Holtyn August F, Washington Wendy Donlin, Knealing Todd W, Wong Conrad J, Kolodner Ken, Silverman Kenneth
Johns Hopkins University School of Medicine.
University of North Carolina Wilmington.
Transl Issues Psychol Sci. 2016 Jun;2(2):192-202. doi: 10.1037/tps0000056.
We sought to identify behavioral factors associated with response to an employment-based intervention, in which participants had to provide drug-free urine samples to gain access to paid employment. The present secondary analysis included data from a randomized clinical trial. The trial evaluated whether employment-based reinforcement could decrease cocaine use in community methadone patients. Participants (N=56) in the trial worked in a model workplace for 4 hr every weekday and earned about $10 per hr. After a 4-week baseline, participants were randomly assigned to an Abstinence & Work (n = 28) or Work Only (n = 28) condition and could work for an additional 26 weeks. Abstinence & Work participants had to provide cocaine-negative urine samples to work and maintain maximum pay. Work Only participants only had to work to earn pay. For Work Only participants, cocaine abstinence during baseline and the intervention period were significantly ( = .72, <.001) correlated. For Abstinence & Work participants, baseline opiate abstinence was significantly correlated ( = .59, <.001) and workplace attendance was marginally correlated ( = .32, = .098) with cocaine abstinence during the intervention period. Furthermore, participants who provided over 60% cocaine-negative urine samples during the intervention period (i.e., responders) had significantly higher baseline rates of opiate abstinence ( <.0001) and workplace attendance ( = .042) than non-responders. Employment-based reinforcement of cocaine abstinence may be improved by increasing opiate abstinence and workplace attendance prior to initiating the cocaine-abstinence intervention.
我们试图确定与基于就业的干预措施反应相关的行为因素，在该干预措施中，参与者必须提供无毒品的尿液样本才能获得有偿工作。本次二次分析纳入了一项随机临床试验的数据。该试验评估了基于就业的强化措施是否能减少社区美沙酮治疗患者的可卡因使用。试验中的参与者（N = 56）每个工作日在一个模拟工作场所工作4小时，每小时收入约10美元。经过4周的基线期后，参与者被随机分配到禁欲与工作组（n = 28）或仅工作组（n = 28），并可再工作26周。禁欲与工作组的参与者必须提供可卡因阴性的尿液样本才能工作并获得最高报酬。仅工作组的参与者只需工作就能获得报酬。对于仅工作组的参与者，基线期和干预期的可卡因戒断情况显著相关（r = 0.72，p <.001）。对于禁欲与工作组的参与者，基线期阿片类药物戒断情况显著相关（r = 0.59，p <.001），干预期的工作场所出勤情况与可卡因戒断情况呈边缘相关（r = 0.32，p = 0.098）。此外，在干预期提供超过60%可卡因阴性尿液样本的参与者（即反应者），其基线期阿片类药物戒断率（p <.0001）和工作场所出勤率（p = 0.042）显著高于无反应者。在启动可卡因戒断干预之前，通过提高阿片类药物戒断率和工作场所出勤率，可能会改善基于就业的可卡因戒断强化措施。
