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Individuals with substance use disorders are often plagued by psychiatric comorbidities and histories of physical and/or sexual trauma. Males and females, although different in their rates of expressed trauma and psychiatric symptomatology, experience comparable adverse consequences, including poorer substance abuse treatment outcomes, diminished psychosocial functioning, and severe employment problems. This study’s goal was to examine the relationships between trauma history, lifetime endorsement of psychiatric symptoms, and gender in a sample of individuals participating in outpatient substance abuse treatment.
Study participants (N=625) from six psychosocial counseling and five methadone maintenance programs were recruited as part of a larger study of an employment intervention conducted through the National Drug Abuse Treatment Clinical Trials Network (CTN-0020, “Job Seekers Training for Patients with Drug Dependence”). Measures included lifetime trauma experience (yes/no), type of trauma experienced (sexual, physical, both), lifetime depression/anxiety, and lifetime suicidal thoughts/attempts (as measured by the Addiction Severity Index-Lite (ASI-Lite)). Lifetime endorsement of psychiatric symptoms was compared between individuals with and without trauma history. The role of gender was also examined. Results indicated that the experience of trauma was associated with an increase in lifetime report of psychiatric symptoms. Experience of physical and combined physical and sexual trauma consistently predicted positive report of psychiatric symptoms in both males and females, even when controlling for demographic and treatment-related variables. Employment outcomes, however, were not predicted by self-reported history of lifetime trauma.
Conclusions: Consistent with previous research, a substantial proportion of the study sample — nearly 50% — reported a lifetime history of physical and/or sexual victimization. Also not surprisingly, the hypothesis regarding gender differences in rates of abuse was also confirmed in this study, a finding consistent with prior research demonstrating that women with SUDs typically experience dramatically higher rates (2 times or greater) of lifetime physical and sexual trauma than men. That said, although rates of trauma in the current sample were higher for women, the severity of mental health symptoms was comparable in males and females, suggesting that the aftermath of trauma equally affects both sexes. These findings highlight the need for improved gender-specific trauma screening and intervention strategies, as well as future research on techniques to better identify and treat the overlooked population of men with trauma histories.
Related protocols: CTN-0020
This is the primary outcomes paper for CTN-0020.
Unemployment is associated with negative outcomes both during and after drug abuse treatment. Interventions designed to increase rates of employment may also improve drug abuse treatment outcomes. The purpose of this multi-site clinical trial, protocol CTN-0020, was to evaluate the Job Seekers’ Workshop (JSW), a three-session, manualized program designed to train patients in the skills needed to find and secure a job. Study participants were recruited through the National Drug Abuse Treatment Clinical Trials Network (CTN) from six psychosocial counseling (n=327) and five methadone maintenance (n=301) drug treatment programs. Participants were randomly assigned to either standard care (program-specific services plus brochure with local employment resources) (SC) or standard care plus JSW. Three 4-h small group JSW sessions were offered weekly by trained JSW facilitators with ongoing fidelity monitoring. JSW and SC participants had similar 12- and 24-week results for the primary outcome measure (i.e., obtaining a new taxed job or enrollment in a training program). Specifically, one-fifth of participants at 12 weeks (20.1-24.3%) and nearly one-third at 24 weeks (31.4-31.9%) had positive outcomes, with “obtaining a new taxed job” accounting for the majority of cases.
Conclusions: JSW group participants did not have higher rates of employment/training than SC controls. Rates of job acquisition were modest for both groups, suggesting more intensive interventions may be needed. Alternate targets (e.g., enhancing patient motivation, training in job-specific skills) warrant further study as well. Secondary analyses of present study findings will examine potential mediators and moderators of study outcomes, with a focus on barriers to employment and other variables.
Related protocols: CTN-0020
This article describes a CTN platform study that evaluated the feasibility and effectiveness of adapting the Job Seeker’s Workshop (JSW), developed as part of CTN-0020, to a residential setting within a Massachusetts-based substance use disorder treatment agency. Implementation of the adapted JSW consisted of a continual sequence of three weekly sessions that focused on job interview rehearsals, practice completing job applications, and identification of job leads. Data were compiled on the employment rates of the 188 patients discharged from the residential treatment program during July to December 2006 (baseline participants, n=95) and January to June 2007 (JSW intervention participants, n=93). The effectiveness of the adapted JSW was evaluated through a comparison of baseline and intervention participants’ employment rates at discharge from residential treatment.
Analyses indicated a trend toward a significant increase in employment at discharge for the intervention period (40.9%) compared with baseline (29.5%). Further evaluation of the JSW in residential settings is necessary, but this preliminary research suggests that the intervention could begin to address the need for vocational services in residential treatment for substance use disorders.
Related protocols: CTN-0020
Employment difficulties are common among American Indian individuals in substance abuse treatment. To address this problem, the Southwest Node of the National Drug Abuse Treatment Clinical Trials Network conducted a single-site adaptation of its national Job Seekers Workshop (protocol CTN-0020) in an American Indian treatment program, Na’Nihoozhi Center (NCI). One hundred and two (80% men, 100% American Indian) participants who were in residential treatment and currently unemployed were randomized to (1) a three-session, manualized program (Job Seekers Workshop: JSW) or (2) a 40-minute video on how to interview for a job (Job Interviewing Video: JIV). Outcomes were assessed at 3-month follow-up: 1) number of days to a new taxed job or enrollment in a job-training program, and 2) total hours working or enrolled in a job-training program. No significant differences were found between the two groups for time to a new taxed job or enrollment in a job-training program. There were no significant differences between groups in substance use frequency at 3-month follow-up.
These results do not support the use of the costly and time-consuming JSW intervention in this population and setting. Despite of the lack of a demonstrable treatment effect, this study established the feasibility of including a rural American Indian site in a rigorous CTN trial through a community-based participatory research approach.
Related protocols: CTN-0020-A-1
Employment is a potent predictor of positive treatment outcome. Efforts to improve rates of employment in persons with substance use disorders (SUDs) have generally been disappointing. This study examined psychosocial and medical co-morbidities in unemployed patients, separately in methadone maintenance and psychosocial abstinence-focused programs participating in protocol CTN-0020, “Job Seekers Training for Patients with Drug Dependence.” Results found that methadone maintenance patients (MM) were more likely to be older, female, unemployed, or disabled, and less likely to be Caucasian, than drug-free patients (DF). MM patients also spent significantly less time enrolled in psychiatric treatment than DF participants, but were more likely to experience chronic medical problems. Future research will examine how psychosocial characteristics related to employment outcomes with Job Seekers Workshop intervention and control group conditions.
Study findings have implications for future drug abuse treatment programming and linkages with programs that provide job training and employment support.
Related protocols: CTN-0020
This presentation begins with the history of contingency management (CM), an intervention that originally developed out of B.F. Skinner’s Operant Conditioning model. CM typically involves the use of positive reinforcements to change behavior and was first applied to problems with alcoholism in the late 1960’s. The New York Node joined the CTN in 2000 and participated in one of the two MIEDAR studies (“Motivational Incentives for Enhanced Drug Abuse Recovery: Methadone Clinics,” CTN-0007). This purpose and outcomes of this study are described in the presentation along with details about the specific involvement of two CTPs from the New York Node in the protocol (Lower Eastside Service Center and Greenwich House MMPT). In 2008, threatened changes in methadone maintenance policy led the New York City Health and Hospitals Corporation (HHC), the largest provider of addiction treatment in the U.S., to adopt new vocational rehabilitation programs. When patients refused to participate in the offered programs, the HHC adopted CM as a technique to increase involvement. The HHC eventually formed an alliance with the CTN to help develop a Vocational Incentives Program. Results from both the CM-related CTN protocols and the HHC’s VIP program are presented. The HHC has maintained its connection to the CTN via co-sponsored CM trainings and other workshops and conference, a perfect example of the CTN’s ability to help foster the dissemination of evidence-based practices in to real-world settings.
The Southwest Node of the National Drug Abuse Treatment Clinical Trials Network conducted a single-site adaptation of protocol CTN-0020 (“Job Seekers Training for Patients with Drug Dependence”) in a Native American treatment program in the American Southwest. Native American participants (N=102) were randomized to either (1) a three-session, manualized program (JSW) or (2) a 40-minute Job Interviewing Video (JIV). No main effect of was no main effect of treatment. This secondary analysis tested for potential moderating effects at both the three-month and six-month follow-up points. Intake data were assembled from the ASI-Lite, Wide Range Achievement Test, pre-treatment Vocational Survey, and demographics form for study participants. Analyses were then conducted to determine whether these variables were predictive of employment status.
The researchers found that some variables that predict future employment, such as local unemployment, age, and work history, were not amenable to employment interventions. Gender and tribal affiliation were not significant predictors of employment at any follow-up. However, it appears that it may be possible to improve employment outcomes by designing interventions to improve reading skill or other job-related skills.
Related protocols: CTN-0020
Social support for abstinence and employment are predictors of successful functioning after substance abuse treatment. Unemployment problems are often significant in Native American communities. To address this problem, the Southwest Node of the National Drug Abuse Treatment Clinical Trials Network (CTN) conducted a single-site adaption of its national Job Seekers Workshop study (protocol CTN-0020) in a Native American treatment program.
Participants were randomized to (1) a three-session, manualized program or (2) a 40-minute Job Interviewing Video. Main effects for treatment on job-seeking behavior or employment rates were not found at 3-month follow-up. One explanation for these null findings is that participant characteristics, i.e., treatment history, may have moderated treatment effects. This study tested for potential moderating effects of treatment history on job seeking behaviors at 3-month follow-up among Native Americans enrolled in a larger study.
Related protocols: CTN-0020
Employment difficulties are common among individuals receiving substance abuse treatment, and employment is an important treatment outcome as well as a predictor of success in other areas such as decreasing problematic substance use. Unemployment problems are often particularly significant in Native American communities. To address this problem, the Southwest Node of the National Drug Abuse Treatment Clinical Trials Network (CTN) conducted a single-site adaptation of its national Job Seekers Workshop study (protocol CTN-0020) in a Native American treatment program, the Na’Nizhoozhi Center. The program targets skills needed to find and secure a job, as well as vocational goal setting and methods for locating available employment.
This poster reports on the primary results for employment outcomes and finds that the interventions, while well received by all participants, did not produce significant changes in rates of employment, total work and training hours, or time to employment.
Related protocols: CTN-0020
Drug abuse treatment programs and university-based research centers collaborate to test emerging therapies for alcohol and drug disorders in the National Drug Abuse Treatment Clinical Trials Network (CTN). Programs participating in the CTN completed Organizational Surveys (n=106 of 112; 95% response rate) and Treatment Unit Surveys (n=348 of 384; 91% response rate) to describe the levels of care, ancillary services, patient demographics, patient drug use and co-occurring conditions. Analyses describe the corporations participating in the CTN and provide an exploratory assessment of variation in the treatment philosophies. A diversity of treatment centers participate in the CTN; not for profit organizations with a primary mission of treating alcohol and drug disorders dominate. Compared to the National Survey of Substance Abuse Treatment Services (N-SSATS), programs located in medical settings are over-represented and centers that are mental health clinics are under-represented.
Outpatient, methadone, long-term residential and inpatient treatment units differ on patients served and services provided. Larger programs with higher counselor caseloads in residential settings reported more social model characteristics. Programs with higher social model scores were more likely to offer self-help meetings, vocational services and specialized services for women. Conversely, programs with accreditation had less social model influence. The CTN is an ambitious effort to engage community-based treatment organizations into research and more fully integrate research and practice.
Related protocols: CTN-0008
This brochure, intended for clinicians thinking about participating in the CTN-0020 clinical trial (Job Seekers Training for Patients with Drug Dependence), describes the interventions the study will be investigating, how study therapists will be chosen, and what participants can expect if they become study therapists themselves.
Related protocols: CTN-0020