The therapeutic workplace to promote treatment engagement and drug abstinence in out-of-treatment injection drug users: A randomized controlled trial

• Most heroin-dependent injection drug users are not enrolled in methadone treatment.
• Therapeutic workplace participants enrolled in methadone treatment at high rates.
• Employment-based reinforcement increased abstinence from opiates and cocaine.
• The therapeutic workplace participants remained in methadone treatment at follow-up.
• Employment-based reinforcement may need to be sustained long-term to sustain abstinence.

ObjectiveDetermine if employment-based reinforcement can increase methadone treatment engagement and drug abstinence in out-of-treatment injection drug users.MethodThis study was conducted from 2008 to 2012 in a therapeutic workplace in Baltimore, MD. After a 4-week induction, participants (N = 98) could work and earn pay for 26 weeks and were randomly assigned to Work Reinforcement, Methadone & Work Reinforcement, and Abstinence, Methadone & Work Reinforcement conditions. Work Reinforcement participants had to work to earn pay. Methadone & Work Reinforcement and Abstinence, Methadone, & Work Reinforcement participants had to enroll in methadone treatment to work and maximize pay. Abstinence, Methadone, & Work Reinforcement participants had to provide opiate- and cocaine-negative urine samples to maximize pay.ResultsMost participants (92%) enrolled in methadone treatment during induction. Drug abstinence increased as a graded function of the addition of the methadone and abstinence contingencies. Abstinence, Methadone & Work Reinforcement participants provided significantly more urine samples negative for opiates (75% versus 54%) and cocaine (57% versus 32%) than Work Reinforcement participants. Methadone & Work Reinforcement participants provided significantly more cocaine-negative samples than Work Reinforcement participants (55% versus 32%).ConclusionThe therapeutic workplace can promote drug abstinence in out-of-treatment injection drug users.Clinical Trial Registration Number: NCT01416584.