presents characteristics of the 448 employed participants in the baseline sample, 75 (17%) of whom had workplace mandates. Compared with the group without mandates, the group with mandates had a significantly larger proportion of men and of African Americans, a smaller proportion of Hispanics and of individuals with a psychiatric diagnosis, and a lower level of education. ASI scores for the group with mandates were higher for employment problem severity, although the difference was not significant (p=.075), and lower for family, psychiatric, alcohol, and drug problem severity.
Baseline characteristics and scores on the Addiction Severity Index (ASI) of 448 employed participants in chemical dependency treatment, by whether they had a workplace mandate
Compared with participants without a workplace mandate, a smaller proportion of those with a workplace mandate considered treatment for alcohol or drug problems to be considerably or extremely important, but a larger proportion considered chemical dependency treatment to address employment problems to be considerably or extremely important.
Among the 75 participants with a workplace mandate, 40 (53%) had no other mandate, 18 (24%) had one other, and 17 (23%) had at least two others. Among those with a workplace mandate who had additional mandates, 32 (43% of all those with workplace mandates) had a mandate from their family, 12 (16%) from a mental health provider, nine (12%) from a health provider, and seven (9%) from a legal source (data not shown). Among the 373 participants without workplace mandates, 267 (72%) had no mandate, 93 (25%) had one, and 13 (3%) had two or more. Of these, 94 (25%) received a mandate from family, nine (2%) from a mental health provider, eight (2%) from a health provider, and ten (3%) from a legal source.
Bivariate analyses examined the relationship between feeling pressure to enter treatment and other variables. A response of “very strong” to the question “How much pressure did you feel to enter treatment?” was positively related to having a workplace mandate. Specifically, at one-year follow-up, 38 of the 70 participants with a workplace mandate (54%) gave this response, compared with 48 of the 335 without a mandate (14%) (p<.001). This response was also related to abstinence at one year; 61 of the 252 participants who were abstinent at one year (24%) gave this response, compared with 25 of the 152 who were not abstinent (16%), but the difference was not significant (p=.065). In addition, feeling very strong pressure to enter treatment was related to perceived need for treatment to address employment problems; 37 of the 106 participants who perceived a need for treatment in this area (35%) gave this response, compared with 49 of the 299 participants who did not perceive such a need (16%) (p<.001). Feeling very strong pressure was not significantly related to the severity of alcohol, drug, psychiatric, or employment problems at one year (data not shown).
Having a workplace mandate was related to length of stay in chemical dependency treatment. At one year, the group with a workplace mandate had longer stays than those without a workplace mandate (mean ± SD of 124±129 and 72±97 days; t=−3.29, df=91, p=.001). Among those with a workplace mandate, length of stay was not significantly different between those with no additional mandates and those with additional mandates (data not shown).
Changes in ASI scores from baseline to the two follow-ups in the groups with and without a workplace mandate are shown in . Scores at one year indicated significant improvements in both groups. However, for participants with a workplace mandate, improvements were not significant in the severity of legal problems and medical problems. At five years, similar patterns persisted; however, those with a workplace mandate showed significant improvement in employment problems, and those without a mandate showed marginal improvement (p=.058) in this area. Medical severity was not significant at five years.
Change in Addiction Severity Index scores from baseline to one- and five-year follow-ups among employed participants in chemical dependency treatment, by whether they had a workplace mandatea
presents an ordinary least-squares regression model of predictors of length of stay in chemical dependency treatment. Having a workplace mandate was related to a longer stay (p<.001), and greater severity of employment problems at intake was marginally related to a shorter stay (p=.054). Severity of alcohol and drug problems and psychiatric diagnosis were not significant predictors of length of stay.
Regression analysis of length of stay on having a workplace mandate and other variables among 405 participants in chemical dependency treatment
Logistic regression models of predictors at one year of abstinence from alcohol and drugs and severity of psychiatric problems, as well as linear regression models of severity of employment problems, are shown in . To examine the role of length of stay, the regression models first excluded length of stay and were then refit to include it. In the model that excluded length of stay, having a workplace mandate predicted abstinence (odds ratio [OR]=1.86). When length of stay was included, having a workplace mandate was no longer significant; however, in this model a longer stay predicted abstinence (OR=1.01). The change in AIC was statistically significant. In both models, perceived need for alcohol treatment and receipt of psychiatric services predicted abstinence. We replicated the analysis, substituting abstinence at six months for length of stay (data not shown). Six-month abstinence was a significant predictor of abstinence at one year (OR=3.22, 95% confidence interval [CI]=13.53–46.78); however, having a workplace mandate was not a significant predictor of abstinence in this model, which is similar to the model in which length of stay was used. In post hoc analysis, a measure of having other types of mandates was added; however, receipt of other mandates was not a significant predictor of abstinence, and addition of the other mandates did not change the significance of having a workplace mandate.
Predictors of one-year outcomes and of having a workplace mandate among participants in chemical dependency treatmenta
Predictors of severity of psychiatric problems at one year (ASI scores below the median at one year) were also examined (). Having a workplace mandate was not related to lower psychiatric severity in either length-of-stay model. In both models, perceived need for psychiatric treatment and receipt of psychiatric services was related to higher psychiatric severity scores. Having a psychiatric diagnosis was not significant in either model. Length of stay was a marginally significant predictor of severity of psychiatric problems. The model fit did not change when length of stay was added. We replicated the analysis while including the baseline measure of psychiatric problem severity and found that higher baseline scores were related to higher psychiatric severity at one year (OR=.09, CI=.02–.33, in the model with length of stay) (not shown).
Predictors of severity of employment problems at one year were also examined (). Having a workplace mandate was not significant in either length-of-stay model. A longer stay was related to lower employment problem severity. Perceived need for chemical dependency treatment to address employment problems was not related to lower scores on severity of employment problems in either model. However, in both models, perceived need for treatment for drug problems was related to lower employment problem severity, and perceived need for treatment for psychiatric problems was related to higher employment problem severity. Higher baseline severity of employment problems was related to higher severity of employment problems at one year. The model fit improved when length of stay was included.
We used logistic and linear regression models to examine the same outcomes at five years, and we also measured treatment readmission and receipt of psychiatric services between one and five years (not shown). All results were consistent with the one-year results, including the significance of length of stay for abstinence (OR=1.004, CI=1.002–1.006). However, having a workplace mandate did not predict abstinence at five years. Baseline and one-year severity scores in all problem areas predicted the same outcomes in the same direction at five years. Perceived need for alcohol treatment remained important in predicting abstinence (OR=3.01, CI=1.36–6.64), and perceived need for psychiatric treatment remained important in predicting psychiatric severity (OR=.59, CI=.35–.997). None of the motivation measures predicted severity of employment problems at five years. Receipt of psychiatric services was positively related to abstinence, even when length of stay was included in the model (OR=.96, CI=.92–.999). Readmission to chemical dependency treatment predicted abstinence at five years (OR=1.83, CI=1.15–2.90 in the model without length of stay; OR=1.91, CI=1.19–3.05 in the model with length of stay) but not severity of psychiatric or employment problems.