Randomized multi-site trial of the Job Seekers' Workshop in patients with substance use disorders

Abstract

Background: Unemployment is associated with negative outcomes both during and after drug abuse treatment. Interventions designed to increase rates of employment may also improve drug abuse treatment outcomes. The purpose of this multi-site clinical trial was to evaluate the Job Seekers' Workshop (JSW), a three session, manualized program designed to train patients in the skills needed to find and secure a job.

Method: Study participants were recruited through the NIDA Clinical Trials Network (CTN) from six psychosocial counseling (n=327) and five methadone maintenance (n=301) drug treatment programs. Participants were randomly assigned to either standard care (program-specific services plus brochure with local employment resources) (SC) or standard care plus JSW. Three 4-h small group JSW sessions were offered weekly by trained JSW facilitators with ongoing fidelity monitoring.

Results: JSW and SC participants had similar 12- and 24-week results for the primary outcome measure (i.e., obtaining a new taxed job or enrollment in a training program). Specifically, one-fifth of participants at 12weeks (20.1-24.3%) and nearly one-third at 24 weeks (31.4-31.9%) had positive outcomes, with "obtaining a new taxed job" accounting for the majority of cases.

Conclusion: JSW group participants did not have higher rates of employment/training than SC controls. Rates of job acquisition were modest for both groups, suggesting more intensive interventions may be needed. Alternate targets (e.g., enhancing patient motivation, training in job-specific skills) warrant further study as well.

Figure 1. CONSORT Flow Diagram

The flow diagram for the 2-group randomized clinical trial is displayed. Participant screening, recruitment, randomization and follow-up rates at 12 and 24 weeks post-randomization are shown.

Figure 2. Employment Outcomes in Three Clinical Trials of Job Seekers’ Workshop

The figure compares present study (CTN0020) findings to those of three previous studies completed in the 1970s/80s (Hall et al., 1977; Hall et al., 1981a, b). The x-axis shows each of the 3 earlier studies, followed by the present study. The y-axis denotes percentage of participants achieving specific outcomes. Outcomes varied across studies, with some focused on taxed job/enrollment in job training and others targeting only employment. Solid black bars represent clients in the standard of care (SC, control) group who obtained a taxed job/enrolled in a job training program at 3 mo. follow-up. Solid white bars represent clients in the JSW group who achieved the same criterion. The dark gray bar denotes clients in SC who obtained a taxed job at 3 mos., and light gray bar denotes this same outcome for JSW group members.