PT  - JOURNAL ARTICLE
AU  - August F Holtyn
AU  - Forrest Toegel
AU  - Shrinidhi Subramaniam
AU  - Brantley P Jarvis
AU  - Jeannie-Marie Leoutsakos
AU  - Michael Fingerhood
AU  - Kenneth Silverman
TI  - Abstinence-contingent wage supplements to promote drug abstinence and employment: a randomised controlled trial
AID  - 10.1136/jech-2020-213761
DP  - 2020 May 01
TA  - Journal of Epidemiology and Community Health
PG  - 445--452
VI  - 74
IP  - 5
4099  - http://jech.bmj.com/content/74/5/445.short
4100  - http://jech.bmj.com/content/74/5/445.full
SO  - J Epidemiol Community Health2020 May 01; 74
AB  - Background Poverty, unemployment and substance abuse are inter-related problems. This study evaluated the effectiveness of abstinence-contingent wage supplements in promoting drug abstinence and employment in unemployed adults in outpatient treatment for opioid use disorder.Methods A randomised controlled trial was conducted in Baltimore, MD, from 2014 to 2019. After a 3-month abstinence initiation and training period, participants (n=91) were randomly assigned to a usual care control group that received employment services or to an abstinence-contingent wage supplement group that received employment services plus abstinence-contingent wage supplements. All participants were invited to work with an employment specialist to seek employment in a community job for 12 months. Abstinence-contingent wage supplement participants could earn training stipends for working with the employment specialist and wage supplements for working in a community job, but had to provide opiate and cocaine-negative urine samples to maximise pay.Results Abstinence-contingent wage supplement participants provided significantly more opiate and cocaine-negative urine samples than usual care control participants (65% vs 45%; OR=2.29, 95% CI 1.22 to 4.30, p=0.01) during the 12-month intervention. Abstinence-contingent wage supplement participants were significantly more likely to have obtained employment (59% vs 28%; OR=3.88, 95% CI 1.60 to 9.41, p=0.004) and lived out of poverty (61% vs 30%; OR=3.77, 95% CI 1.57 to 9.04, p=0.004) by the end of the 12-month intervention than usual care control participants.Conclusion Abstinence-contingent wage supplements can promote drug abstinence and employment.Trial registration number ClinicalTrials.gov NCT02487745.