Abstract
BackgroundEmployment is associated with better outcomes of substance use treatment and protects against relapse after treatment completion. Unemployment rates are high for people with substance use disorders (SUD) who undergo treatment, with Norwegian estimates ranging from 81 to 91%. Evidence-based vocational models are lacking for patients in SUD treatment but exist for patients with psychosis in terms of Individual Placement and Support (IPS). The aim of the IPS for substance use disorders (IPS-SUD) trial is to investigate the effect of IPS in a SUD population.Methods/designThe IPS-SUD trial is a randomized controlled trial (RCT) comparing IPS to an enhanced control intervention. The study is a seven-site, two-arm, pragmatic, parallel-group, superiority RCT. Participants are randomly assigned (1:1) to receive either IPS plus treatment as usual (TAU) or to receive a self-help guide book and 12-h workshop plus 1-h individual vocational guidance plus TAU. Aiming to recruit 200 participants, we will be able to detect a 20% difference in the main outcome of employment with 90% power. We will make assessments at inclusion and at 6- and 12-month follow-ups and obtain outcome data on employment from national mandatory registries. The primary outcome will be at least 1 day of competitive employment during the 18-month follow-up period. Secondary employment outcomes will capture the pattern and extent of employment in terms of total time worked (days/hours), time to first employment, number of different jobs, duration of the longest employment, and sustained employment. Secondary non-employment outcomes will be substance use, mental distress, and quality of life measured by validated instruments at 6, 12, and 18 months follow-up assessments. To be eligible, participants must be between 18 and 65 years, currently unemployed and in treatment for SUD.DiscussionThe IPS-SUD trial will provide evidence for the use of IPS in a SUD population. Findings from the study will have implications for service delivery.Trial registrationClinicalTrials.gov NCT04289415. Registered on February 28, 2020
Highlights
Employment is associated with better outcomes of substance use treatment [2] and protects against relapse after treatment completion [3]
Having a job may give a sense of dignity, belonging, and meaning—needs commonly expressed by patients with substance use disorders (SUD) but perhaps insufficiently met by the treatment system
We find effects of this magnitude improbable in a Norwegian context with the extensive public employment service offered, and we base our assumptions on Norwegian data
Summary
Employment is associated with better outcomes of substance use treatment and protects against relapse after treatment completion. Evidence-based vocational models are lacking for patients in SUD treatment but exist for patients with psychosis in terms of Individual Placement and Support (IPS). Employment is associated with better outcomes of substance use treatment [2] and protects against relapse after treatment completion [3]. Individual Placement and Support (IPS) is an evidencebased psychosocial approach to help people with severe mental disorders obtain and keep competitive employment [6]. It is based on eight principles including a focus on competitive work and integration of vocational and clinical services in the same team, rapid job search, and ongoing in-work support. After 20 years of accumulated evidence in favor of IPS for people with psychosis, researchers call for IPS to be disseminated and tested on new target groups [9]
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