Employment-based contingency management for women arrested for prostitution

This study was a preliminary evaluation of the therapeutic workplace intervention in opioid dependent women arrested for prostitution. Participants (N = 37) were randomly assigned to a specialized diversion program, or the diversion program plus the therapeutic workplace for four months. To be included in the present study, participants were required to be enrolled in medication-assisted treatment (i.e., methadone or buprenorphine) for the treatment of opioid use disorder and referred to the study by social workers employed by a State’s Attorneys’ Office. Participants were paid $8.00 per hour for up to four hours each day. In addition, participants earned bonus pay based on performance on the job training programs. This bonus pay varied but was programmed to be approximately $2.00 per hour for average performance. Participants could track their earnings via their computer workstation and request to convert their electronic funds to gift cards of their choice as they saw fit. Access to the workplace (and thus wages) was contingent upon provision of a urine sample every Monday, Wednesday, and Friday. For the first two weeks, participants in the therapeutic workplace group could gain access to the workplace independent of the results of the urine toxicology test. Thereafter, drug abstinence reinforcement contingencies were implemented, starting with cocaine abstinence. Under this contingency, participants were required to submit cocaine-negative urine samples to access the workplace and maintain the maximum hourly wage. If the sample was positive for cocaine or the sample was not submitted, then the participant was not permitted to enter the workplace, and the rate of hourly pay was decreased to $1.00. Thereafter, each day that the participant gained access to the workplace their base pay was increased by $1.00 per hour until fully restored. When a participant successfully completed two consecutive weeks of cocaine abstinence, opioid abstinence contingencies were added. Similarly, after four consecutive weeks of cocaine and opioid abstinence, additional contingencies for cannabis, amphetamines, and PCP were added simultaneously. This terminal set of abstinence requirements included the complete panel of drugs that are typically used in pre-employment drug screening. Participants who submitted at least 10 drug negative urine samples across their last 12 submitted samples, and who attended a minimum of 10 days in the last 20 possible workdays were admitted to the four-month wage supplement program. Under the wage supplement program, participants who became employed in the community or who engaged in verifiable job search activities were paid $4 per hour for each hour of verified work or job searching, up to 40 hours per week. During this period, drug abstinence was verified by a drug testing of urine samples that were required once per week on average.