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 program and comparison groups.

Program: Abstinence-Contingent Wage Supplements to Promote Alcohol Abstinence and Employment

Characteristics of study participants:

At least a high school diploma or equivalent, Homelessness, Substance use disorder, Unemployed

Services provided:

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

Setting: Urban only

Methods and Standards Protocol version used for review: Version 2.0

Learn about our protocol

Study design

Design:

Randomized controlled trial

Study group formation:

Participants were recruited from treatment clinics and recovery houses in Baltimore, Maryland serving adults with alcohol use disorder, online job boards, and participant referrals. Prior to random assignment, participants were introduced to workplace contingencies over a one-month trial period, where they could earn up to $5 per hour for up to four hours each day for contacting research staff each day. Participants who had contacted research staff for at least half of the workdays in the final three weeks of this trial period were then randomly assigned to either an abstinence-contingent wage supplement program group or to a usual care comparison group. A total of 119 participants were enrolled, with 62 participants assigned to the program group and 57 participants assigned to the comparison group.

Time period of study:

The study ran from January 2019 through November 2022. Study enrollment occurred in two phases: January 2019 through March 2020 and October 2020 through May 2022, with a pause due to restrictions related to the COVID-19 pandemic. Study data collection ran from January 2019 through November 2022, with outcomes measured monthly over a 6-month follow-up period.

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

Sample characteristics

Age

Mean age

39 years

Sex

Female	15%
Male	85%

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.

Employment and public benefit status

Were employed	8%
Were unemployed	92%

Education

Had a high school diploma or GED

83%

Specific employment barriers

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

Program implementation

Implementing organization:

Johns Hopkins Center for Learning and Health

Program services:

The program group was offered abstinence-contingent wage supplements for up to six months while also wearing 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 up to $8 per hour for all verified hours up to 40 hours per week worked in a community job. 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 five 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

View the glossary for more information about these and other terms used on this page.

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.

Return to top

Study of Abstinence-Contingent Wage Supplements to Promote Alcohol Abstinence and Employment