Drug addicts often have trouble holding down a job. Yet many experts believe that having a steady income is key to helping addicts quit. To that end, psychiatrist Kenneth Silverman of the Johns Hopkins University School of Medicine and his colleagues created “therapeutic workplaces.” The technique features frequent drug tests, unlimited second chances and cash bonuses to addicts who keep clean. Research in recent years has suggested that Silverman has indeed homed in on a winning strategy.
In a therapeutic workplace, full-time employees agree to be tested at least three times a week to see if they are clean or becoming cleaner. If not, they are sent home—but they can return the next day to try again. If clean, they can work full-time for an hourly wage until the next drug test.
Paychecks come frequently, and cash bonuses are a constant possibility if workers meet drug- or job-related goals, such as staying clean for a certain period or performing, say, a data-entry task more proficiently. In early trials, researchers worried that giving addicts cash would tempt them to buy drugs, but results showed the opposite—workers who got cash bonuses stayed clean longer than those who simply drew their hourly wage.
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The researchers' theories about therapeutic workplaces have now been validated in a series of randomized controlled trials using data-entry training regimens or jobs at a business that served the Johns Hopkins research community. Some trials enrolled cocaine users; others tested opiate addicts with medication-assisted treatment such as methadone or naltrexone. The studies consistently showed that around 80 percent of subjects in the therapeutic workplace regimen remained clean and refrained from other addictive behaviors, compared with 50 percent of the groups that worked without financial incentives.
A 2012 review of therapeutic workplaces concluded that this method is highly effective to ensure long-term abstinence, perhaps because it acknowledges the nuanced reality of addiction recovery—relapses are to be expected, but if sobriety continues to offer immediate rewards, addicts will move toward abstinence.
In 2014 the federal Office of National Drug Control Policy honored Silverman for his concept of therapeutic workplaces, although it has not widely spread throughout the addiction community. The intense monitoring required prevents most businesses from being able to embrace the model. Silverman has now teamed up with American Substance Abuse Professionals, the organization behind the “Drug-Free Workplace” campaign, to try to figure out how to bring this technique to the masses.