Interventions for Unemployed Hazardous Drinkers

Not Applicable

Completed

Conditions: Hazardous Drinking
Unemployment

Interventions: Behavioral: Contingency management for completing job related activities
Behavioral: Contingency management for alcohol abstinence
Behavioral: Job relelated activity contracting

Registration Number: NCT02559609

Lead Sponsor: UConn Health

Brief Summary: Despite recent improvements in the US economy, unemployment remains a significant concern, and estimates indicate that one-third of unemployed persons drink at hazardous levels, adversely impacting their health and abilities to find jobs. Reinforcement interventions are highly efficacious in reducing substance use, and they can be applied to increase job-seeking activities as well. In partnership with CT United Labor Agency, this project is designed to reduce hazardous drinking and enhance active participation in job-seeking activities among those with job loss. It will evaluate the independent and combined effects of reinforcing negative breathalyzer samples and job-seeking activities to ascertain the simplest and most cost-effective approach to improving outcomes in this population. Unemployed individuals with hazardous drinking (N = 280) will be randomly assigned to one of four conditions using a 2 x 2 design: standard care, standard care with reinforcement for submitting negative breathalyzer samples, standard care with reinforcement for job-seeking activities, or standard care plus reinforcement for both negative breathalyzer samples and job-seeking activities. Participants in all conditions will receive usual services part of CT United Labor Agency, along with a novel remote breath alcohol monitoring procedure. The study interventions will be in effect for three months, and participants will be followed for one year. Alcohol and other drug use, employment, psychiatric symptoms, and global measures of health will be assessed throughout treatment and follow-up. Reinforcing negative breathalyzer samples is expected to significantly reduce drinking, and reinforcing job-seeking activities is expected to increase re-employment rates and reduce time until job attainment. Reinforcing both negative breathalyzer samples and job-seeking activities is hypothesized to improve outcomes along both domains. The reinforcement interventions may also decrease psychiatric distress and slow progression of physical decline, common among the unemployed. If efficacious and cost-effective, results from this study may stimulate adoption of reinforcement interventions in the context of unemployment services. Reducing the adverse consequences of hazardous drinking and improving job re-entry may have pronounced benefits in a highly vulnerable segment of the US population.

Detailed Description: Not available

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 240

Inclusion Criteria

age 18-65 years
not worked for pay in the formal economy for >4 weeks
willing to participate in a workforce training program and willing to accept either part-time or full-time work
hazardous alcohol use defined by AUDIT scores >8, a mean of >2 drinks/drinking day or >14 drinks/week in men (>1 drink/drinking day or >7 drinks/week in women) in the past 2 months, or submission of an alcohol positive breathalyzer (>0.02 g/dl) or EtG positive urine sample
English or Spanish speaking and able to read at 5th grade level
have a valid photo ID
willing and able to use study equipment and sign an off-campus property transfer form

Exclusion Criteria

have begun receiving unemployment benefits within the past 4 weeks
worked full- or part-time <3 months in the past 3 years in the formal or informal economy
physiological alcohol withdrawal symptoms (score >10 on Clinical Institute Withdrawal Assessment for Alcohol-revised)
physiological withdrawal symptoms from an illicit drug use disorder
serious untreated psychiatric illness
in recovery from gambling disorder

Study & Design

Study Type: INTERVENTIONAL

Study Design: FACTORIAL

Arm && Interventions

Group	Intervention	Description
reinforcement for completing activities	Contingency management for completing job related activities	Standard services plus job activity contracting and alcohol monitoring plus reinforcement for completing job-related activities
reinforcement for negative alcohol samples	Job relelated activity contracting	Standard services plus job activity contracting and alcohol monitoring plus reinforcement for negative breath alcohol recordings
reinforcement for negative alcohol samples	Contingency management for alcohol abstinence	Standard services plus job activity contracting and alcohol monitoring plus reinforcement for negative breath alcohol recordings
reinforcement for negative alcohol samples & activities	Contingency management for alcohol abstinence	Standard services plus job activity contracting and alcohol monitoring plus reinforcement for negative breath alcohol recordings and for completing job-related activities
reinforcement for negative alcohol samples & activities	Contingency management for completing job related activities	Standard services plus job activity contracting and alcohol monitoring plus reinforcement for negative breath alcohol recordings and for completing job-related activities
job activity contracting	Job relelated activity contracting	Standard services plus job activity contracting and alcohol monitoring
reinforcement for completing activities	Job relelated activity contracting	Standard services plus job activity contracting and alcohol monitoring plus reinforcement for completing job-related activities
reinforcement for negative alcohol samples & activities	Job relelated activity contracting	Standard services plus job activity contracting and alcohol monitoring plus reinforcement for negative breath alcohol recordings and for completing job-related activities

Primary Outcome Measures

Name	Time	Method
Longest Duration of Alcohol Abstinence (Samples) (Physiological Measure)	12 weeks	Greatest number of consecutive breath tests submitted on-time (within 1 hour of prompt) and reading alcohol negative (BAL \< 0.02)
Time to First Worked	12 weeks	From study day 1, the number of days until first worked in the formal or informal economy during the 12-week intervention, censored at day 85.
Percent Alcohol Negative Breath Tests	12 weeks	Of alcohol breath tests requested, the percentage submitted on-time (within 1-hour of prompt) and reading alcohol-negative (BAL \< .02)
Percent of Days Worked for Pay (Missing Data Treated as Missing)	12 weeks	The percentage of days of work for pay (in the formal or informal economy), with the number of days of data in the denominator (missing data considered missing)

Secondary Outcome Measures

Name	Time	Method
Longest Duration of Alcohol Abstinence (Days) (Physiological Measure)	12 weeks	Greatest number of consecutive days of submitting all breath tests requested on-time and reading alcohol negative
Percent of Days Worked for Pay (84 Day Intervention Period in the Denominator)	12 weeks	The percent of days worked for pay (in the formal or informal economy), with 84 days (intervention period duration; missing treated as not working) in the denominator