Skip to main content

Table 5 Results #3 – Engagement can occur without complete abstinence from drugs

From: Improving psychosocial health and employment outcomes for individuals receiving methadone treatment: a realist synthesis of what makes interventions work

Citation Intervention summary (Qualitative/Quantitative) Main psychosocial/employment outcomes Engagement can occur without complete abstinence from drugs
Abbott et al. [1999]. Two groups were compared: 1) A Methadone Free at Intake (MFI) group; and, 2: Methadone Maintenance Transfers (MMT) or those who were on methadone for a period of time. The goal of the study was to determine if enhanced services would benefit the groups. Both groups received two treatments: a) Community Reinforcement Approach (CRA) (problem-solving skills, drug-refusal training, communication skills etc.) with referrals to the Job Finding Club; and, b) Standard Counseling (SC) with referrals to "resources in the clinic or community" (p. 131). (Quanitative) For both groups of clients (MMT and MFI) there were improvements in "drug, alcohol, legal, employment, social and in some measures of psychiatric distress" with the use of additional services and this continued up to the 6 month follow-up point (p. 129). At 6 months "the two groups [MMT and MFI] were comparable with regard to psychiatric problems", legal problems and both showed decreases in depression (p. 135). 3) Engagement can occur without complete abstinence from drugs
Both groups had some positive psychosocial and employment outcomes even with continuation of drug use. At 6 months both groups were approximately 75% opiate-free, however, according to the researchers, "cocaine use was not altered in either group by our treatment interventions" (p. 136).
Carpenter et al. [2006]. The intervention involved behavioral therapy and contingency management through individual counseling. No control or comparison group. (Quantitative) According to the researchers, "Approximately 48.3% of the patients demonstrated at least a 50% reduction" in self-rated depression and clinic rated depression at 12 weeks relative to baseline (p. 544). They also report that, "Cocaine and opiate use…did not differ between the groups" (p. 545). 3) Engagement can occur without complete abstinence from drugs
Responders to treatment demonstrated a 50% reduction in depression scores following the 16-week intervention. These responders did not, however, differ from non-responders in terms of cocaine and opiate use, suggesting that engagement can occur in an intervention even in a context of continued drug use.
Coviello et al. [2009]. Two groups were compared using a manual based interpersonal cognitive problem solving (ICPS) theory: 1) a control group using ICPS focusing on drug counselling; and, 2) an experimental group using ICPS with integrated employment and drug counselling. (Quantitative) According to the researchers, "While there were no differences between the integrated and control conditions, both groups showed a significant improvement in employment outcomes'at the six-month follow-up" (p.189). 3) Engagement can occur without complete abstinence from drugs
Both groups (the control and experimental) had significant improvements in outcomes yet there was some continued drug use in both groups. According to the researchers, "There were no significant between-group differences in opiate use and no overall reduction in opiate use from baseline to six months" (p. 195). The researchers also note that there were "no differences in use of cocaine or benzodiazepines, either between groups or from baseline to follow-up" (p. 195).
Kidorf et al. [1998]. This intervention involved a mandatory employment programme based on contingency management (i.e., more intensive counseling and eventually methadone tapering if did not meet employment goals). The intervention included counseling to help find employment (paid or volunteer). No control or comparison group. (Quantitative) According to the researchers, "Seventy-five percent of the patients secured employment and maintained the position for at least 1 month. Positions were found in an average of 60 days. Most patients (78%) continued working throughout the 6-month follow-up" (p. 73). 3) Engagement can occur without complete abstinence from drugs
Although patients who met the employment goal had lower proportions of cocaine and opioid-positive urines than those who did not met the goal, there was still drug use. This suggests engagement can occur when using drugs. The researchers do indicate that employment may have lowered the use of drugs. They note that, "We hoped that employment would operate as a powerful relapse-prevention strategy; the lower rates of drug use by those who found a job lends some support to this hypothesis" (p. 78).
McLellan et al. [1993]. Three groups were compared: 1) A Minimum Methadone Services (MMS) group which involved methadone only; 2) Standard Methadone Services group (counseling only) (SMS); and, 3) Enhanced Methadone Services (EMS) group which included counseling and extended on site medical/psychiatric, employment, and family therapy services. (Quantitative) The SMS group had "significant decreases in illegal drug use…with some additional changes in alcohol, legal, family and psychiatric problem area status measures" (p. 1957). The EMS group had the most improvements in both drug use and psychosocial outcomes overall (including employment, criminal activity and psychiatric status). According to the researchers, "The EMS group showed better outcomes than did the SMS group on 14 of the 21 measures" within the Addiction Severity Index (ASI) (p. 1957). 3) Engagement can occur without complete abstinence from drugs
According to the researchers, although there was some reduction in drug use, it was not eliminated even when there were improvements in psychosocial and employment outcomes. For example, with respect to the EMS group the researchers note that this group "showed a 30% increase in number of days of employment a 57% decrease in cocaine use and 67% reductions in the number of days of alcohol use, opiate use, illegal activities and psychological problems" (p. 1957).
Woody et al. [1995]. Two groups were compared: 1) A Drug Counseling (DC) group; and, 2) A Supportive-expressive (SE) Psychotherapy group. Both groups received drug counseling which included referrals to medical, social and legal services when needed, along with "exploring current problems and providing support… and responding to acute personal or social crises" (p.1303). (Quantitative) At one month follow up both groups had improved approximately the same. However, after 6 months the counseling group (DC) "had lost many of its gains or failed to improve further, while the group receiving supportive expressive psychotherapy showed continued improvement in several areas, to the point where both statistically and clinically significant differences became apparent" (p. 1307). The SE group improved in terms of employment and psychiatric symptoms. 3) Engagement can occur without complete abstinence from drugs
According to the researchers, across all weeks, the SE group (which was the group which showed improvement in employment and psychiatric symptoms) averaged 22% cocaine-positive urines while the DC group averaged 36%. According to the researchers, "31% of the patients receiving supportive-expressive psychotherapy and 27% of the drug counseling patients had urine samples that were positive for at least one other drug (usually benzodiazepines) each week during the course of treatment" (1305).