Director / Principal Investigator: Kenneth Silverman, Ph.D.
The Center for Learning and Health (CLH) is a treatment and research unit dedicated to developing and evaluating interventions to reduce drug addiction and improve health. Extensive evidence from the laboratory and the clinic suggests that drug addiction can be viewed as operant behavior and effectively treated through the application of principles of operant conditioning. CLH is devoted to developing interventions that directly apply these conditioning principles to increase existing behaviors and to build new behaviors needed for a healthy lifestyle.
Since its establishment in 1996, CLH has been developing and evaluating a novel employment-based intervention called the therapeutic workplace. The therapeutic workplace is designed to address the interrelated problems of poverty and drug addiction and has been recognized by the Substance Abuse and Mental Health Services Administration’s National Registry of Effective Programs as a "Promising Program." The therapeutic workplace is a motivational intervention that uses access to employment and wages to reinforce therapeutic behavior change. Like typical employment, individuals in the therapeutic workplace are hired and paid to work over extended periods of time. To promote therapeutic behavior change, employment-based reinforcement contingencies are arranged by which workplace participants are required to maintain target behaviors, such as drug-free urine samples, to gain and maintain access to the workplace and/or to maximize earnings.
Since our research has focused on serving poor and chronically unemployed individuals, many of whom lack the skills or credentials needed to obtain gainful employment, CLH operates a learning center that provides basic skills and job skills training (e.g., data entry skills). Our training is individualized, most of it is computerized, and all of the training employs state-of-the-art teaching methods that have been shown effective in a wide range of populations. Trainees in the learning center typically train for four hours every weekday for six or seven months and earn training stipends contingent on attendance and performance on training programs. To promote a therapeutic behavior change such as drug abstinence, employment-based reinforcement contingencies are arranged for learning-center trainees as well. Participants who acquire needed skills are referred to employment opportunities in the community or are hired in our in-house therapeutic workplace business. To implement and evaluate the therapeutic workplace business, CLH operates a model data entry business under its nonprofit corporation, the Center for Learning and Health Corporation. A recent analysis showed that CLH provides over 20,000 hours of computerized training and employment annually.
CLH operates its learning center and business in over 6,000 sq ft of space located on The Johns Hopkins Bayview Medical Center Campus. CLH is equipped with 45 computer workstations for trainees in the learning center and for data entry operators in the therapeutic workplace business as well as an onsite urinalysis laboratory. Both the training and business are implemented and evaluated through our custom web-based therapeutic workplace application program that computerizes most aspects of both programs.
The National Institute on Drug Abuse (NIDA) has funded most of the research that has been conducted at CLH. Several randomized controlled clinical trials have shown that the techniques used in the therapeutic workplace can be effective in increasing abstinence from cocaine, heroin and alcohol in chronically unemployed and treatment-resistant individuals. Ongoing research is investigating whether employment-based reinforcement can be used to promote the use of oral and depot naltrexone in opiate-dependent individuals.
A number of faculty members collaborate on CLH research protocols, including faculty within the department (George E. Bigelow, Ph.D., Maxine L. Stitzer, Ph.D.,Annie Umbricht, M.D., Eric C. Strain, M.D., and Karin Neufeld, M.D.) and in the Department of Medicine (Michael Fingerhood, M.D.). CLH maintains close collaborations with the Behavioral Pharmacology Research Unit (BPRU) and provides training and research opportunities to post-doctoral fellows in BPRU’s T32 post-doctoral training program funded by the National Institute on Drug Abuse (NIDA).
For more information, call Dr. Silverman at 410-550-2694.
