copenhagen, Denmark.

A cohort of 169 opiate drug addicts was followed for 8 years. The mortality rate was 3.3 per year. The average lethality per observation year was found to be higher than in other studies. The treatment with methadone was unstable and only 11% had received stable prolonged maintenance treatment. It is not possible to reject a model that described increasing mortality rates neither as a function of falling methadone maintenance treatment nor as a function of socially unstable addicts contra stable addicts. Unemployment was high in the cohort (87%), and no relationship could be demonstrated between methadone maintenance treatment and employment

1: Przegl Lek. 2005;62(6):361-4.Links

[Assessment of socio-demographic factors in alcohol-addicted patients recurrently treated in a detoxification unit]

[Article in Polish]

Chrostek Maj J, Kamenczak A, Bock R, Polewka A, Krawczyk E.

Katedra Toksykologii Klinicznej i Srodowiskowej Collegium Medicum, Uniwersytetu Jagiellońiskiego, Krakowie.

The aim of the presented study was the assessment some socio-demographic factors of alcohol dependent patients more times hospitalized in Department of Toxicology in Kraków in the years 1999-2004. The repeatedly hospitalization of 334 patients (298 men and 36 women), aged from 17 to 71 years (mean 45.1 years) due the alcohol problem on the basis of clinic documentation were established. The following socio-demographics traits were taken in analysis: age, sex, marital status, place of living, education, kind of jobs, employment and others sources of money. The patients were admitted from 2 or more 29 times during 6 years. Medical history of addiction of mentioned patients was from 1 to 40 years, mean 25 years. 43.7% persons live single and 53.6% was married. The most patients live in Kraków (80%) and others near the town. The education of them: 15.0% ended high school, 28.7% "medium", 30.5% "low professional" and elementary school--13.8% of them. This factor was similar like regional data. Amount mentioned persons 25.8% worked for salary, 11.7% had own business, and 25.4% was retired, and 29.0% was unemployed. This last factor was worse liked similar from mentioned region. The kind of jobs of persons on the aspect of "social safety" was described. Among the mentioned chronic alcohol addicted persons about 18.8% of them with machines in traffic was worked (bus drivers i.e.) and 7.5% described persons in special jobs was worked (policemen, physician i.e.). The authors were suggested that mentioned factors due health services cost in Poland and propose integration of treatment of alcohol-addicted patients.

1: Subst Use Misuse. 2008;43(10):1464-75.Links

Effectiveness of an outreach treatment program for inner city crack abusers: compliance, outcome, and client satisfaction.

Henskens R, Garretsen H, Bongers I, Van Dijk A, Sturmans F.

Trimbos Institute, Utrecht, The Netherlands.

In a randomized controlled trial the effectiveness of an outreach treatment program (OTP) was compared with standard addiction care services for hard-drug addicts in Rotterdam (The Netherlands). The study aimed at chronic, high-risk crack abusers who were insufficiently engaged in standard addiction treatment services. Data were collected from February 2000 to December 2001. A total of 124 subjects participated in the study at baseline. Follow-up data were available for 94 subjects. Outcome measures included treatment compliance, outcome, and satisfaction. Data were collected by means of monthly registrations, EuropAsi interviews and an evaluation form. There was a high compliance with OTP in the treatment group; the average length-of-stay was 6 months, with visits three times a week. Although both groups were well represented in standard care, participation was mainly based on methadone maintenance. Subjects treated in OTP showed significant improvements in physical health, general living conditions, and psychiatric status, but no change in employment, substance abuse, and legal status. The control group remained almost unchanged. Clients of OTP reported feeling very satisfied with their treatment. On-the-spot incentives and a positive relationship with the care provider were directly associated with treatment retention. An outreach treatment program, as conducted in this study, is associated with high compliance, general improvement, and treatment satisfaction. Characteristics of this treatment modality are (1) assertive outreach, (2) a mixed program with incentives, and (3) a strong focus on individual-bound therapy. Further research is needed with larger groups and similar conditions at baseline assessment.

PMID: 18615321 [PubMed - inde

1: Am J Public Health. 2009 Feb;99(2):328-33. Epub 2008 Dec 4.Links

Improving 24-month abstinence and employment outcomes for substance-dependent women receiving temporary assistance for needy families with intensive case management.

Morgenstern J, Neighbors CJ, Kuerbis A, Riordan A, Blanchard KA, McVeigh KH, Morgan TJ, McCrady B.

NationalCenter on Addiction and Substance Abuse, Columbia University, New York, NY10017, USA.

OBJECTIVE: We examined abstinence rates among substance-dependent women receiving Temporary Assistance for Needy Families (TANF) in intensive case management (ICM) over 24 months and whether ICM yielded significantly better employment outcomes compared with a screen-and-refer program (i.e., usual care). METHODS: Substance-dependent (n = 302) and non-substance dependent (n = 150) TANF applicants in Essex County, New Jersey, were recruited. We randomly assigned substance-dependent women to ICM or usual care. We interviewed all women at 3, 9, 15, and 24 months. RESULTS: Abstinence rates were higher for the ICM group than for the usual care group through 24 months of follow-up (odds ratio [OR] = 2.11; 95% confidence interval [CI] = 1.36, 3.29). A statistically significant interaction between time and group on number of days employed indicated that the rate of improvement over time in employment was greater for the ICM group than for the usual care group (incidence rate ratio = 1.03; 95% CI = 1.02, 1.04). Additionally, there were greater odds of being employed full time for those in the ICM group (OR = 1.68; 95% CI = 1.12, 2.51). CONCLUSIONS: ICM is a promising intervention for managing substance dependence among women receiving TANF and for improving employment rates among this vulnerable population.

1: Dialogues Clin Neurosci. 2007;9(4):399-412.Links

Outpatient Long-term Intensive Therapy for Alcoholics (OLITA): a successful biopsychosocial approach to the treatment of alcoholism.

Krampe H, Stawicki S, Hoehe MR, Ehrenreich H.

Division of Clinical Neuroscience, Max-Planck-Institute of Experimental Medicine, Goettingen, Germany.