This page refers to the current evidence on the effectiveness of the available educational interventions for improving the employability of drug users. Information on the methodology used and the definition of terms can be found on the methodology page.
Date of last update: 12.2016 Next update: 04.2017
Summary: Motivated Stepped care interventions (motivational behavioural reinforcement) for methadone maintenance clients is effective in helping people to find employment. Employment-based interventions and vocational training may support the employment rate, while employment counselling is ineffective.
Motivated stepped care intervention based on motivational behavioural reinforcement and specifically targeting methadone maintenance clients was found to be effective in one cross-sectional study (n = 228; Kidorf et al., 2004, cited in EMCDDA, 2012 - Online appendix):
Customised employment supports for methadone maintenance clients focusing on individualised interventions to promote vocational skills and reduction of non-vocational barriers (e.g. low self-efficacy) was found to be effective in one RCT (n = 168; Magura et al., 2007, cited in EMCDDA, 2012 - Online appendix):
Employment-based training, including vocational counselling, job-seeking skills and job development, was found to be effective in one cross-sectional study (n = 223; Schottenfeld et al., 1992, cited in EMCDDA, 2012 - Online appendix):
Employment counselling was found to be effective in one secondary analysis of national survey (n = 297; SAMHSA - Substance Abuse and Mental Health Services Administration; Reif et al., 2004, cited in EMCDDA, 2012 - Online appendix):
The Helping Offenders to Work programme, consisting of four different targeted strategies to help recipients gain skills and employment, was found to be effective in one UCBA (n = 245; Kemp et al., 2004, cited in EMCDDA, 2012 - Online appendix):
A skills training programme for drug court attendees, divided among a low-upgrading intervention group (LUG), a high-upgrading intervention group (HUG) and a no intervention group, was found to be effective in one RCT (n = 500; Leukefeld et al., 2007, cited in EMCDDA, 2012 - Online appendix):
A multiservice intervention designed targeting women substance users and promoting the move to sobriety and self-sufficiency, with vocational training sessions as a component of the programme, was found to be effective in one UCBA (n = 529; McLennan et al., 2003, cited in EMCDDA, 2012 - Online appendix):
No interventions met the criteria for this category.
The Job Seekers’ Workshop (JSW) programme focused on job skills training, in particular interview preparation, versus a job interviewing video (JIV) revealed in one RCT (n = 102; Foley et al., 2010, cited in EMCDDA, 2012 - Online appendix):
The Effectiveness of Vocational Problem Solving Skills (VPSS) intervention focused on job-seeking motivation and action steps for stabilised in clients receiving methadone treatment revealed in one RCT (n = 109; Coviello et al., 2004, cited in EMCDDA, 2012 - Online appendix):
The Experimental Training Programme (TEP), focused on job employment training and skills development, showed no difference in one RCT (n = 250; Karuntzos et al., 1994, cited in EMCDDA, 2012 - Online appendix):
The Training and Employment Programme, including skills development and a budget for any identified training needs, showed no evidence of effectiveness in one RCT (n = 249; Dennis et al., 1993, cited in EMCDDA, 2012 - Online appendix):
A combination of the Vocational Problem-Solving programme and the Job Seekers’ Workshop programme based on cognitive behavioural intervention and interpersonal problem-solving theories revealed in one RCT (n = 417; Lidz et al., 2004, cited in EMCDDA, 2012 - Online appendix):
A Drug Treatment Alternative-to-Prison (DTAP) programme, focusing on vocational training and job skills development, showed no evidence of effectiveness in one secondary analysis of client records (n = 406; Sung, 2001, cited in EMCDDA, 2012 - Online appendix):
Employment counselling was found to be not effective in one secondary analysis of national survey, the Alcohol and Drug Services Study (n = 1 802; Shepard and Reif, 2004, cited in EMCDDA, 2012 - Online appendix):
Below you can find definitions and further explanation for some of the terms used in this section of the Best practice portal. A more general glossary for the best practice portal is also available.
A type of prevention intervention which aims to they aim to modify inner qualities (personality traits such as self-esteem and self-efficacy, and motivational aspects such as the intention to use drugs).
Before-after (BA) study design
Blood alcohol level (BAL)
Interventions for which precise measures of the effects in favour of the type of intervention were found in systematic reviews of relevant studies. An intervention ranked as ‘beneficial’ is suitable for most patients/contexts. See the relevant module methodology page for further information.
Controlled before-after (CBA) study design. UCBA stands for Uncontrolled before-after study design.
Cognitive behavioral therapy is an individual based intervention occurring in three stages. Phase 1 is aimed at determining and prioritizing the patient’s problems and constructing the treatment contract. Phase 2 is aimed at increasing coping competence and reducing risky behaviors. Phase 3 focuses on relapse prevention. Each session is administered once per week over a period of 4-6 months with 60- to 90-minute sessions (Beck AT, Wright FW, Newman CF, Liese B. Cognitive Therapy of substance abuse. New York: Guilford Press, 1993).
Controlled clinical trials (CCT)
A cohort study is a type of observational study that follows a group of people (i.e. a cohort) over time. In a prospective cohort study, the cohort is formed and then followed over time. In a retrospective cohort study, data is gathered for a cohort that was formed sometime in the past.
The Confidence Interval (CI) is a measure of the precision (or uncertainty) of study results. It is the interval that most likely includes the true value of the parameter we are calculating, where 'most likely' is taken by common usage to be a 95% probability. Thus the current expression of '95 % CI'. A wide CI indicates less precise estimates of effect and vice versa.
Current population survey (CPS)
A cross-sectional study is a study employing a single point of data collection for each participant or system being studied.They are usually conducted to estimate the prevalence of the outcome of interest for a given population at a given point in time.
Interventions that gave negative results if compared with a standard intervention or no intervention, for example. See the relevant module methodology page for further information.
Additional information for prevention
For ethical reasons this category in prevention should be considered as interventions with negative and undesired (iatrogenic) effect.
Individual psychotherapy is a standard individual treatment based on counseling and motivational interviewing and focused on substance use triggers and strategies for relapse prevention. It includes elements of cognitive-behavioral therapy (CBT).
Interquartile range (IQR) - also called the midspread or middle fifty - is a measure of statistical dispersion. It is a trimmed estimator, defined as the 25% trimmed mid-range, and is the most significant basic robust measure of scale.
Intermittent time series design (ITS)
Knowledge-focused prevention intervention
A type of prevention intervention which aims to to enhance knowledge of drugs, and drug effects, and consequences.
Interventions that were shown to have limited measures of effect, that are likely to be effective but for which evidence is limited. An intervention ranked as ‘likely to be beneficial’ is suitable for most contexts/patients, with some discretion. See the relevant module methodology page for further information.
The Number Needed to Treat (NNT)indicates the number of patients that needs to be treated to obtain one respondent patient. Numerically the NNT is the reciprocal of the difference between the proportion of events in the experimental and the comparison group (absolute risk reduction). Taking into consideration that the ideal NNT would be 1 (the unreal situation in which every single patient succeeded) it is easily understood that a NNT value close to 3 or 4 would be very good.
The Adjusted Odds Ratio is a way of comparing whether the probability of a certain event is the same between two groups, yet they are calculated adjusting for or controlling for other possible contributions from other variables (tipically demographic variables) in the model. An AOR equal to 1 implies that the the event is equally probable in both groups. An AOR greater than 1 implies that the event is more likely in the first group. An AOR less than 1 implies that the event is less likely in the first group.
The Odds Ratio is a way of comparing whether the probability of a certain event is the same between two groups. Like the Relative Risk, an OR equal to 1 implies that the the event is equally probable in both groups. A OR greater than 1 implies that the event is more likely in the first group. A OR less than 1 implies that the event is less likely in the first group. In medical research, the odds ratio is commonly used for case-control studies, as odds, but not probabilities, are usually estimated. Relative risk is used in randomized controlled trials and cohort studies.
A p-value is a measure of how much evidence we have against the null hypothesis. The null hypothesis represents the hypothesis of no change or no effect. The smaller the p-value, the more evidence we have against the null hypothesis thus it is more likely that our sample result is true. Traditionally, researchers will reject a null hypothesis if the p-value is less than 0.05.
Responsible beverage service (RBS)
Randomised controlled trial (RCT)
The Relative Risk (RR) is used to compare the risk in the two different groups of people, i.e. treated and control groups to see if belonging to one group or another increases or decreases the risk of developing certain outcomes. This measure of effect will tell us the number of times an outcome is more likely (RR > 1) or less likely (RR < 1) to happen in the treatment group compared with the control group.
Interventions that obtained measures of effects in favour of the intervention, but that showed some limitations or unintended effects that need to be assessed before providing them. See the relevant module methodology page for further information.
Interventions for which there are not enough studies or where available studies are of low quality (with few patients or with uncertain methodological rigour), making it difficult to assess if they are effective or not. Interventions for which more research should be undertaken are also grouped in this category.
Additional information for prevention
For prevention interventions, this is also known as 'zero effect'.
A type of prevention intervention which aims to enhance students’ abilities in generic skills, refusal skills and safety skills.
The Standardised Mean Difference (SMD) is the difference in means divided by a standard deviation. Note that it is not the standard error of the difference in means (a common confusion). The standardized mean difference has the important property that its value does not depend on the measurement scale. It may be useful if there are several trials assessing the same outcome, but using different scales.
The z-score (aka, a standard score) indicates how many standard deviations an element is from the mean of the population.
In this portal, ‘education’ is defined as a specific learning opportunity for former or current drug users. This implies that education is defined as the learning or upgrading of literacy or numeracy skills but does not include specific training for a given kind of job. Vocational training is designed to help participants acquire employment readiness and/or the practical skills and understanding necessary for employment in a particular occupation or trade or class of occupations or trades.
limited or no qualifications, including low levels of literacy and numeracy; poor employment histories; criminal records precluding certain careers (e.g. police, teaching, working with children, financial institutions); chronic mental and physical ill health; insecure housing circumstances; limited interpersonal skills; complex personal needs; lack of confidence; chaotic lifestyles (e.g. poor timekeeping); family problems; low expectations of themselves and of life in general.
requirement to attend treatment on a daily basis; inadequate opening hours of treatment services that are incompatible with working hours; lack of interagency coordination; stigmatising and discriminative views, actions and procedures; inability to open a bank account to receive wages; increased likelihood of temporary or insecure work; shortage of suitable employment opportunities; perceived ‘benefit trap’ whereby an (incorrect) belief is held that the loss of welfare benefits as a consequence of employment will result in a reduction in income that is not compensated by the salary; criminal record checks required by employers.
Vocational training incorporates programmes that aim to support employment-finding strategies and self-efficacy; improve commitment to work and interview skills; and develop transferable (e.g. time management, presentation skills, self-evaluation) and role-specific (e.g. computer literacy) skills. Training courses are often offered by both drug treatment services and specialist private or state providers (e.g. national employment services).
These interventions refer to formalised education during which the client undertakes examinations and other forms of assessment to gain nationally recognised qualifications.
Not a formalised intervention per se, but many problematic drug users who have recovered or are in recovery contribute to drug treatment services after retraining as drugs workers themselves. Clients enter the workplace in the drug treatment field as either a volunteer or a specialist worker.
Volunteering and temporary work experience placements are often important components of vocational rehabilitation. The objective of volunteering (with respect to the long-term goal of gaining employment) is to allow the individual to gain workplace confidence and self-esteem, acquire new skills and demonstrate to potential employers that he or she is able to adapt to the workplace environment.
Temporary work experience aims to enhance existing skills and prepares the individual to conduct a specific role, particularly those of a more specialist nature. Selection processes often mirror those of paid employment, and work experience may attract a salary.
The main outcomes considered as proxy of social reintegration were employment-related outcomes.