Toward application of the Therapeutic Workplace: Reply to Higgins (2001), Marlatt (2001), McLellan (2001), and Petry (2001)

The Therapeutic Workplace appears effective at initiating abstinence from heroin and cocaine in pregnant and postpartum women. However, the cost and complexity of the intervention must be reduced before it is ready for widespread application. This treatment is designed to train and employ drug abuse patients, and to use the salary that they earn for working to reinforce abstinence. Limiting teaching to only critical skills can reduce the costs of training. Computerizing the intervention also can reduce its cost and complexity. Major cost efficiencies should be realized when participants become employed in Therapeutic Workplace businesses; these businesses could provide a self-sustaining means of arranging long-term employment and salary-based abstinence reinforcement. Studies are required that simultaneously demonstrate the effectiveness and cost efficiencies of using salary for real work to reinforce drug abstinence.