Research on Employment and Substance Abuse Treatment

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Research on Employment and

Substance Abuse Treatment

Timothy P. Janikowski, Ph.D., C.R.C

Timothy P. Janikowski, Ph.D., C.R.C

Associate Professor

Associate Professor

University at Buffalo

University at Buffalo--SUNYSUNY

Email: tjanikow@buffalo.edu

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Major Limitation of the Body of

Research on Employment and

Treatment

n

n Almost all research in the area uses Almost all research in the area uses

employment or vocational status as a

employment or vocational status as a

dependent (or outcome) variable

dependent (or outcome) variable

n

n Very few studies examine vocational Very few studies examine vocational

services as an independent (or treatment)

services as an independent (or treatment)

variable

(3)

Other Limitations

n

n Typically descriptive, nonTypically descriptive, non--experimental designsexperimental designs

u

u Restricted to using correlation or regression analyses to Restricted to using correlation or regression analyses to examine relationships

examine relationships u

u NonNon--random assignment or samples of conveniencerandom assignment or samples of convenience u

u Poorly defined client groups (i.e., heterogeneous Poorly defined client groups (i.e., heterogeneous samples)

samples) u

u Few studies use control or comparison groups of people Few studies use control or comparison groups of people not in treatment

not in treatment

n

n Systematic bias or threats to validity are often not Systematic bias or threats to validity are often not

addressed (e.g., self

addressed (e.g., self--selection, response rates, response selection, response rates, response bias, inadequate measures, labor market factors, etc.) bias, inadequate measures, labor market factors, etc.)

(4)

Limitations (continued)

n

n Employment criteria are loosely defined and Employment criteria are loosely defined and

often watered down (e.g., $1000 in earnings

often watered down (e.g., $1000 in earnings

= employment)

= employment)

n

n Few longitudinal studiesFew longitudinal studies

n

n Most studies have small n Most studies have small n –– larger studies larger studies

are archival

are archival

n

(5)

Employment As An Outcome

Measure

n

n What is the impact of substance abuse on What is the impact of substance abuse on

employability?

(6)

People With Alcohol and Drug

Problems Are Employable

n

n 70% of illicit drug users are employed (NIDA, 70% of illicit drug users are employed (NIDA, 1990)

1990)

n

n 10% of employed males and 2% of employed 10% of employed males and 2% of employed females are heavy drinkers

females are heavy drinkers

n

n 8% of employed males and 6% of employed 8% of employed males and 6% of employed

females used illicit drugs within the last 30 days

females used illicit drugs within the last 30 days

(Normand et al., 1994)

(Normand et al., 1994)

n

n Substance abusing population have about 15Substance abusing population have about 15--30% 30% employment rate (compared to 71

employment rate (compared to 71--76% for non76% for non- -abusers; TIP, 2000)

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Most People in Treatment Are

Not Employed (Platt & Metzger,

1987)

n

n Less than 33% are employed while in Less than 33% are employed while in

treatment

treatment

n

n 74% of those in methadone treatment are 74% of those in methadone treatment are

inconsistently employed, typically

inconsistently employed, typically

unemployed, or constantly unemployed

unemployed, or constantly unemployed

n

n Less than 50% of people in methadone Less than 50% of people in methadone

treatment consider themselves to be “job

treatment consider themselves to be “job

ready” (NIDA, 1996)

(8)

Identified Barriers to

Employment (Jason et al., 2001)

n

n Low motivation and learned helplessnessLow motivation and learned helplessness

n

n High risk environmentsHigh risk environments

n

n Poor social supportsPoor social supports

n

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The likelihood of obtaining employment

is negatively correlated with commonly

found conditions (Platt, 1995):

n

n Cultural minority status;Cultural minority status;

n

n Physical disability;Physical disability;

n

n Criminal record;Criminal record;

n

n Mental instability;Mental instability;

n

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Research on Employment as

Treatment Outcome

n

n Predicting Employment Outcome (Wickizer et al., Predicting Employment Outcome (Wickizer et al., 1997)

1997)

u

u 1212--18% of outcome accounted for by treatment 18% of outcome accounted for by treatment

factors (e.g., duration of treatment)

factors (e.g., duration of treatment)

u

u 33% of outcome accounted for by client 33% of outcome accounted for by client

characteristics (e.g., gender, age)

characteristics (e.g., gender, age)

n

n Pretreatment employment is the best predictor of Pretreatment employment is the best predictor of posttreatment employment (Gill, 1994)

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Employment Outcome Research

(continued)

n

n Receiving treatment increased the Receiving treatment increased the

probability of obtaining employment and

probability of obtaining employment and

increased earnings (Wickizer et al 2000)

increased earnings (Wickizer et al 2000)

n

n Obtaining and holding posttreatment Obtaining and holding posttreatment

employment is the best predictor of long

employment is the best predictor of long-

-term successful treatment outcome in

term successful treatment outcome in

women (Gregoire & Snively, 2001)

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Some Gender-based findings (Suffet,

2001)

n

n Men are more likely than women to be employed both Men are more likely than women to be employed both

before and after treatment before and after treatment

n

n Employment was positively related to education and stable Employment was positively related to education and stable

housing in both sexes housing in both sexes

n

n Employment was negatively related to the number of work Employment was negatively related to the number of work

barriers in both sexes barriers in both sexes

u

u Women had more barriers to employment than menWomen had more barriers to employment than men

n

n Employment was negatively correlated with mobility and Employment was negatively correlated with mobility and

sensory impairment in men sensory impairment in men

n

n Employment was negatively correlated with the number of Employment was negatively correlated with the number of

children and being pregnant children and being pregnant

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Vocational Services as a

Component of Treatment

n

n Employment may provide a continuum of Employment may provide a continuum of

benefits to client which support treatment

benefits to client which support treatment

goals.

goals. Objective

Objective SubjectiveSubjective

Wages

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Substance Abuse Clients Want

Vocational Services That Result

in Meaningful Help

n

n 88% want vocational services if services 88% want vocational services if services

resulted in full

resulted in full--time employment paying $8time employment paying $8- -10 per hour (French et al. 1992).

(15)

The Availability of Vocational

Services Declined Relative to

Demand (Etheridge et al., 1995)

n

n proportion of clients entering treatment with proportion of clients entering treatment with

vocational and financial service needs grew

vocational and financial service needs grew

from 1981 to 1993

from 1981 to 1993

n

n proportion of clients whose employment proportion of clients whose employment

and financial needs went unmet grew from

and financial needs went unmet grew from

1981 to 1993

(16)

Barriers to Integrating Vocational

Services (Brewington et al.,

1987)

u

u Conflicts with medial treatment model or Conflicts with medial treatment model or

psychotherapeutic philosophy

psychotherapeutic philosophy

u

u Financial and programmatic disincentives Financial and programmatic disincentives

to programs (too costly and time

to programs (too costly and time

consuming)

consuming)

u

u Inadequate preparation of staff and Inadequate preparation of staff and

supervisors

supervisors

u

(17)

Employment Services in

Treatment (Drake et al., 1994)

n

n Types of ServicesTypes of Services

u

u Vocational Screening, PreVocational Screening, Pre--vocational services vocational services

(Work adjustment), Job Readiness (Job Seeking

(Work adjustment), Job Readiness (Job Seeking

Skills Instruction), Job placement, Job Club,

Skills Instruction), Job placement, Job Club,

Follow up

Follow up

n

n In a comparative study, In a comparative study,

u

u All clients experienced a 15% improvement in All clients experienced a 15% improvement in

competitive employment outcome

competitive employment outcome

u

u Clients who used vocational services regularly Clients who used vocational services regularly

had a 22% improvement in competitive

had a 22% improvement in competitive

employment outcome

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Research is Needed to Examine

the Impact of Vocational

Services on Treatment Outcome

n

n Findings from such research should then Findings from such research should then

u

u Shape programs structures and staffing Shape programs structures and staffing

patterns

patterns

u

u Determine preDetermine pre--service education and service education and

determine in

determine in--service trainingservice training

u

u Result in systematic theory building and Result in systematic theory building and

more research

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References

Drake, R. E., Becker, D. R., Biesanz, J. C., Torrey, W. C., McHugo, G. J., & Wyzik, P. F. (1994). Rehabilitative day treatment vs. supported employment: I. Vocational outcomes. Community Mental Health Journal, 30, 519-532

Etheridge. R., Craddock, S., Dunteman, G., & Hubbard, G. (1995). Treatment services in two national studies of community based drug abuse treatment programs. Journal of Substance Abuse. 7. 9-26.

French, M., Dennis, M., McDougal, G., Karuntzos, G., & Hubbard, R. (1992). Training and employment programs in methadone treatment: Client needs and desires. Journal of Substance abuse Treatment. 9, 293-303.

Gill, J. (1994). Alcohol problems in employment: Epidemiology and responses. Alcohol & Alcoholism. 29, 233-248.

Gregoire, T. & Snively, C. (2001). The relationship of social support and economic self-sufficiency to substance abuse outcomes in a long-term recovery program for women. Journal of Drug Education. 31(3), 221-237.

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References (cont.)

n

n Jason, L., Davis, M., Ferrari, J., & Bishop, P. (2001). Oxford HJason, L., Davis, M., Ferrari, J., & Bishop, P. (2001). Oxford House: a review of research and ouse: a review of research and implications for substance abuse recovery and community research

implications for substance abuse recovery and community research. . Journal of Drug Education. Journal of Drug Education.

31(1), 1

31(1), 1--27.27.

Platt, J., & Metzger, D. (1985). The role of employment in the r

Platt, J., & Metzger, D. (1985). The role of employment in the rehabilitation of heroin ehabilitation of heroin addicts. In R. S.

addicts. In R. S.AsheryAshery(Ed.), (Ed.), Progress in the development of cost effective treatment for drugProgress in the development of cost effective treatment for drug abusers

abusers(pp.111(pp.111--121). Rockville, MD: National121). Rockville, MD: NationalInstitiuteInstitiuteon Drug Abuse.on Drug Abuse.

Suffet

Suffet, F. (2001). Some sex, F. (2001). Some sex--neutral and sexneutral and sex--specific factors related to employment among specific factors related to employment among substance abuse clients.

substance abuse clients. American Journal of Drug Abuse.American Journal of Drug Abuse.25(3), 51725(3), 517--527.527. Swan, N. (1996). Vocational screener helps methadone patients ov

Swan, N. (1996). Vocational screener helps methadone patients overcome job barriers. ercome job barriers. NIDANIDA Notes

Notes. 11(3).. 11(3).

Wickizer

Wickizer, T., Campbell, K.,, T., Campbell, K.,KrupskiKrupski, A., & Stark, K. (2000). Employment outcomes among , A., & Stark, K. (2000). Employment outcomes among AFDC recipients treated for substance abuse in Washington State.

AFDC recipients treated for substance abuse in Washington State.The Milbank QuarterlyThe Milbank Quarterly. 78(4), . 78(4), 585

585--608.608.

Wickizer

Wickizer, T.,, T.,JoeschJoesch, J.,, J.,LonghiLonghi, D.,, D.,KrupskiKrupski, A., & Stark, K. (1997). , A., & Stark, K. (1997). Employment outcomes Employment outcomes of

ofindigent clients receiving alcohol and drug treatment in Washington stateindigent clients receiving alcohol and drug treatment in Washington state. Rockville, MD.: . Rockville, MD.: Substance Abuse and Mental Health Services Administration, Offic

Substance Abuse and Mental Health Services Administration, Office of Applied Studies. e of Applied Studies.

Young, N. (2000). Integrating substance abuse treatment and voca

Young, N. (2000). Integrating substance abuse treatment and vocational services. U. S. tional services. U. S. Department of Health and Human Services. Rockville, MD.

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