Article Details

Research Database: Article Details

Citation:  Zanis, D.A., Coviello, D., Alterman, A.I., & Appling, S.E. (2001). A community-based trial of vocational problem-solving to increase employment among methadone patients. Journal of Substance Abuse Treatment, 21 (1), 19-26.
Title:  A community-based trial of vocational problem-solving to increase employment among methadone patients
Authors:  Zanis, D.A., Coviello, D., Alterman, A.I., & Appling, S.E.
Year:  2001
Journal/Publication:  Journal of Substance Abuse Treatment
Publisher:  Elsevier
Full text:   
Peer-reviewed?  Yes
NIDILRR-funded?  No
Research design:  Randomized controlled trial

Structured abstract:

Background:  Following drug use stabilization, employment has long been considered an important secondary goal for patients enrolled in methadone maintenance treatment programs. Several studies have found moderate positive correlations between increased employment, decreased substance use, and positive social functioning. Given the low rates of employment, patients’ desire for employment services, and the association of employment with improved outcomes, employment interventions appear to be important to explore .
Purpose:  The main purposes of the study were to (a) train methadone counselors to deliver the Vocational Problem-Solving Skills (VPSS) intervention and (2) evaluate whether unemployed patients randomized to VPSS counseling would improve their employment functioning compared to patients randomized to an alternate activity.
Setting:  The study was conducted at two comparable methadone treatment centers, each of which had both employed and unemployed clients.
Study sample:  The study sample consisted of 109 individuals receiving methadone treatment. Entrance criteria included the following: (1) Unemployed or underemployed, defined as working ‘‘under the table’’ less than 10 hours per week; (2) stabilized on methadone and enrolled in the treatment program for a minimum of 3 months; (3) expressed interest and capacity to work at least 20 hours per week; and (4) actively seeking employment as defined by the Bureau of Labor Statistics. Males constituted 61% of the sample, and African-Americans 61%
Intervention:  Vocational Problem-Solving Skills (VPSS) is a cognitive-based intervention designed to assist chronically unemployed individuals transition to work. The five objectives of the VPSS intervention are to help participants (1) understand why they want to work; (2) understand how to overcome barriers to work; (3) set realistic vocational goals; (4) identify realistic resources to help locate job opportunities; and (5) take appropriate actions to obtain work. All VPSS sessions were designed to be approximately 30 to 60 minutes in length and delivered within a maximum of a 12-week period. Both patients and counselors were provided with a manual and workbook, outlining each of the sessions.
Control or comparison condition:  The comparison group participated in an Interpersonal Problem Solving (IPS) intervention of similar duration and intensity as the VPSS. The goal of IPS counseling was to help patients develop improved problem-solving skills to either reduce drug use or continue abstinence from drug use. The five objectives of the IPS counseling were to: (1) reduce/eliminate illicit drug use or maintain an abstinence plan; (2) understand the utility of social supports in recovery; (3) examine successful and unsuccessful efforts at recovery; (4) formulate realistic recovery plans; and (5) engage in planned activities.
Data collection and analysis:  Participants were assessed by interviews at baseline, biweekly for 12 weeks, and at 6 months post-baseline. Measures included standardized measures of addiction and independent urine sampling, a vocational assessment, a treatment service review, chart review, and independent employment verification. Data analysis included descriptive statistics, a series of bivariate analyses to examine the correlation between potential predictor variables and the criterion variable (employed/not employed at least one day in the past 30 days at the 6-month follow-up point), and multinomial regression analysis.
Findings:  Of the 109 participants, 101 could be located for six-month follow-up. At the point, 53 (54.6%) were considered, 19 (19.6%) were termed part-time employees (paid for working between 1 and 14 days), and 25 (25.8%) were considered full-time employees (paid for working 15 or more days in the past 30). VPSS participants were significantly more likely to be employed than the comparison group. However, enrollment in the VPSS condition did not predict employment when entered into the regression analysis with the other variables.
Conclusions:  Although a greater percentage of patients who received the VPSS counseling program actually worked, VPSS was not predictive of employment after controlling for other factors, such as work history and motivation. Structured employment interventions may assist unemployed methadone patients in obtaining employment; however, the type of employment services provided must reflect a variety of employment needs.

Disabilities served:  Alcohol and drug abuse
Populations served:  Gender: Female and Male
Race: Black / African American
Race: White / Caucasian
Ethnicity: Hispanic or Latino
Ethnicity: Not Hispanic or Latino
Interventions:  Non-psychological counseling
Training and technical assistance
Outcomes:  Employment acquisition
Full-time employment
Part-time employment