A New Work Placement Model for Unemployed Methadone Maintenance Patients

Abstract

Traditionally, methadone-maintained patients have made only limited progress in vocational rehabilitation programs, largely because they encounter multiple individual-level barriers to their employment. The Customized Employment Supports (CES) model is designed to help patients overcome these employment barriers and attain paid work as soon as possible. To facilitate this transition, the model assigns CES counselors small caseloads so that, using intensive interventions, they can engage patients in a working alliance and enhance patients’ self-efficacy. Methods used to help patients increase their self-efficacy are derived from social psychological literature and include role modeling, persuasion, and minimizing emotional arousal. Because the transition to competitive work is a major change, many patients initially take smaller steps such as entering training programs and accepting informal employment. The CES model is being evaluated in a randomized clinical trial.

• Methadone treatment
• Vocational rehabilitation
• Employment
• Substance use
• Self-efficacy
• Customized employment supports (CES) model
• Supported employment
• Working alliance
• Field work

Additional information

Notes on contributors

Laura Blankertz

Laura Blankertz, Ph.D., is a research associate at Bryn Mawr College and a consultant. She has been a principal investigator on studies sponsored by the Center for Mental Health Services, the National Institute on Alcohol Abuse and Alcoholism, and the Department of Education. These studies have included mental health services research, treatment outcomes for individuals with comorbidities of serious mental illness and substance abuse, and vocational rehabilitation programs for individuals with serious mental illness and for youth with serious emotional disorders. Dr. Blankertz is the past president of the Eastern Evaluation and Research Society, has served on national research steering committees, is on the editorial boards of two professional journals, and is a recipient of the International Association of Psychosocial Rehabilitation Services research award.

Stephen Magura

Stephen Magura, Ph.D., C.S.W., is Acting Executive Director of NDRI and has been the Principal Investigator of many studies sponsored by the National Institute on Drug Abuse, the National Institute on Alcohol Abuse and Alcoholism, and the National Institute on Child Health and Development. These studies have included drug abuse clinical trials, treatment outcome evaluations, health services research, social epidemiology studies, HIV prevention research, and policy analysis. Dr. Magura has authored or edited several books and special journal issues, including Outcome Measures for Child Welfare Services (1986), Experimental Therapeutics in Addiction Medicine (1994), a special issue of Health and Social Work on “Chemical Dependency” (1994), and a special issue of Substance Use & Misuse on “Program Quality in Substance Dependency Treatment" (2000). He serves on the Editorial Boards of five professional journals, is an elected member of the College on Problems of Drug Dependence (CPDD) and the Research Society on Alcoholism (RSA), serves on federal advisory committees, and is a faculty member of the Middle Eastern-Mediterranean Summer Institute on Drug Use.

Graham L. Staines

Graham L. Staines, Ph.D., is a Senior Project Director at NDRI where he has directed projects on modified therapeutic communities for both methadone patients and mentally ill chemical abusers (MICAs), treatment matching on levels of care among alcoholics, and new models of vocational rehabilitation for methadone clients. Prior to coming to NDRI, he was a Study Director at the Institute for Social Research at the University of Michigan. Funded by the Department of Labor, his research, which focused on the quality of work life, included three national Quality of Employment Surveys of representative samples of workers. In addition to journal articles, his publications on the relationship between work and family life include The Impact of Work Schedules on the Family (co-authored with Joseph H. Pleck in 1983).

Elizabeth M. Madison

Elizabeth M. Madison holds an M.A. in Vocational Rehabilitation from New York University, a B.S. in Forensic Psychology, and is a Certified Rehabilitation Counselor (CRC) and Certified Workforce Development Professional (CWDP). She is a professional in the field of career and workforce development, specializing in vocational rehabilitation for chemically dependent individuals and the welfare-to-work population. She has developed innovative and creative programs to help these populations achieve self-sufficiency and economic independence. She is the Director for NADAP/Project ACE and the owner and president of Potential Unlimited, which develops career and workforce development programs and training for nonprofit organizations, school systems, and individuals. Ms. Madison facilitates training on vocational rehabilitation and substance abuse at various academic institutions and nonprofit organizations such as Lehman College at the City University of New York and Local 1199. She is a Fellow with the Join Together Program at Boston University and a member of the National Association of Workforce Development Professionals (NAWDP) and the Advocates for Vocational Rehabilitation and Substance Abuse (AVRASA).

Michael Spinelli

Michael Spinelli, M.Sed., CRC, ADS, CASAC-T, is an employment specialist with the NIDA-funded vocational research project, Innovative Job Placement in methadone treatment. After graduating with a Masters of Science in Education (rehabilitation counseling), Mr. Spinelli acquired national certification as a Certified Rehabilitation Counselor (CRC), Acupuncture Detoxification Specialist (ADS) and is in the final stage of becoming a New York State Credentialed Alcohol/Substance Abuse Counselor (CASAC). Mr. Spinelli has worked in the social service field for approximately 14 years, with specialties in vocational rehabilitation and MMTP. Psychopharmacology/neurobiology of heroin addicts/methadone patients and their effects on job acquisition/retention are two of Mr. Spinelli's prime professional interests, on which he also provides trainings.

Emily Horowitz

Emily J. Horowitz, B.A., has been a Senior Research Assistant on the NIDA-funded Innovative Job Placement for methadone-maintained patients since 2002. She received her B.A. from Tufts University and is currently pursuing her Psy.D. in clinical psychology from the Ferkauf Graduate School of Psychology at Yeshiva University. Her interests include posttraumatic stress disorder and substance abuse.

Priti Bali

Priti Bali, B.A., is an Assistant Project Director at the National Development and Research Institutes, Inc. in New York City. She conducts data management and data analysis, along with other day-to-day project operations, for the NIDA-funded Innovative Job Placement study, and has been working at NDRI for over five years. She received her undergraduate degree in Forensic Psychology from John Jay College of Criminal Justice. Ms. Bali was recently accepted to a Ph.D. program in Holistic Counseling Psychology in Bangalore, India, which she plans on attending in August 2004. Her main research interests are concentrated around substance abuse and gender issues.

Honoria Guarino

Honoria Guarino, Ph.D., is a Senior Research Assistant for the Innovative Job Placement study at NDRI, and has worked on the project since its inception in 2000. Dr. Guarino received her Ph.D. in Linguistic Anthropology from the University of Arizona in 2003. Her dissertation focused on the effects of institutional involvement on the personal narratives and self-concepts of HIV-positive clients of a New York City AIDS service organization. She is interested in pursuing research on the social aspects of HIV/AIDS and drug use and language use in institutional settings.

Audrey Grandy

Audrey Grandy, B.A., attended Trinity and New Paltz State University and has worked on projects for the Columbia School of Public Health, New York State Psychiatric Institute, New York Urban League, Harlem Center for Health Promotion and Disease Prevention; she is currently Sr. Research Assistant with National Development and Research Institutes. She has been a major contributor on an array of social- and health-related projects. Her responsibilities have spanned all phases of research, including creating and maintaining data sets, assisting in construction and editing of code books, and coordinating schedules at study sites, with particular emphasis on the day-to-day operations of a research project. Ms. Grandy has extensive experience with interviewing, recruitment, screening, and locating individuals who are considered inaccessible or unreachable. Her future goal is to collaborate on a project that would focus on alternatives to incarceration for nonviolent felons and have an active role in implementing such changes.

Rebecca Young

Rebecca Young, Ph.D., is a Principal Investigator and Deputy Director of the Social Theory Core of the Center for Drug Use and HIV Research at NDRI, Inc., and is also an Assistant Professor of Women's Studies at Barnard College. She has conducted behavioral research on HIV/AIDS, substance use, sexuality, and urban health for 15 years. Dr. Young has an interest in philosophy of science, and is involved in several interconnected studies of measurement issues and investigators’ beliefs in scientific research on sexuality, gender, and race.