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Introduction

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  1. Psychosocial and substance use severity in unemployed patients enrolled in methadone maintenance and psychosocial abstinence-based programsR. Pickens, L. Keyser-Marcus, A. Sepulveda, N. Snead, M. Stitzer, & D SvikisVirginia Commonwealth University, Richmond, VAThe Johns Hopkins University, Baltimore, MD

  2. Introduction • Employment is a potent predictor of positive treatment outcomes (Kiddorfet al, 2004). • Efforts to improve rates of employment in persons with substance use disorders (SUDs) have generally been disappointing. • One third of individuals who exhibit substance dependence or abuse also experience serious psychological distress (SAMSHA, 2003). • The presence of co-morbid mental health symptoms has been found to have a significant impact on substance abuse treatment outcomes (Compton et al, 2003).

  3. Purpose To examine psychiatric and medical co-morbidities that may influence employment outcomes in individuals enrolled in substance abuse treatment.

  4. Recruitment • Participants were identified through 6 psychosocial (PS) and 5 methadone maintenance (MM) community treatment programs. • All sites participated in the randomized clinical trial of the Job Seekers’ Workshop (JSW), CTN 0020, through the NIDA Clinical Trials Network (CTN).

  5. Inclusion Criteria • 18 years of age or older; • Met DSM-IV criteria for 1+ (lifetime) Substance Use Disorder; • Reported unemployment or underemployment (worked <20 hrs/week in 4 weeks prior to study enrollment); • Completed at least 30 days of SUD treatment; and • Motivated to get a job.

  6. Procedure • Patients meeting study criteria, completed a standardized baseline assessment prior to randomization in the clinical trial of JSW. • Baseline measures included a demographic survey and the Addiction Severity Index-Lite (ASI-Lite), as well as other assessments not used for the present study.

  7. Results • MM participants were more likely to be older, female, unemployed, African American and have a medical disability than PS program participants (all p<.05; See Demographic Table). • PS participants were more likely to report recent (past 30 days) depression (p<.04) and anxiety (p<.011) than MM participants. Rates of lifetime anxiety were also higher in PS as compared to MM participants (see Results Table 1). • PS participants were nearly twice as likely to report both recent and lifetime trouble concentrating (p<.001) than MM participants. More than half of PS participants reported trouble controlling violence (lifetime) as compared to one-fourth (26.2%) of MM patients (p<.001) (see Results Table 2).

  8. Results (cont’d) • PS program participants were nearly twice as likely to report suicidal thoughts/plan (47.1%) compared to MM program participants (25.9%) (p<.001) (see Results Table 3). • PS participants were also more likely to report a suicide attempt (lifetime) than MM participants (p<.001) (see Results Table 3).

  9. Summary and Conclusions • MM and PS participants differed on a variety of demographic variables. • Overall, PS participants presented with greater psychiatric symptom severity (current and lifetime) at time of study enrollment than MM participants. • MM participants, however, were more likely to present with chronic medical problems and need for medications to treat such conditions. • Future research will examine the extent to which these psychiatric and demographic variables relate to outcomes for the RCT of the JSW intervention.

  10. Demographics

  11. Results

  12. Results

  13. Results

  14. Treatment Sites N=11

  15. Funding • This research was supported by NIDA Clinical Trials Network (CTN) grant DA 2U10DA013034 (Mid-Atlantic Node)

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