A reinforcement-based Therapeutic Workplace for the treatment of drug abuse: Six-month abtinence outcomes.

This study evaluated a novel drug abuse treatment, the Therapeutic Workplace. In this treatment, patients are paid to perform jobs or to participate in job training. Salary is linked to abstinence by requiring patients to provide drug-free urine samples to gain access to the workplace. Pregnant and postpartum drug abuse patients (N ?=?40) were randomly assigned to a Therapeutic Workplace or usual care control group. Therapeutic Workplace participants were invited to work 3 hr every weekday for 6 months and could earn up to $4,030 in vouchers for abstinence, workplace attendance, and performance. On average, 45% of participants attended the workplace per day. Relative to controls, the Therapeutic Workplace nearly doubled patients' abstinence from opiates and cocaine (33% vs. 59% of thrice-weekly urine samples drug negative, respectively, p ?     

Toward application of the Therapeutic Workplace: Reply to Higgins (2001), Marlatt (2001), McLellan (2001), and Petry (2001).

Responds to comments by N. M. Petry, S. T. Higgins, A. T. McLellan, and G. A. Marlatt (see records 2001-14365-003, 2001-14365-004, 2001-14365-005, 2001-14365-006 respectively) on the article by K. Silverman et al. (see record 2001-14365-002). The Therapeutic Workplace appears effective at initiating abstinence from heroin and cocaine in pregnant and postpartum women. However, the cost and complexity of the intervention must be reduced before it is ready for widespread application. This treatment is designed to train and employ drug abuse patients, and to use the salary that they earn for working to reinforce abstinence. Limiting teaching to only critical skills can reduce the costs of training. Computerizing the intervention also can reduce its cost and complexity. Major cost efficiencies should be realized when participants become employed in Therapeutic Workplace businesses; these businesses could provide a self-sustaining means of arranging long-term employment and salary-based abstinence reinforcement. Studies are required that simultaneously demonstrate the effectiveness and cost efficiencies of using salary for real work to reinforce drug abstinence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A randomized controlled trial of the therapeutic workplace for community methadone patients: A partial failure to engage.

The Therapeutic Workplace is an employment-based treatment for drug addiction that uses wages for work to reinforce drug abstinence. The Therapeutic Workplace has promoted abstinence from heroin and cocaine in treatment-resistant mothers in methadone treatment. This study attempted to replicate that effect in crack cocaine users recruited from community-based methadone programs. Participants were randomly assigned to a Therapeutic Workplace (n=22) or usual care control (n=25) group. Therapeutic Workplace participants were invited to work in the workplace and earn vouchers every weekday for 9 months contingent on documented opiate and cocaine abstinence. The two groups did not differ significantly on measures of cocaine or opiate use collected during study participation. Daily attendance and urinalysis results of the Therapeutic Workplace group were analyzed, and only 7 of the 22 participants initiated consistent periods of abstinence and workplace attendance. Two individuals gained access to the workplace on a few days, and 9 participants attempted to gain access to the workplace but never provided a drug-negative urine sample. Possible reasons for differences between the current study and the previous Therapeutic Workplace study are considered. Procedures that increase participant contact with the Therapeutic Workplace and its reinforcement contingencies might increase the likelihood of these individuals being successful in the treatment program. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of reinforcer magnitude on data-entry productivity in chronically unemployed drug abusers participating in a therapeutic workplace.

The Therapeutic Workplace is a substance abuse treatment wherein patients are hired and paid to work in a job contingent on daily drug-free urine samples. The present study examined data-entry productivity of 6 unemployed methadone patients who demonstrated relatively variable and low data-entry response rates. A within-subject reversal design was used to determine whether increasing reinforcement magnitude tenfold could increase response rates. Four of the 6 participants showed the highest rates of responding in the high magnitude reinforcement condition. Two participants, who had the lowest overall response rates, showed less robust changes to the magnitude manipulation. The results suggest that reinforcement magnitude can be used to improve productivity in Therapeutic Workplace participants. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A reinforcement-based Therapeutic Workplace for the treatment of drug abuse: Three-year abstinence outcomes.

Long-term Therapeutic Workplace effects were evaluated in heroin- and cocaine-dependent, unemployed, treatment-resistant young mothers. Participants were paid to work or to train in the Therapeutic Workplace but had to provide drug-free urine samples to gain daily access. Participants (N=40) were randomly assigned to a Therapeutic Workplace or usual care control group. Therapeutic Workplace participants could work for 3 years. Relative to controls, Therapeutic Workplace participants increased cocaine (28% vs. 54% negative; p=.04) and opiate (37% vs. 60% negative; p=.05) abstinence on the basis of monthly urine samples collected until 3 years after intake. The Therapeutic Workplace can be an effective long-term treatment of cocaine and heroin addiction in poor and chronically unemployed young mothers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A promising intervention for a daunting problem: Comment on Silverman et al. (2001).

Six features of the report are commented on (K. Silverman et al., see record 2001-14365-002). First, the Therapeutic Workplace intervention described in the report represents a creative and promising new approach to drug abuse treatment. Second, to the author's knowledge, it represents the first intervention that has been shown in a randomized clinical trial to significantly reduce cocaine abuse among pregnant women. Third, the report and study are commendable for their scientific rigor. Fourth, the treatment approach is science-based, integrating concepts and principles from several behavioral science literatures. Fifth, the intervention offers a potentially practical way of extending incentive-based drug abuse treatments to community clinics. Sixth and last, the report has the potential to provoke serious thought and consideration of what more might be done to combat the daunting and related problems of chronic unemployment and drug abuse in our poorer communities. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Efficacy of a computerized abuse and safety assessment intervention for women with disabilities: A randomized controlled trial.

Objective: To evaluate the effects of a computerized disability-specific abuse assessment intervention on abuse awareness, safety self-efficacy, and safety promoting behaviors of women with diverse disabilities. Research Design: A randomized control group design was used, with the intervention group completing the assessment intervention both at Time 1 (T1) and 3 months later at Time 2 (T2) and control participants completing it for the first time at T2. Analyses compared intervention and control groups at T2 and evaluated change over time in intervention group participants. The relationship between outcome variables (abuse awareness, safety self-efficacy, safety behaviors) was also explored. Results: The intervention group had greater abuse awareness than the control group at T2, and abuse awareness increased from T1 to T2 among women in the intervention group, particularly among women who had experienced little or no abuse in the past year. Both abuse awareness and safety self-efficacy were significantly related to safety behaviors. Conclusions: The computerized program offers promise as a nonthreatening method of conducting abuse assessments among women with disabilities while also serving as an intervention to enhance abuse awareness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A Controlled Study of a Cigarette Smoking Cessation Intervention for Adolescents in Substance Abuse Treatment.

Tobacco use is prevalent among youth with alcohol and other drug problems, yet this issue has received limited research and clinical attention. This study reports on a controlled evaluation of a cigarette smoking intervention with 54 adolescents in treatment for substance abuse, ages 13-18 (22% female). Participants were assessed at 4 time points. A greater proportion of participants in the treatment condition (n = 26) reported cessation attempts and point abstinence than did control participants (n = 28) at all time points. However, significant differences were found only for point abstinence at a 3-month follow-up. These findings provide initial support for the efficacy of a smoking cessation intervention delivered in the context of adolescent substance abuse treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Human drug self-administration in a medium of exchange.

In a laboratory setting, a medium of exchange procedure was used to study factors relevant to drug taking. Participants could earn an income, respond to obtain cigarette puffs, and purchase puffs. Across sessions, either the work required for money increased while the work required for puffs remained constant, or vice versa (puffs always cost $0.25 each). Each manipulation was conducted twice, once when they could keep income not spent on puffs, and once when they could not. The two manipulations had equivalent effects on drug taking when income could be spent only on puffs; both manipulations decreased drug taking in equal magnitudes. When participants could keep income not spent on puffs, however, the two manipulations had different effects. Participants spent less on puffs and consumed less when it was the work required for puffs that increased. These and other results show the utility of the medium-of-exchange procedure and the unit-price metric for evaluating basic features of the drug-taking environment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Use of monetary reinforcement to reduce the cigarette smoking of persons with schizophrenia: A feasibility study.

The feasibility of using monetary reinforcement to promote abstinence from substance use in adult individuals with schizophrenia was addressed. Cigarette smoking was studied as an exemplar of drug use in 11 individuals with schizophrenia by use of a within-subject experimental design. The study duration was 3 weeks, with weeks 1 and 3 serving as baseline conditions and week 2 serving as the intervention condition; in the latter, patients could earn money by abstaining from cigarette smoking. Abstinence was significantly greater during the intervention condition than during the baseline conditions. These results illustrate the potential sensitivity of drug use in this population to reinforcement contingencies, suggesting that contingency-management interventions are a feasible option for treating the substance abuse of individuals with schizophrenia (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Workplace Triple P: A controlled evaluation of a parenting intervention for working parents.

This paper examined the effects of a parenting intervention targeting working parents called Workplace Triple P. The intervention targeted both parenting and work factors, focusing on key transition times (e.g., from home to work) and trained parents to more effectively manage these transitions. One-hundred-and-twenty-one working parents with children ranging in age from 1–16 years were randomly assigned to either a Workplace Triple P condition (WPTP) or to a waitlist control condition (WLC). Results showed that parents who had received the intervention reported significantly lower levels on measures of personal distress and dysfunctional parenting; and higher levels of work commitment, work satisfaction, and self-efficacy. Implications for the delivery of parenting interventions as employee assistance programs are discussed along with how such interventions can enhance work and family life. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Enrolling and retaining mothers of substance-exposed infants in drug abuse treatment.

This study provided an experimental test of a drug abuse treatment enrollment and retention intervention in a sample of 103 Black mothers of substance-exposed infants. Significantly more women assigned to the Engaging Moms Program enrolled into drug abuse treatment than did women assigned to the control condition (88% vs. 46%). Sixty-seven percent of participants in the Engaging Moms Program received at least 4 weeks of drug abuse treatment compared with 38% of the control women. However, there were no differences between the groups 90 days following treatment entry. Logistic regressions revealed that readiness for treatment predicted both short-term and long-term treatment retention. The Engaging Moms Program has considerable promise in facilitating treatment entry and short-term retention, but it did not influence long-term retention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Direct placement versus multistage models of supported housing in a population of veterans who are homeless.

This study presents information about two models of supported housing when combined with ready access to rent subsidies: a direct placement approach (where individuals are placed directly into independent housing from homelessness), and a multistage continuum approach (where individuals are placed first into a residential setting prior to independent housing). Using observational data from the national Housing and Urban Development–Veterans Affairs Supported Housing (HUD-VASH) program, which provided case management and housing subsidies to homeless veterans with psychiatric or substance abuse disorders, participants were categorized as receiving direct placement housing or multistage housing based on where they spent the majority of days prior to entry into HUD-VASH. Results indicate that multistage housing participants had significantly worse scores on baseline measures of alcohol and drug use, quality of life, and social support, and subsequently experienced significantly greater improvements over time so that, with the exception of employment outcomes, between-groups differences were not significant at later time periods. Multistage participants had health care costs that averaged more than three times those of direct placement participants during the initial period of residential care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Team resilience for young restaurant workers: Research-to-practice adaptation and assessment.

This paper describes a method for taking a known prevention intervention and modifying it to suit young restaurant workers. Such workers are at high risk for alcohol and other drug (AOD) abuse according to national surveys. While evidence-based programs for AOD prevention exist, they have not been delivered to restaurants. Accordingly, an adaptation methodology was developed by integrating curricula from a previous evidence-based program with research on resilience and input from stakeholders, such as young restaurant workers, their managers, trainers, and subject matter experts. A new curriculum (Team Resilience) maintained fidelity to the original program while incorporating stakeholder insights. At the end of each of three training sessions, participants (n = 124) rated their awareness of AOD risks, help-seeking orientation, and personal resilience. Ratings tended to increase across sessions, showing participants perceived benefits from Team Resilience. Discussion highlights the need for research-to-practice protocols in occupational health psychology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effects of frequently rotating shiftwork on sleep and the family life of hospital nurses

The effects of three frequently rotating shifts in an irregular sequence on the daily activities of 239 Japanese female hospital nurses were studied by the time-budget method. The nurses recorded their daily activities for several consecutive days. The questionnaire was returned by 80.8% of the participants, and recordings of 1016 days were analysed. A two-way analysis of variance clarified that the shift combination influenced the daily activities. The most distinct result was that nurses spent significantly more time on free-time activities on the day when they worked the night shift followed by the evening shift than they did on the day when they worked any other shift combination. Nurses offset sleep deprivation either by sleeping during the day before and after working the night shift (82-100%) or by sleeping 2 to 4 h later in the morning after working the evening shift and on days off. There was a strong positive correlation between total sleep time (including day sleep) and the length of the interval between two consecutive shifts (r = 0.95, p < 0.001). This result suggests that more than 16 h between work shifts is required to allow more than 7 h of total sleep time. In an analysis by household status, nurses who had young children (average age, 2.8 years) slept less and spent less time on free-time activities than did other nurses.     

Immunocytochemical detection of advanced glycated end products in rat renal tissue as a function of age and diabetes

Lifestyle practices and the health promoting environment of hospital nurses This paper examined the lifestyle practices of hospital nurses and the impact of specific interventions in the hospital environment. The perception of nurse as health promoter and as carer of AIDS patients was also examined. A self-administered questionnaire was used to collect data at two different time periods. The sample represented 729 nurses (at pre- and post-time periods), both qualified and student nurses. Qualified nurses reported the highest stress levels while student nurses reported more negative lifestyle practices such as smoking, alcohol consumption and drug use. A greater number of current smokers (29%) consumed alcohol and used drugs than non-smokers. The impact of intervention strategies around compliance with smoking policy and work-site walk routes reduced exposure to passive smoking at work for qualified nurses and increased exercise participation for both groups of nurses. Workplace was identified as the main source of stress which included relationships at work and demands of the job. Hospital nurses experiencing high work stress were more likely to use professional support and personal coping (discuss problems with friends/family, have a good cry and eat more) than others. Nurses believed in the importance of health promotion as part of their work; however, qualified nurses felt more confident and gave more health related information than student nurses. Student nurses perceived a lower risk of contacting AIDS through work and a higher concern/worry in caring for AIDS patients than qualified nurses.     

Exploring the nature of the relationship between child sexual abuse and substance use among women

AIMS: This study investigated whether child abuse (CSA) was associated with earlier substance use and greater severity of substance dependence and what aspects of CSA might predict substance abuse. DESIGN: The study compared (a) drug and alcohol treatment clients with and without a history of CSA and (b) CSA survivors outside drug and alcohol treatment who did or did not have current substance abuse. SETTINGS: Semi-structured interviews took place at participants' homes, treatment agencies or the research centre. PARTICIPANTS: Volunteer participants included 100 women recruited from drug and alcohol treatment programmes and 80 CSA survivors recruited through CSA counseling services and medial advertising. MEASUREMENTS: The results focus on data from the Opiate Treatment Index, Severity of Alcohol Dependence Questionnaire, Substance Dependence Scale, Self-Esteem Inventory and self-reported histories of CSA. FINDINGS: There were no differences between CSA survivors and other drug and alcohol treatment clients in their severity of dependence. Women with a history of CSA more frequently identified stimulants as their main problem drug and reported an earlier age of first intoxication and earlier use of inhalants. Among abused CSA survivors outside drug and alcohol treatment, women with current substance abuse had typically been abused during adolescence by someone outside the family, whereas those without current substance abuse were typically abused by family members before adolescence. CONCLUSIONS: The results suggest that adolescence is a crucial time for the influence of CSA experiences on substance abuse.     

Digital replantation in children: a long-term follow-up study

Symptoms of conduct disorder (CD), antisocial personality disorder (ASP), alcohol abuse, drug abuse, and somatization were tabulated for the families of 35 delinquent, substance-abusing (multiple-problem) adolescent male probands and 35 age-matched control males. Alcohol abuse, CD/ASP, and somatization were assessed with either the Diagnostic Interview Schedule (DIS) (for participants aged 18 and up) or the Diagnostic Interview for Children and Adolescents (DICA) (for participants aged 12 to 17). Drug abuse for all participants was assessed with the Substance Abuse Module (SAM) of the Comprehensive Interview for Diagnostic Evaluation (CIDE). As expected, proband groups had significantly more (p < .0001) CD/ASP, alcohol abuse, and drug abuse symptoms than control groups. A significant (p < .01) positive correlation among CD/ASP, alcohol abuse, and drug abuse was found for each group. Somatization was not differentially associated with proband status. It was concluded that identifying male multiple-problem youths also identifies families with a high incidence of similar problems.     

Sex differences in vulnerability to drug self-administration.

Recent evidence from both human and animal studies indicates that there are sex differences in all phases of the addiction process, including initiation and acquisition of use, patterns and levels of use, the progression to addiction, and relapse. This brief review summarizes a series of studies on sex differences in drug self-administration in rats on which the Wyeth Young Psychopharmacologist Award was based and relates these findings to human clinical data. Briefly, preclinical findings show that female rats acquire drug self-administration at a faster rate, work harder to obtain drug infusions, "binge" for longer initial periods of time and show a more diurnally dysregulated pattern of self-administration under extended-access conditions, and respond at higher levels under reinstatement testing conditions compared with male rats. Similar results have been reported in humans, suggesting a biological basis of sex differences in vulnerability to drug abuse. A number of biological mechanisms have been explored, and the results show that ovarian hormones play a critical role in modulating the reinforcing effects of drugs of abuse in females. Preclinical studies, in conjunction with human studies, should further inform a sex-specific model for differences in drug abuse, and such a model may be useful for developing prevention and treatment strategies for drug abuse. (PsycINFO Database Record (c) 2010 APA, all rights reserved)