Hazardous Drinking, Unemployment
Conditions
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.
Interventions
BEHAVIORALContingency management for completing job related activities
Participants will earn reinforcement (incentives) for completing specific job-related activities during the 12-week intervention period.
BEHAVIORALContingency management for alcohol abstinence
Participants will earn reinforcement (incentives) for each alcohol negative breath test provided (when prompted to submit a test) during the 12-week intervention period.
BEHAVIORALJob relelated activity contracting
Participants will complete job-related activity contracts each week with the goal of obtaining employment.
Sponsors
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
UConn Health
Study design
Allocation
RANDOMIZED
Intervention model
FACTORIAL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
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
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| 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) |
| 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) |
| 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. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| 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 |
| 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 |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Group A - Standard Job Activity Contracting and Alcohol Monitoring Standard services plus job activity contracting and alcohol monitoring
activity contracting: participants will complete job-related activity contracts each week with the goal of obtaining employment | 50 |
| Group B - Reinforcement for Negative Alcohol Samples Standard services plus job activity contracting and alcohol monitoring plus reinforcement for negative breath alcohol recordings
contingency management for alcohol abstinence: participants will earn chances to win prizes for each negative breath alcohol recording provided
activity contracting: participants will complete job-related activity contracts each week with the goal of obtaining employment | 65 |
| Group C - Reinforcement for Completing Job Activities Standard services plus job activity contracting and alcohol monitoring plus reinforcement for completing job-related activities
activity contracting: participants will complete job-related activity contracts each week with the goal of obtaining employment
contingency management for activity completion: participants will earn chances to win prizes for completing specific job-related activities | 58 |
| Group D - Reinforcement for Negative Alcohol Samples & Job Activities Standard services plus job activity contracting and alcohol monitoring plus reinforcement for negative breath alcohol recordings and for completing job-related activities
contingency management for alcohol abstinence: participants will earn chances to win prizes for each negative breath alcohol recording provided
contingency management for activity completion: participants will earn chances to win prizes for completing specific job-related activities | 67 |
| Total | 240 |
Baseline characteristics
| Characteristic | Group A - Standard Job Activity Contracting and Alcohol Monitoring | Group B - Reinforcement for Negative Alcohol Samples | Group C - Reinforcement for Completing Job Activities | Group D - Reinforcement for Negative Alcohol Samples & Job Activities | Total |
|---|---|---|---|---|---|
| Age, Categorical <=18 years | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical >=65 years | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical Between 18 and 65 years | 50 Participants | 65 Participants | 58 Participants | 67 Participants | 240 Participants |
| Age, Continuous | 46.10 years STANDARD_DEVIATION 9.77 | 45.94 years STANDARD_DEVIATION 11.34 | 42.38 years STANDARD_DEVIATION 10.89 | 46.37 years STANDARD_DEVIATION 10.06 | 45.23 years STANDARD_DEVIATION 10.63 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 4 Participants | 7 Participants | 8 Participants | 10 Participants | 29 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 46 Participants | 58 Participants | 50 Participants | 57 Participants | 211 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 1 Participants | 1 Participants | 0 Participants | 0 Participants | 2 Participants |
| Race (NIH/OMB) Asian | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Black or African American | 29 Participants | 37 Participants | 25 Participants | 36 Participants | 127 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 2 Participants | 0 Participants | 0 Participants | 2 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 1 Participants | 0 Participants | 0 Participants | 0 Participants | 1 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants | 1 Participants | 2 Participants | 3 Participants | 6 Participants |
| Race (NIH/OMB) White | 19 Participants | 24 Participants | 31 Participants | 28 Participants | 102 Participants |
| Region of Enrollment United States | 50 participants | 65 participants | 58 participants | 67 participants | 240 participants |
| Sex: Female, Male Female | 17 Participants | 34 Participants | 30 Participants | 35 Participants | 116 Participants |
| Sex: Female, Male Male | 33 Participants | 31 Participants | 28 Participants | 32 Participants | 124 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk |
|---|---|---|---|---|
| deaths Total, all-cause mortality | 0 / 50 | 0 / 65 | 1 / 58 | 0 / 67 |
| other Total, other adverse events | 5 / 50 | 5 / 65 | 1 / 58 | 6 / 67 |
| serious Total, serious adverse events | 6 / 50 | 8 / 65 | 9 / 58 | 9 / 67 |
Outcome results
Primary
Longest Duration of Alcohol Abstinence (Samples) (Physiological Measure)
Greatest number of consecutive breath tests submitted on-time (within 1 hour of prompt) and reading alcohol negative (BAL \< 0.02)
Time frame: 12 weeks
Population: N=234 analyzed. n=6 with no data: n=1 Group B withdrawal; n=5 had no samples submitted (n=1 Group A, n=1 Group B, n=1 group D) or none submitted on-time (n=2 Group B).
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Group A - Standard Job Activity Contracting and Alcohol Monitoring | Longest Duration of Alcohol Abstinence (Samples) (Physiological Measure) | 6.0 number of alcohol negative breath tests |
| Group B - Reinforcement for Negative Alcohol Samples | Longest Duration of Alcohol Abstinence (Samples) (Physiological Measure) | 11.0 number of alcohol negative breath tests |
| Group C - Reinforcement for Completing Job Activities | Longest Duration of Alcohol Abstinence (Samples) (Physiological Measure) | 7.0 number of alcohol negative breath tests |
| Group D - Reinforcement for Negative Alcohol Samples & Job Activities | Longest Duration of Alcohol Abstinence (Samples) (Physiological Measure) | 7.5 number of alcohol negative breath tests |
Comparison: Group A/C (contrast -1) compared to Group B/D (contrast 1) to test Aim 1p-value: 0.028Wilcoxon (Mann-Whitney)
Primary
Percent Alcohol Negative Breath Tests
Of alcohol breath tests requested, the percentage submitted on-time (within 1-hour of prompt) and reading alcohol-negative (BAL \< .02)
Time frame: 12 weeks
Population: N=234 analyzed. n=6 with no data: n=1 Group B withdrawal; n=5 had no samples submitted (n=1 Group A, n=1 Group B, n=1 group D) or none submitted on-time (n=2 Group B).
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Group A - Standard Job Activity Contracting and Alcohol Monitoring | Percent Alcohol Negative Breath Tests | 90.8 percentage of alcohol negative tests |
| Group B - Reinforcement for Negative Alcohol Samples | Percent Alcohol Negative Breath Tests | 98.1 percentage of alcohol negative tests |
| Group C - Reinforcement for Completing Job Activities | Percent Alcohol Negative Breath Tests | 91.2 percentage of alcohol negative tests |
| Group D - Reinforcement for Negative Alcohol Samples & Job Activities | Percent Alcohol Negative Breath Tests | 97.1 percentage of alcohol negative tests |
Comparison: Group A/C (contrast -1) compared to Group B/D (contrast 1)p-value: 0.027Wilcoxon (Mann-Whitney)
Primary
Percent of Days Worked for Pay (Missing Data Treated as Missing)
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)
Time frame: 12 weeks
Population: N=228, n=12 no score: n=1 Group B withdrawal; n=1 Group D on disability (no working allowed); no data for n= 2 Group A, n=4 Group B, n=1 Group C, n=3 Group D
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Group A - Standard Job Activity Contracting and Alcohol Monitoring | Percent of Days Worked for Pay (Missing Data Treated as Missing) | 1.79 percentage of days work occurred |
| Group B - Reinforcement for Negative Alcohol Samples | Percent of Days Worked for Pay (Missing Data Treated as Missing) | 4.76 percentage of days work occurred |
| Group C - Reinforcement for Completing Job Activities | Percent of Days Worked for Pay (Missing Data Treated as Missing) | 6.25 percentage of days work occurred |
| Group D - Reinforcement for Negative Alcohol Samples & Job Activities | Percent of Days Worked for Pay (Missing Data Treated as Missing) | 1.33 percentage of days work occurred |
Comparison: Group A/B (contrast -1) was compared to Group C/D (contrast 1) to test Aim 2.p-value: 0.66ANOVA
Primary
Time to First Worked
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.
Time frame: 12 weeks
Population: N=228 analyzed. n=12 no score: n=1 Group B withdrawal; n=1 Group D on disability (no working allowed); no data for n= 2 Group A, n=4 Group B, n=1 Group C, n=3 Group D
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Group A - Standard Job Activity Contracting and Alcohol Monitoring | Time to First Worked | 79.50 days |
| Group B - Reinforcement for Negative Alcohol Samples | Time to First Worked | 57.00 days |
| Group C - Reinforcement for Completing Job Activities | Time to First Worked | 63.00 days |
| Group D - Reinforcement for Negative Alcohol Samples & Job Activities | Time to First Worked | 63.00 days |
Comparison: Group A/B (contrast -1) compared to Group C/D (contrast 1) to test Aim 2.p-value: 0.89Regression, Cox
Secondary
Longest Duration of Alcohol Abstinence (Days) (Physiological Measure)
Greatest number of consecutive days of submitting all breath tests requested on-time and reading alcohol negative
Time frame: 12 weeks
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Group A - Standard Job Activity Contracting and Alcohol Monitoring | Longest Duration of Alcohol Abstinence (Days) (Physiological Measure) | 4.0 days |
| Group B - Reinforcement for Negative Alcohol Samples | Longest Duration of Alcohol Abstinence (Days) (Physiological Measure) | 9.0 days |
| Group C - Reinforcement for Completing Job Activities | Longest Duration of Alcohol Abstinence (Days) (Physiological Measure) | 5.0 days |
| Group D - Reinforcement for Negative Alcohol Samples & Job Activities | Longest Duration of Alcohol Abstinence (Days) (Physiological Measure) | 6.0 days |
Comparison: Group A/C (contrast -1) compared to Group B/D (contrast 1) to test Aim 1.p-value: 0.024Wilcoxon (Mann-Whitney)
Secondary
Percent of Days Worked for Pay (84 Day Intervention Period in the Denominator)
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
Time frame: 12 weeks
Population: N=228 analyzed. n=12 no score: n=1 Group B withdrawal; n=1 Group D on disability (no working allowed); no data for n= 2 Group A, n=4 Group B, n=1 Group C, n=3 Group D
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Group A - Standard Job Activity Contracting and Alcohol Monitoring | Percent of Days Worked for Pay (84 Day Intervention Period in the Denominator) | 1.19 percentage of days work occurred |
| Group B - Reinforcement for Negative Alcohol Samples | Percent of Days Worked for Pay (84 Day Intervention Period in the Denominator) | 4.17 percentage of days work occurred |
| Group C - Reinforcement for Completing Job Activities | Percent of Days Worked for Pay (84 Day Intervention Period in the Denominator) | 4.76 percentage of days work occurred |
| Group D - Reinforcement for Negative Alcohol Samples & Job Activities | Percent of Days Worked for Pay (84 Day Intervention Period in the Denominator) | 1.19 percentage of days work occurred |
Comparison: Group A/B (contrast -1) compared to Group C/D (contrast 1) to test Aim 2.p-value: 0.58ANOVA