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Home > Innovative job placement model for methadone-maintained clients.

Keane, Martin (2007) Innovative job placement model for methadone-maintained clients. Drugnet Ireland, Issue 24, Winter 2007, pp. 7-8.

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The Report of the Working Group on Drugs Rehabilitation 1 which was compiled to form the basis of the proposed rehabilitation pillar of the National Drugs Strategy recommends that measures to improve the employability of current, former and recovering drug users should form a key part of rehabilitation care plans, with the overall aim ‘to maximise the quality of life, re-engagement in independent living and employability of the recovering problem drug user, in line with their aspirations’ (p. 21). 

The logic of this aspiration to improve employment prospects for individuals affected by the use of drugs is supported by research from the US by Platt, 2 which found that clients in employment stayed in treatment longer and achieved better outcomes than their unemployed counterparts. However, with unemployment rates among treatment contacts remaining high (61% of cases entering treatment in 2003 in Ireland were unemployed3), finding ways to improve employment opportunities is a challenge for service providers. 

There is no vocational intervention or programme that has been generally adopted for any client population or treatment modality in the addiction field, although some initiatives have been tried, primarily in the US. One such intervention is the Customized Employment Supports (CES) model. This model is a manual-based, theory-driven approach and involves a skilled vocational counsellor working intensively with a small caseload of clients to overcome the vocational and non-vocational barriers to employment. The model comprises individual counselling, rapid job searching and therapeutic fieldwork. 

A recent evaluation of this model suggests that it can be an effective approach to improving the employment prospects of methadone clients.4 This study tested the hypothesis that methadone-maintained clients assigned to the experimental (CES) group would have better employment outcomes than those assigned to a control condition who received standard vocational counselling. The study involved 184 clients at two methadone clinics in New York City. Unemployed or underemployed clients who were stablised on methadone for at least 30 days and who had negative urine tests for heroin and/or cocaine use in the previous four weeks were eligible to take part in the study. Also, an absence of severe mental illness or disability and a willingness to enter the study were required. 

Participants were randomly assigned to the CES group or the control group. The research team implemented quality assurance procedures to ensure consistency in the way CES counsellors delivered the intervention and in the way researchers conducted interviews and recorded the data from participants. 

Data were collected at baseline and at 6-month and 12-month follow-ups in interviews with participants and from vocational activities logs provided by counsellors and documentation of employment activity. The retention rate at 12-month follow-up was 91% (168/184). The final analytical sample comprised 168 participants, of whom 78 were in the CES group and 90 in the control group. 

The results supported the hypothesis that those in the CES group were significantly more likely than those in the control group to obtain any paid employment and informal, ‘of the books’ employment. However, no significant differences for competitive employment or total earnings were observed between the groups. Competitive employment was defined as full-time work in the labour market, and any paid employment meant part-time and temporary jobs. Informal employment included jobs that were ‘of the books’ and operated in what may be termed the ‘black economy’, where clients did not pay tax or qualify for employment-related protections such as pension, annual leave or insurance. 

The authors of the study put forward a number of reasons why outcomes for competitive employment were not better. These included:

Clients’ reluctance to seek or accept full-time paid employment as this would mean entering a competitive labour market, probably at the rate of minimum wage because of their poor employment histories and lack of skills, with the threat to their eligibility for welfare assistance plus rent supplement, food stamps and medical insurance if they did not succeed in maintaining competitive employment

  • Clients’ fear at leaving a familiar but unproductive lifestyle and entering the competitive world of work where they would be compared with employees of long-standing in the labour market
  • Client’s preference for temporary or ‘of the books’ employment as a way of increasing their ability and confidence to eventually enter the competitive labour market
  • A deteriorating job-market during the study period.

 Although this study involved relatively small numbers of methadone-maintained clients and the transferability of findings from the US to Europe is not proven, the findings suggest that intensive vocational intervention during treatment can improve employment outcomes. 

Finally, in discussing the findings of this study and possible implications for policy and practice, the authors make a number of pertinent points that require further reflection by all stakeholders interested in the rehabilitation and social reintegration of drug users. 

  • There is a need for skilled vocational counsellors, located in or near treatment centres, to engage and motivate clients to improve their employability.
  • For such interventions to be more widely adopted there has to be a strong belief in the value of client employment among all treatment staff.
  • Each job taken on by recovering drug users, no matter how brief, must be valued as a positive learning experience for the client.
  • There is a need for research that follows employed substance users over considerable periods of time to determine how much support they need, and for how long.
  • Progressive social policies that promote appropriate incentives for prospective employers to encourage them to hire persons in recovery need to be developed.  

1. Working Group on Drugs Rehabilitation (2007) National Drugs Strategy 2001–2008: Rehabilitation. Report of the working group on drugs rehabilitation. Dublin: Department of Community, Rural and Gealtacht Affairs.

2. Platt JJ (1995) Vocational rehabilitation of drug abusers. Psychological Bulletin, 117(3): 416–433.

3. Keane M (2007) Social Reintegration as a response to drug use in Ireland. Overview 5. Dublin: Health Research Board.

4. Magura S, Blankertz L, Madison EM, Friedman E and Gomez A (2007) An innovative job placement model for unemployed methadone patients: a randomized clinical trial. Substance Use & Misuse, 42(5): 811–828.

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