An Innovative Job Placement Model for Unemployed Methadone Patients: A Randomized Clinical Trial

Abstract

This article presents the outcomes of an innovative vocational rehabilitation model designed for methadone-maintained patients—the Customized Employment Supports (CES) model. CES counselors work intensively with a small caseload of patients to overcome the vocational as well as non-vocational barriers that hinder employment, with the goal of attaining rapid job placement. A randomized clinical trial was implemented at two methadone treatment programs in New York City and was funded by the National Institute on Drug Abuse The study tested the hypothesis that patients assigned to the experimental (CES) condition would have better employment outcomes than those assigned to a control condition who received standard vocational counseling at the programs. The data were collected from May 2001 through April 2005. The efficacy sample for the analysis consisted of 168 patients who completed follow-up interviews. The sample was 58% male, 75% minority group, average age 45 years, and in methadone treatment for an average of five years. The results supported the hypothesis for two measures of employment; i.e., the CES group was significantly more likely than the control group to obtain both any paid employment and informal paid employment. However, there were no significant differences for competitive employment or total earnings. The study's limitations are noted. Implications of the findings for the improvement of vocational rehabilitation for addiction patients are discussed.

Keywords:

• Customized Employment Supports model
• randomized clinical trial
• methadone treatment
• substance use
• vocational counseling

Notes

¹Treatment can be briefly and usefully defined as a planned, goal-directed change process, which is bounded (culture, place, time, etc.) and can be categorized into professional-based, tradition-based, mutual help–based (AA, NA, etc.), and self-help (“natural recovery”) models. There are no unique models or techniques used with substance users—of whatever types—that are not also used with non-substance users. In the West, with the relatively new ideology of “harm reduction,” there is now a new set of goals in addition to those derived from/associated with the older tradition of abstinence-driven models. Editor's note.