Kang Sung-Yeon, Magura Stephen, Blankertz Laura, Madison Elizabeth, Spinelli Michael
National Development and Research Institutes, Inc., New York, New York 10010, USA.
Subst Use Misuse. 2006;41(8):1125-38. doi: 10.1080/10826080500411551.
Employment enhances the outcomes of substance dependency treatment. Unfortunately, although unemployed methadone treatment patients frequently state they are interested in a job, many fail to participate in vocational services when available. Unless patients become engaged, vocational services do not have an opportunity to be effective. This is the first study to explore a broad array of factors that may be associated with differential engagement in vocational services among methadone patients. The study was conducted in two methadone programs in New York City during 2001-2004. Unemployed methadone patients (n = 211) were voluntarily randomly assigned to either of two vocational counseling programs (standard vs. experimental) and followed for 6 months. The sample was 59% male, 75% minority group, aged 45 years on average, and in methadone treatment for 5 years on average. Being engaged in the vocational counseling programs was defined as five or more sessions with the counselor in the first 6 months after study entry. In multivariate analysis, the factors associated with higher engagement in vocational counseling were being non-Hispanic, having more education, a drug injection history, a crack use history, having chronic emotional/mental problems, better work attitudes, and assignment to the experimental vocational program. The results indicate that it is often the most "needy" unemployed methadone patients who become more engaged in vocational counseling. A vocational counseling model which emphasizes assertive outreach and attends to nonvocational clinical issues as well is more likely to engage patients.
就业能改善药物依赖治疗的效果。不幸的是，尽管失业的美沙酮治疗患者经常表示他们对工作感兴趣，但许多人在有职业服务时却未能参与其中。除非患者积极参与，否则职业服务就没有机会发挥作用。这是第一项探索可能与美沙酮患者职业服务参与差异相关的一系列广泛因素的研究。该研究于2001年至2004年在纽约市的两个美沙酮项目中进行。失业的美沙酮患者（n = 211）被自愿随机分配到两个职业咨询项目中的一个（标准项目与实验项目），并随访6个月。样本中59%为男性，75%为少数群体，平均年龄45岁，平均接受美沙酮治疗5年。参与职业咨询项目被定义为在研究进入后的前6个月内与咨询师进行五次或更多次面谈。在多变量分析中，与更高程度参与职业咨询相关的因素包括非西班牙裔、受教育程度更高、有药物注射史、有快克使用史、有慢性情绪/心理问题、工作态度更好以及被分配到实验性职业项目。结果表明，往往是最“需要帮助”的失业美沙酮患者更积极参与职业咨询。一种强调积极外展并关注非职业临床问题的职业咨询模式更有可能让患者参与进来。
