Are workplace recovery programs successful in helping people to quit abusing drugs and avoid relapsing? A growing field of research suggests the answer is yes, though their success may have more to do with incentives than the nature of work itself.

There are a few ways that scholars have studied the relationship between employment and recovery, according to Matthew Walton, an instructor at the University of Louisville’s Kent School of Social Work. He is also the author of “The Effects of Employment Interventions on Addiction Treatment Outcomes: A Review of the Literature,” which looks at 12 studies on workplace recovery programs and concludes that they tend to be effective.

Walton described the two dominant approaches: one views employment as a benchmark of successful recovery. The other area of research focuses on whether being employed is a therapeutic intervention in and of itself.

Paid work as an incentive to abstinence

Kenneth Silverman, professor of psychiatry at Johns Hopkins Medicine in Baltimore, is a leading researcher in this latter field. Silverman has developed an experimental therapeutic workplace that offers paid employment to poor, unemployed people with opioid dependencies and other substance use disorders — with the understanding that the researchers will be studying them.

“We’re studying access to paid work as reinforcer or incentive to abstinence,” Silverman explained.

In this model, which has been the subject of study since 1996, participants have to provide drug-free urine samples to keep their jobs and/or avoid a dock in pay.

The model has proven effective in promoting and maintaining abstinence from heroin and cocaine among people who have been unable to stop on their own, he said.

Silverman was careful to say that his research shows that work alone does not keep employees from using drugs. Money and accountability matter, too.

“When we randomly assign people to just work and get paid, but they don’t have to provide drug-free samples to obtain maximum pay, they work a lot, but they continue to use heroin or cocaine,” he said. Only when paid work is contingent on abstaining does it serve as powerful incentive to maintain sobriety.

“I’m not sure that it’s right to say that work is a powerful incentive. Paid work is a powerful incentive,” Silverman said. “It’s probably the money that’s the most important thing.”

Doctors with opioid addiction

Anthony DeFulio, an assistant professor of psychology at Western Michigan University who studies workplace recovery programs, offered a similar perspective regarding treatment for physicians with opioid addictions.

DeFulio cited research on the national system of Physician Health Programs, which involves outpatient treatment and random drug testing over a period of five years. The results of these tests are reported to employers, insurers and state licensing boards, and if participants test positive, they can lose their license to practice medicine. These programs are quite successful, with only 22 percent of physicians testing positive at any point in the five-year follow-up screening period, according to a 2009 study involving 49 medical directors in charge of their state-run programs.

“When someone has a lot to lose, then that alone seems to be sufficient,” DeFulio said in a recent phone call.