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Summary

Abstinence-Contingent Wage Supplements to Promote Drug Abstinence and Employment was designed to promote drug abstinence and vocational entry among unemployed adults in treatment for opioid use disorder by providing financial incentives dependent on verified abstinence.

During the 12-month program period, unemployed participants could earn up to 20 hours per week of wages for engaging in job-seeking activities with an employment specialist, at $10 per hour. Employed participants could receive wage supplements for verified hours worked, capped at $8 per hour for up to 40 hours per week. These payments were contingent upon maintaining drug abstinence, which was verified through a routine and random drug testing schedule.  

Positive results on the drug test resulted in a temporary reset of the base supplement rate to $1 per hour and restarting of routine mandatory testing. The rate increased by $1 per day for each day the participant provided a drug negative result and worked for at least five minutes until the maximum amount of $8 per hour was achieved.   

The program was implemented in Baltimore, MD. 

 

101057-Study of Abstinence-
Populations and employment barriers: Justice involvement, Substance use disorder

Implementation at a glance

Primary service
Performance- or behavior-based financial incentives

Read Evidence Snapshot for Financial Incentives
Program services
Job placement, Job search assistance, Performance- or behavior-based financial incentives, Treatment or recovery services for substance use disorder
Review services terms
Setting(s)
Urban only
Year evaluation began
2015
Implementing organization(s)Johns Hopkins Center for Learning and Health

Effectiveness rating and effect by outcome domain

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Outcome domain Term Effectiveness rating Effect in 2024 dollars and percentages Effect in standard deviations Sample size
Increase earnings Short-term Cannot assess support
Long-term Cannot assess support
Very long-term Cannot assess support
Increase employment Short-term Cannot assess support
Long-term Little evidence to assess support favorable 18% (in percentage points) 0.437 91
Very long-term Cannot assess support
Decrease benefit receipt Short-term Cannot assess support
Long-term Cannot assess support
Very long-term Cannot assess support
Increase education and training All measurement periods Cannot assess support

Effectiveness ratings

  • Well- supported
  • Supported
  • Mixed support
  • Not supported
  • Insufficient evidence
  • Cannot assess support

Studies of this program

Study quality rating Study counts per rating
High High 1
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Program cost

No cost information available.

Cost results

Estimate (in 2024 dollars) Quality of cost analysis that produced the estimate
Total program cost, per participant $13,454
Good quality
Cost per program outcome $53,886 per participant employed in past 12 months, 12-month follow-up
Good quality
Cost per program outcome $107,771 per participant employed in past 12 months, 24-month follow-up
Good quality

Cost information

How much did the program cost per participant? 

The average total program cost per participant was $13,454 in 2024 dollars. This figure is based on cost information for this program reported in one cost study reviewed by Pathways to Work (for details, see the FAQ). This study received a rating of Good quality for the cost analysis.

How much did the program cost relative to its effects on participant outcomes? 

A cost-effectiveness analysis was conducted in the cost study reviewed, receiving a rating of Good quality. This study estimated a cost of $53,886 in 2024 dollars per participant employed in the past 12 months based on a 12-month follow-up survey and a cost of $107,771 in 2024 dollars per participant employed in the past 12 months based on a 24-month follow-up survey. This means that, relative to the comparison group, each additional program participant employed in the past year due to the program cost $53,886 at the 12-month follow-up and $107,771 at the 24-month follow-up.

Cost information is not directly comparable across programs due to differences in the categories of costs reported and program length. Cost information is not an official price tag or guarantee.

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Implementation details

The information contained here reflects how the program was implemented at the time of the evaluation.

Local context

Characteristics of research participants
Black or African American
56%
White
40%
Another race
4%

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.

State(s) where implemented

AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Canada

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