# Augmenting early phase substance use treatment with therapeutic work activity to improve clinical outcomes: a new indication for an old intervention

> **NIH VA I01** · VA CONNECTICUT HEALTHCARE SYSTEM · 2023 · —

## Abstract

Approximately 1 in 15 Veterans currently meet criteria for a substance use disorder (SUD). SUDs have
deleterious effects on interpersonal, role, and community function, and are highly comorbid with mental and
physical health problems. They are considered chronic conditions, with reported 75% relapse rates in Veterans
1-year post treatment.
 In our prior VA rehabilitation research, we observed that participation in Incentive Therapy (IT) was
associated with very favorable outcomes in Veterans recently discharged from intensive SUD day treatment,
with close to 90% of abstinent days over the 3-month course of IT, and favorable clinical and quality of life
outcomes in about two-thirds of the sample at 12-month follow-up. This contrasts starkly with outcome data
from a historical matched comparison sample of Veterans who were also discharged from SUD day treatment
but were not enrolled in any vocational rehabilitation services, only about a quarter of whom had favorable
clinical and quality of life outcomes at 12 months.
 VHA is unique in providing a comprehensive, integrated system of care that includes an infrastructure to
provide Therapeutic and Supported Employment Services (TSES) to those in SUD outpatient treatment. These
programs include pre-vocational programs such as IT, which are intended for Veterans not interested in
competitive employment and which focus on the therapeutic effects of work activity on clinical outcomes and
overall functioning, as well as Other TSES programs which include supported employment and vocational
assistance. While Other TSES programs are specifically intended for Veterans interested in competitive
employment, both types of programs may boost recovery outcomes by providing a return to meaningful role
function.
 The primary purpose behind the current proposal is to obtain rigorous scientific data on the potential
therapeutic benefits of both IT and Other TSES, so this information may be used to understand the important
role these two types of programs play in recovery from SUD. We propose a trial to test the effects of IT and
Other TSES on improving SUD outcomes in newly recovering Veterans in outpatient treatment. In line with
eligibility criteria for different TSES programs, we will employ a two branch study: One branch will be for
Veterans who are not interested in pursuing competitive employment, and will be a two arm RCT with
randomization (2:1) to referral for IT + treatment as usual (TAU; including usual SUD outpatient treatment) or
TAU alone. The second branch will be for Veterans who express interest in competitive employment, and will
be a two arm RCT with randomization (2:1) to referral for TSES competitive employment services + TAU or
TAU alone. Total Intent to Treat sample will be 140 (n=70 per branch). Assessments will be conducted at
baseline, 3 months, 6 months, and 12 months. Primary outcomes will be sobriety and global functioning.
Secondary outcomes will be psychiatric symptoms, self-esteem, self...

## Key facts

- **NIH application ID:** 10814127
- **Project number:** 5I01RX003493-03
- **Recipient organization:** VA CONNECTICUT HEALTHCARE SYSTEM
- **Principal Investigator:** MORRIS D. BELL
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2023
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2021-10-01 → 2026-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10814127

## Citation

> US National Institutes of Health, RePORTER application 10814127, Augmenting early phase substance use treatment with therapeutic work activity to improve clinical outcomes: a new indication for an old intervention (5I01RX003493-03). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10814127. Licensed CC0.

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