Silverman Kenneth, Holtyn August F, Morrison Reed
Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine.
American Substance Abuse Professionals .
Transl Issues Psychol Sci. 2016 Jun;2(2):203-212. doi: 10.1037/tps0000061.
Research on a model Therapeutic Workplace has allowed for evaluation of the use of employment in the treatment of drug addiction. Under the Therapeutic Workplace intervention, adults with histories of drug addiction are hired and paid to work. To promote drug abstinence or adherence to addiction medications, participants are required to provide drug-free urine samples or take prescribed addiction medications, respectively, to gain access to the workplace and/or to maintain their maximum rate of pay. Research has shown that the Therapeutic Workplace intervention is effective in promoting and maintaining abstinence from heroin, cocaine and alcohol and in promoting adherence to naltrexone. Three models could be used to implement and maintain employment-based reinforcement in the treatment of drug addiction: A Social Business model, a Cooperative Employer model, and a Wage Supplement model. Under all models, participants initiate abstinence in a training and abstinence initiation phase (Phase 1). Under the Social Business model, Phase 1 graduates are hired as employees in a social business and required to maintain abstinence to maintain employment and/or maximum pay. Under the Cooperative Employer model, cooperating community employers hire graduates of Phase 1 and require them to maintain abstinence to maintain employment and/or maximum pay. Under the Wage Supplement Model, graduates of Phase 1 are offered abstinence-contingent wage supplements if they maintain competitive employment in a community job. Given the severity and persistence of the problem of drug addiction and the lack of treatments that can produce lasting effects, continued development of the Therapeutic Workplace is warranted.
对模范治疗性工作场所的研究使得对就业在药物成瘾治疗中的应用评估成为可能。在治疗性工作场所干预措施下，有药物成瘾史的成年人被雇佣并领取工资来工作。为了促进戒毒或坚持服用成瘾药物，参与者分别被要求提供无毒品尿液样本或服用处方成瘾药物，以进入工作场所和/或维持其最高工资率。研究表明，治疗性工作场所干预措施在促进和维持戒除海洛因、可卡因和酒精以及促进坚持服用纳曲酮方面是有效的。有三种模式可用于在药物成瘾治疗中实施和维持基于就业的强化措施：社会企业模式、合作雇主模式和工资补贴模式。在所有模式下，参与者在培训和戒断启动阶段（第1阶段）开始戒毒。在社会企业模式下，第1阶段的毕业生被雇佣为社会企业的员工，并被要求保持戒毒状态以维持就业和/或最高工资。在合作雇主模式下，合作的社区雇主雇佣第1阶段的毕业生，并要求他们保持戒毒状态以维持就业和/或最高工资。在工资补贴模式下，如果第1阶段的毕业生在社区工作中保持有竞争力的就业，他们将获得与戒毒相关的工资补贴。鉴于药物成瘾问题的严重性和持续性以及缺乏能产生持久效果的治疗方法，治疗性工作场所的持续发展是有必要的。
