A therapeutic workplace for opiate dependent women arrested for prostitution David Sottile, Anthony DeFulio, and Kenneth Silverman INTRODUCTION The traditional criminal justice response to prostitution and drug crime is expensive and ineffective. The therapeutic workplace may be useful in addressing the needs of drug dependent adults arrested for prostitution In the therapeutic workplace, unemployed drug users living in poverty are provided with access to employment or stipend supported job training contingent on drug abstinence. The primary purpose of this study was to provide a preliminary assessment of the therapeutic workplace as a means of increasing drug abstinence and decreasing HIV risk behaviors in women arrested for prostitution in Baltimore City. A secondary purpose of this study was to determine whether drug-abstinence contingent wage supplements could be used to promote community employment in individuals who successfully initiated drug abstinence while engaged in stipend-supported job training in the therapeutic workplace. RESULTS & DISCUSSION Figure 1 shows that the opiate abstinence contingency increased opiate abstinence in opiate-dependent adults charged with prostitution. Figure 2 shows the results from an individual participant who used multiple drugs at baseline and suggests that the stepped approach may be of value in the treatment of poly drug users. Table 1 shows HIV risk behaviors and indicates that both study groups engaged in high rates of HIV risk behaviors at study intake, and lower rates at study month 4. Interestingly, it appears that there was greater proportional reduction in HIV risk behaviors in the TW group. Table 2 shows descriptive social validity measures and indicates that the therapeutic workplace was well received by participants. There were very low rates of community employment or employment related activities in both groups during the wage subsidy intervention period. Only one participant (TW group) obtained steady employment, and an additional three (one from TW) found occasional work. FIGURE 1 – Effect of the opiate abstinence contingency on overall proportion of opiate negative samples submitted by participants who were exposed to the contingency (N=10). Open circles show percentages when missing data are counted as indicating drug use, and filled circles show percentages when missing data are ignored. METHOD Participants (N=38) were opiate dependent adults arrested for prostitution whose cases were being processed in early resolution court. All participants were either enrolled in methadone or buprenorphine treatment prior to enrolling in this study. Participants were recruited from the East District Court on North Avenue. Participants were randomly assigned to usual care or usual care plus the therapeutic workplace intervention. Therapeutic workplace participants could attend the therapeutic workplace for four hours every weekday for four months. Urine samples were collected three days per week (M,W,F). Drug abstinence contingencies were implemented in four steps. Step 1 included no drug abstinence contingencies. Step 2 required cocaine abstinence. Step 3 required cocaine and opiate abstinence. Step 4 required cocaine, opiate, marijuana, and amphetamine abstinence Failure to meet the drug abstinence contingencies resulted in a temporary reduction in the rate of base pay from $8 per hour to $1 per hour. FIGURE 2 – Single case urinalysis results from a successful TW participant. TABLE 1 – HIV risk behavior in the control group and therapeutic workplace group at study intake and at study month 4, the last month of the intervention period. M4/Intake is a means of characterizing the change in the proportion of participants engaging in a risk behavior at study month 4 relative to the base rate observed at intake. METHOD (continued) Participants who initiated drug abstinence and maintained drug abstinence during study month 4 were invited to an additional four-month wage subsidy program. In the wage subsidy program participants were required to submit urine samples on a weekly basis at a community collection facility. Mandatory collection days were randomly determined weekdays. If the weekly drug test indicated drug abstinence, then participants were paid $4.00 per hour for every hour they spent in verifiable community employment , job search, or job skills training during that week. If the drug test was missed or indicated drug use, then participants received $1.00 per hour in wage subsidies. TABLE 2 – Social validity measures for the TW intervention at two time points. Only TW participants were surveyed. CONCLUSION The therapeutic workplace is a potentially effective and acceptable intervention for women arrested for prostitution, however, additional supports are likely to be necessary to promote long-term abstinence and community employment. Supported by grant R34DA033141 (DeFulio, PI)