Bertz Jeremiah W, Smith Kirsten E, Panlilio Leigh V, Stull Samuel W, Reamer David, Murville Marie-Louise, Sullivan Michael, Holtyn August F, Toegel Forrest, Epstein David H, Phillips Karran A, Preston Kenzie L
Intramural Research Program, National Institute on Drug Abuse, 251 Bayview Blvd., Suite 200, Baltimore, MD 21224, United States.
Delight Me Inc., Washington, DC, United States.
Drug Alcohol Depend Rep. 2021 Dec 4;1:100011. doi: 10.1016/j.dadr.2021.100011. eCollection 2021 Dec.
Employment and improved quality of life (QOL) are, separately, valued outcomes of substance use disorder (SUD) treatment. It is also important to understand QOL changes caused by employment itself; therefore, we assessed QOL during a randomized trial of a contingency-management-based Therapeutic Workplace for people with opioid use disorder.
For 12 weeks, participants ( = 61) responded to QOL questionnaires in a mobile web app accessed with study-issued smartphones. At enrollment, participants were randomized to work in the Therapeutic Workplace immediately (immediate work group, IWG) or after a 3-week waitlist delay (delayed work group, DWG). Once both groups could work, wage-resetting contingencies were introduced for their opiate- and cocaine-urinalysis. Data were analyzed by (1) access to work with and without contingencies and (2) overall urinalysis-verified opiate- and cocaine-abstinence.
DWG and/or IWG reported improvements in several QOL areas (sleep, transportation, recreation); however, they also reported increased money-related difficulties and less time spent with friends/family. These changes did not coincide with DWG's work access, but some (more sleep, money-related difficulties) coincided with the urinalysis contingencies. Greater opiate- and/or cocaine-abstinence was also associated with several improvements: sleep, paying bills, time spent with friends/family, and exercising. Surprisingly, intermediate cocaine abstinence was associated with reductions in work-capacity satisfaction and recreation.
Participants reported complex QOL differences during their experimental employment and associated with drug abstinence. Future work should help participants address issues that may be relevant to employment generally (e.g., time with friends/family) or contingency management specifically (e.g., money-related issues for non-abstinent participants).
就业和生活质量（QOL）的改善分别是物质使用障碍（SUD）治疗的重要成果。了解就业本身所导致的生活质量变化也很重要；因此，我们在一项针对阿片类药物使用障碍患者的基于应急管理的治疗性工作场所的随机试验中评估了生活质量。
在12周的时间里，参与者（n = 61）通过使用研究发放的智能手机访问移动网络应用程序来回答生活质量问卷。在入组时，参与者被随机分为立即在治疗性工作场所工作（立即工作组，IWG）或在等待名单上延迟3周后工作（延迟工作组，DWG）。一旦两组都可以工作，就对他们的鸦片和可卡因尿液分析引入工资重置应急措施。数据通过以下方式进行分析：（1）有无应急措施时的工作机会；（2）经尿液分析证实的总体鸦片和可卡因戒断情况。
DWG和/或IWG报告了几个生活质量领域（睡眠、交通、娱乐）的改善；然而，他们也报告了与金钱相关的困难增加，与朋友/家人相处的时间减少。这些变化与DWG的工作机会不一致，但有些变化（更多睡眠、与金钱相关的困难）与尿液分析应急措施一致。更大程度的鸦片和/或可卡因戒断也与一些改善相关：睡眠、支付账单、与朋友/家人相处的时间以及锻炼。令人惊讶的是，中度可卡因戒断与工作能力满意度和娱乐的降低有关。
参与者在实验性就业期间报告了复杂的生活质量差异，且与药物戒断有关。未来的工作应帮助参与者解决可能普遍与就业相关的问题（例如与朋友/家人相处的时间）或特别是与应急管理相关的问题（例如非戒断参与者的金钱相关问题）。
