The effect of Individual Placement and Support on employment outcomes for individuals with substance use disorders

Background: Employment is associated with better outcome of substance use treatment, and employment protects against relapse after treatment completion. However, for persons in SUD-treatment, unemployment rates are extremely high, Norwegian estimates ranging from 81 % to 89 %. Individual Placement and Support (IPS) is an evidence-based method developed to help patients with severe mental disorders obtain and keep employment. In IPS, employment specialists are integrated in the SUD treatment service, and provide high-quality employment support according to strict methodological guidelines. In this study, we investigate if IPS is effective in helping individuals with SUD obtain employment. 

Methods: In a randomized controlled trial, participants were assigned to either an intervention group receiving up to 13 months of IPS, or a control group with enhanced treatment as usual. Participants were outpatients and inpatients receiving specialized SUD treatment at Oslo University Hospital, with all types of SUD including a large proportion undergoing opioid agonist treatment. Inclusion criteria were being unemployed, in treatment, and wanting to work. Trial outcomes are in accordance with previous IPS trials: at least 1 day of employment in the open labour market during 18-month follow-up from inclusion in the trial (main outcome); total time worked; time to first employment; duration of longest employment; engagement in education or training (secondary employment-related outcomes). Also secondary outcomes related to substance use, mental health and quality of life will be reported. Inclusion in the trial took place from 2020 to 2022, and ended at target sample size (N=200). The trial is registered in clinicaltrials.gov (identifier NCT04289415) and recommended by the Regional Ethical Committee (identifier 54204).

Results: Descriptive results: The total sample included 192 participants (eight withdrew consent), of whom 93 were randomized to the intervention group and 99 to the control group. Mean age was 38,34 years (sd=10,55), and 21,9% were women. The majority (79,2%) had no education above upper secondary school. While half of the sample (49,0%) received work clarification support, only 10,4% had actually participated in a work-preparatory program during the past year. There were 32 individuals (16,7%) on permanent disability pension. The most common substances of abuse were alcohol (28,1%), heroin (24,0%) and cannabis (17,7%), followed by amphetamines (8,3%), benzodiazepines and sedatives (6,8%) and cocaine (6,3%). 

Outcome results will be ready by spring 2024. We are currently waiting for employment-related outcome data to be linked with our project survey data by Statistics Norway. This will provide complete coverage on the main outcome and the secondary employment related outcomes, with no missing data. 

Conclusions: Awaits analyses.