Study Details | Pathways to Work

101084-Study of Abstinence-

Study quality: Low

Low

Reason for the rating: This study received a low study quality rating because it is a high-attrition randomized controlled trial that does not adjust estimated impacts for potentially important differences between the intervention and comparison groups.

Intervention: Abstinence-Contingent Wage Supplements for Alcohol Use

Population and employment barriers:

Educational attainment (At least a high school diploma or equivalent), Employment status (Unemployed), Specific employment barriers (Homelessness, Substance use disorder)

Services provided:

Case management, Job readiness, Job search assistance, Performance- or behavior-based financial incentives

Setting: Urban only

Study design

Design:

Randomized controlled trial

Study group formation:

After a one-month induction period where participants were introducted to workplace contingencies, participants who had contacted research staff for at least half of the workdays in the final 3 weeks of the induction period were randomly assigned to either the abstinence-contingent wage supplement group or to a usual care control group. Participants were recruited from treatment clinics and recovery houses serving adults with alcohol use disorder, online job boards, and participant referrals.

Time period of study:

Four years

Pathways only reports results from studies with a study quality rating of high or moderate.

Sample characteristics

Adults experiencing homelessness who have an alcohol use disorder.

Age

Mean age

39 years

Sex

Female	15%
Male	85%

Participant race and ethnicity

Black or African American	36%
White	61%
Hispanic or Latino of any race	3%
American Indian or Alaska Native	1%
Tribal/Native American	1%
Native Hawaiian or Other Pacific Islander	1%
Another race	1%

The race and ethnicity categories may sum to more than 100 percent if the authors reported race and ethnicity separately; in these cases, we report the category White, rather than White, not Hispanic.

Participant employment and public benefit status

Were employed	8%
Were unemployed	92%

Participant education

Had a high school diploma or GED

83%

Specific employment barriers

Had a substance abuse disorder	100%
Were experiencing homelessness	100%

Intervention implementation

Implementing organization:

Not specified.

Intervention services:

The intervention group was offered abstinence-contingent wage supplements for up to 6 months while also wearning a transdermal alcohol concentration (TAC) wearable biosensor monitoring device. While unemployed, participants could earn a wage of $10 per hour for up to 20 hours per week for engaging with an employment specialist and engaging in job-seeking behaviors. While employed, participants could earn wage supplements for all verified hours worked in a community job (up to $8 per hour for up to 40 hours per week). If a participant's TAC indicated alcohol use, base pay for the wage supplement was reset to $1 per hour and could then increase by $1 per hour for each day the participant both maintained abstinence and worked for at least 5 minutes.

Mandatory services:

None

Comparison services:

Participants in the comparison group received usual care.

Study publications

Novak, Matthew D., Forrest Toegel, August F. Holtyn, Andrew M. Rodewald, Meghan Arellano, Mackenzie Baranski, Nancy P. Barnett, Jeannie-Marie Leoutsakos, Michael Fingerhood, and Kenneth Silverman (2023). Abstinence-contingent wage supplements for adults experiencing homelessness and alcohol use disorder: A randomized clinical trial, Preventative Medicine 176: Article 107655. Available at: https://doi.org/10.1016/j.ypmed.2023.107655

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The Pathways Clearinghouse refers to interventions by the names used in study reports or manuscripts. Some intervention names may use language that is not consistent with our style guide, preferences, or the terminology we use to describe populations.

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Study of Abstinence-Contingent Wage Supplements for Alcohol Use