A Bridge to Treatment: The Therapeutic Workplace and Methadone Treatment

A randomized study is planned for 5 years to evaluate the effectiveness of the Therapeutic Workplace in promoting methadone treatment and abstinence in unemployed injection drug users. Participants will be recruited through street outreach, at agencies that serve the target populations, and informal word-of-mouth referrals. Participants will be invited to attend the workplace and to enroll in the methadone treatment. To engage participants in the workplace, they will be allowed to work independent of whether they enroll in methadone treatment and independent of their drug use. The workplace participants (N=162) will be randomly assigned to three groups. The "Usual Care Control" participants will be allowed to work independent of their methadone use or urinalysis results. The "Methadone Contingency" participants will be required to take methadone to attend work, and will receive a brief pay decrease for failing to take their medication. The "Methadone & Abstinence Contingency" participants will be required to take their medication in order to attend work, as well as receive a brief pay decrease for any positive urine samples for both cocaine and methadone.

Individuals were eligible if they were:

• at least 18 years old,
• reported injection drug use in the past 30 days,
• met the Diagnostic and Statistical Manual (DSM)-IV criteria for opioid dependence,
• reported using heroin at least 21 out of the past 30 days,
• provided an opiate-positive urine sample,
• showed visible signs of injection drug use (i.e., track marks),
• reported not receiving substance abuse treatment in the past 30 days,
• lived in Baltimore,
• and were unemployed.

Participants were excluded if they

• had current severe psychiatric disorders or chronic medical conditions that would interfere with their ability to participate in the workplace,
• reported current suicidal or homicidal ideation,
• had physical limitations that would prevent them from using a keyboard,
• had medical insurance coverage (as this would disqualify them from receiving interim methadone treatment),
• were pregnant or breastfeeding,
• or were currently considered a prisoner.

Eligible participants were invited to participate in a 4-week induction. Participants who attended the workplace for at least five minutes on two out of five workdays in the last week of induction were randomly assigned to one of three conditions and were invited to attend the workplace for an additional 26 weeks