Obtaining, Maintaining, and Upgrading Employment: A Drug Court Intervention Study

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Obtaining, Maintaining, and Upgrading Employment
A Drug Court Intervention Study

• Carl Leukefeld, Michele Staton-Tindall, Matt
  Webster, Matt Hiller, Robert Walker, Lon Hays
  TK Logan
• Center on Drug and Alcohol Research
• University of Kentucky

Presented at Bridging the Gaps Scottish Addiction
Studies University of Stirling, Scotland April,
2003
This project is funded by Grant No. RO1-13076
awarded by the National Institute on Drug Abuse,
Points of view in this presentation are those of
the authors and do not necessarily represent the
official position or policies of the National
Institutes of Health.
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Presentation Objectives

• Describe a theoretically grounded employment
  intervention which incorporates research based
  approaches
• Motivational Interviewing
• Structured Stories
• Thought Maps
• Present initial data for 120 drug court
  participants in two drug courts which compares
  those employed full-time and those not employed
  full-time at drug court entry

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Possible Pathways to Alcohol and Drug Abuse
Biological/Genetic
(Nature)
Alcohol and Drug
Psychological
Behavior
Social
Attitudes
Environmental
Values
Cultural
Familial
Knowledge
(Nurture)
Peers
Spiritual
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Theoretically Grounded in the Stages of Change
(Prochaska DiClemente, 1982)PrecontemplationCo
ntemplationDeterminationActionMaintenanceRelap
se

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Initial Focus Group Findings

• Dont use jargon and educated words
• Dont overwhelm participants with paperwork
• Dont stereotype and depersonalize participants
• Dont try to control participants
• Dont be humorless

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Intervention Overview

• Focus
• Antecedents, Behavior and Consequences
• Stages of Change (Prochaska DiClemente,
  1982)
• Methods
• Motivational Interviewing (Miller Rollnick,
  1989).
• Structured Stories
• Thought Mapping Problem Solving

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Intervention Targeted on - Antecedents, Behavior
and Consequences

• Learning Theory focused on teaching behaviors and
  skills.
• An assumption that a behavior can be learned
  using a cognitive behavioral approach.
• A B C

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Exit
Relapse
Sustaining
Not Thinking
Thinking
Changing
Planning
adapted from Miller, W. Rollnick, S. (1991)
Motivational interviewing Preparing people to
change addictive behavior. The Guilford Press,
NY, p. 15.
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Intervention Structure
Assessment
Intervention
Follow-up
Groups
Group Sessions Problem Solving Structured
Stories Thought Mapping
Individual Sessions using Motivational
Interviewing
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Structured Stories

• Structured Stories are used to focus on changing
  behavior (Leukefeld et al., 1999)
• Acceptable
• Models specific behavior andconsequences
• Example Structured Story -- Rick the construction
  worker

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Storytelling

• Stories are used to provide information about
  beliefs, values, attitudes, and behaviors.
• Stories can be used to give how-to and
  how-not-to information.
• Personal stories are most often remembered and
  are used to transfer information to others.
• Stories can be cognitive rehearsals for new
  behaviors and attitudes.

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Stories

• We use stories when we talk with other people.
• Stories are not just entertainment but a way of
  processing information.

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Structured Stories

• Stories are structured and scripted to target a
  specific behavior, the antecedents of the
  behavior -- what came before the behavior -- and
  the consequences of the behavior -- what came
  after the behavior.
• Structured stories are used to cue or initiate
  individual and personal stories which are called
  counter stories.
• Personal counter stories can then be discussed
  and examined.

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Structured Stories

• Structured stories can be modified to cognitively
  rehearse how different behaviors might change
  outcomes in the same story.
• Some people engage quickly in structured stories
  to cognitively try out new behaviors.

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Structured Story (example)

• Rick is a young man who had opportunities and
  hard knocks. His father was an alcoholic. His
  mother raised him. He finished high school and
  got a factory job and married his high school
  sweetheart. After 3 years, Rick lost his job.
  He used alcohol in addition to grass and served
  time.
• He returned and stopped using because his wife
  threatened to leave him. He got a demolition
  construction job and made foreman. Ricks wife
  fell in love with another man and left him. Rick
  stalked his wife, she filed a protective order,
  he kept stalking her, and he was jailed.
• One evening after work and having a few hits,
  Rick met his friends at a bar. For the first
  time in weeks, he was laughing. He spotted a
  good looking woman at the bar. He smiled and she
  smiled back. She came over to him and asked his
  name. One thing led to another and

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Thought Mapping

• Thought Mapping is a structured, preformatted
  mapping approach to help participants organize
  their own thoughts and behaviors visually using a
  map
• Thought Mapping focuses on linking information
  using associations between
• Personal feelings,
• What others thought and did,
• What the person did, and
• What could have been done differently.

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Thought Map
My feelings
What others thought
What I did
2. What camebefore theproblem or experience?
Leads to
3. What happened?
Consequences
Different Behavior
4. What could I have done instead?
5. What would be different?
Different Consequences
My feelings
What others wouldthink and do
What I would do
6. How would things be different?
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Drug Courts in Kentucky
40 Courts Statewide
Employment readiness drug court research sites
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Typical Kentucky Drug Court Treatment
Phase I
Phase II
Phase III
4-8 Weeks Long
8-12 Months Long
3-5 Months Long
4-6 Sessions/Week
3-4 Sessions/Week
2-3 Sessions/Week
UAs 3Xs/Week
UAs 2Xs/Week
UAs 1X/Week
Source (Logan, Williams, Leukefeld, Minton,
2000)
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Correlates of Dropping Out or Completing Drug
Court Treatment
Factors at Intake
Dropout
Completer
?
Employment Problems
?
Younger Age
?
Longer Incarceration History
?
More Health/Psych Problems
?
Desire for Help (Motivation)
Source (Logan, Williams, Leukefeld, Minton,
2000)
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Employment Readiness InterventionOverview
Obtaining
Maintaining
Upgrading
Drug Court Phase 1 4-5 Weeks 15 Sessions
Drug Court Phase 2 32 Weeks 29 Sessions
Drug Court Phase 3 16 Weeks 18 Sessions
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Obtaining Employment
Central focus Acquiring skills to get the job
Obtaining

• Job readiness assessment
• Getting immediate employment
• Employment behavioral contracting

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Maintaining Employment
Central focus Acquiring skills to keep the job
Maintaining

• Resolving conflicts at work
• Setting goals and problem solving
• Life skills development

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Upgrading Employment
Central focus Acquiring skills to get a better
job
Upgrading

• Researching possible employers
• Job development
• Job placement

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Exploratory Question

• Do drug abusers who are employed full-time report
  different employment problems, different drug use
  (ASI measures), and different sexual risk
  behaviors (RBA measures) than drug abusers not
  employed full-time at drug court treatment entry.

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Study Design
12-Month Follow-up Interview
Random Assignment
24-Month Follow-up Interview
4 Judges (Fayette County) 2 Judges (Warren
County)
Baseline Interview Self-Assessments Exit
Interview Program Records
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Demographics (N 120)
Employment Group
Male
White
Average Age
Cook andConstruction Jobs
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Employment Groups at Treatment Entry
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Income at Treatment Entry
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Job History at Treatment Entry
plt.05
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Drug Use and Sexual Behaviors
plt.05
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Findings

• Overall, drug abusers employed full-time and
  those not employed full-time were not very
  different at drug court treatment entry.
• As expected, those employed full-time were more
  likely to have earned more before entering
  treatment and from legitimate jobs.
• There were no differences in the two major jobs
  held -- construction and cook -- in employment
  status.
• There was only one difference in 12 drug
  categories examined -- years of opiate lifetime
  use.
• There was only one difference in the 10 sexual
  behaviors examined -- those employed full-time
  reported more days of having sex in the previous
  30 days.

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Implications

• Employment is an important part of Drug Court and
  other drug treatment.
• Because employment is an outcome as well as a
  program intervention, it is surprising that
  limited attention has focused on employment
  (Platt, 1995 and Schottenfeld et.al, 1992).
• These preliminary and descriptive data suggest
  that employment (employed full-time vs. not
  employed full-time) was not protective since
  there were few differences in drug use and sexual
  behaviors examined.
• Additional attention needs to be paid to better
  understanding the role of employment in drug
  treatment.
• Employment interventions need to be examined to
  determine their utility for enhancing employment
  and keeping drug abusers in treatment.

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Concluding Comments

• A cognitive behavioral employment intervention
  was developed which focuses on employment
  Antecedents, Behavior, and Consequences using
• Motivational Interviewing
• Structured Stories
• Thought mapping