Volume 44 Number 6, 2007
Pages 851 — 866

Abstract - Adding contingency management intervention to vocational rehabilitation:
Outcomes for dually diagnosed veterans

Charles E. Drebing, PhD;1* E. Alice Van Ormer, PhD;1 Lisa Mueller, MA;1 Marcie Hebert, PsyD;1 Walter E. Penk, PhD, ABPP;1 Nancy M. Petry, PhD;2 Robert Rosenheck, MD;3 Bruce Rounsaville, MD3

1Bedford Department of Veterans Affairs Medical Center, Bedford, MA; 2University of Connecticut Health Center, Farmington, CT; 3Yale University School of Medicine, New Haven, CT

Abstract — In this random-assignment trial, we evaluated the efficacy of using a contingency management (CM) intervention to enhance job acquisition and tenure among participants of a vocational rehabilitation (VR) program. The CM intervention offered participants cash incentives up to $1,170 for completing tasks related to sobriety and job search and maintenance. Participants were 100 veterans with comorbid psychiatric disorders and substance dependence who were randomly assigned either to VR only or VR + CM. Relative to participants in the VR-only group, those in the VR + CM group showed more intense job searches and transitioned to competitive employment faster and at higher rates. No significant difference was found in job tenure, though this may be due to the limited follow-up period. Abstinence rates were significantly better in the VR + CM group during the first 16 weeks of follow-up but not significantly different in subsequent follow-ups. No relationship was found between relapse and employment. These results suggest that rehabilitation outcomes may be enhanced by adding CM to current programming or by restructuring traditional work-for-pay contingencies to include direct financial rewards for achievement of clinical goals.

Key words: compensated work therapy, contingency management, dual diagnosis, employment, job search, job tenure, psychiatric rehabilitation, sobriety, vocational rehabilitation, work.

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