INCLUDING VOCATIONAL
REHABILITATION
IN
SUBSTANCE ABUSE TREATMENT
H. L. Brostrand, Ph.D., LPCC, CRC
Now: Mental Health Vocational Counselor II Contra Costa County, Behavioral Health Services
Next week: Associate Professor, CSUS
Graduate and Professional Studies in Education
August 13, 2014
A Love Affair: Unemployment & Relapse
• (1) Risky alcohol consumption is more prevalent amongthe unemployed. They are also more likely to be smokers… and to have SUD.
• (2) Problematic substance use increases the likelihood of unemploymentand decreases the chance of finding and holding down a job.
• (3) Unemploymentis a significant risk factor for substance use.
• (4) Unemployment increases the risk of relapseafter alcohol and drug addiction treatment.
Current Drug Abuse Reviews. 2011 Mar; 4(1):4-27. Unemployment and substance use: a review of the literature (1990-2010). Henkel D.
Employment statistics in the US (DOL)
• National Unemployment Rate: 6.5%• For those with a disability: 14.5%
• California unemployment rate: 8.0%
• With SUD or in recovery: ???
• http://store.samhsa.gov/product/Ready-Willing-and-Able-to- Work-Employment-for-People-In-Recovery/All-New-Products/SMA12-4676DVD
National Unemployment
0 5 10 15 20 25 Men Women White Black or African… Asian Hispanic or Latino…Less than a high… High school… Some college or… Bachelor's degree…
Persons with no disability
Persons with a disability
Where’s the voc rehab in SUD tx?!
• Title 22 Treatment Standards• Assessment of treatment needs in:
• Vocational counseling and training • Job referral and placement • Discharge Summary
• Vocational/educational achievements
• We surveyed substance treatment facilities in the United States in 2006
From a checklist of 17 vocational components:
• Sixty-two facilities (40%) provided no job related services whatsoever.
• Of the 60%, 82% refer clients to the state Department of Rehabilitation for vocational services.
Benefits of employment
• Provides structure • Self-esteem • Self-efficacy • Security • Sober relationships• Activities (on and off the job) • Develop job skills
• Develop social skills • Income!
Barriers to employment in recovery
• Continued use/later use• Personality/behavioral impairment • Poor work histories are common • Motivation to work may be low • Work ethics, work values • Family and social support • Conviction record
• Lack of job skills • Economic conditions • Discrimination
Barriers to job retention in recovery
• Low paying jobs with few/no fringe benefits• Jobs with little/no upward mobility
• Discrimination
• Lack of education
• Fear; Anger; Frustration
• Poor interpersonal/relationship skills
• Cognitive impairment
• Co-existing disabilities
• Continued use of AOD
• Return to substance abuse
• Return to crime
SUD is a disability
• The ADA defines “disability” as:• a physical or mental impairment that substantially limits one or more major life activities; or
• a record of a physical or mental impairment that substantially limited a major life activity; or
• when a covered entity takes an action prohibited by the ADA because of an actual or perceived impairment.
• "Disability" under Social Security is based on your inability to work. We consider you disabled if:
• You cannot do work that you did before;
• We decide that you cannot adjust to other work because of your medical condition(s); and
• Your disability has lasted or is expected to last for at least one year or to result in death.
DSM-IV Substance Dependency
Maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring in 12-month period:
• Tolerance
• Withdrawal
• Substance is often taken in larger amounts or over a longer period than intended.
• Persistent desire or unsuccessful efforts to cut down/control substance use.
• A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects.
• Important social, occupational, or recreational activities are given up or reduced because of substance use.
• The substance use is continued despite knowledge of having a persistent problem.
Does the ADA cover SUD?
•
The ADA may protect a “qualified” alcoholic
who can meet the definition of “disability.”
The ADA does not protect an individual who
currently engages in the illegal use of drugs,
but may protect a recovered drug addict who
is no longer engaging in the illegal use of
drugs, who can meet the other requirements
of the definition of “disability,” and who is
“qualified.”
PAW = disabling symptoms of SUD
• Symptoms of SUD have a
substantial impact on activities of daily living.
• PAW symptoms, which can last up to two years, usually result in significant impairment in activities of daily living.
• In addition, without continued treatment (relapse prevention) clients will most likely deteriorate in one or more important areas of life functioning.
Significantly limiting effects of PAW
Interpersonal/relationship skills
• isolation
• minimal or no social supports
• no community ties
• criminal record
• stigma
• emotional instability
• poor coping skills
• poor impulse control
• unassertiveness
• sexual dysfunction
• increased stress
• physical pain
• irritability
• shame and guilt
• low self-confidence
• childhood trauma
• side effects of medication
Self-care/personal upkeep • poor health • pessimistic outlook • hopelessness • isolation • listlessness • fatigue • sleep disorders • depressive symptoms • emotional overload • impaired judgment • immaturity • impulse control • cognitive limitations
• limited financial resources*
• never learned how
Work limiting symptoms of PAW
• physical limitations• decreased productivity
• lack of problem-solving skills
• anxiety
• impatience
• cognitive deficits
• poor memory
• decreased comprehension
• slower mental processing
• distorted perceptions
• diminished concentration
• can impact ability to learn and/or perform work functions, to plan, problem solve and/or organize work functions, as well as to meet the required level of functioning on the job.
Common co-existing disabilities
• As many as 6 in 10 substance abusers also have at least one other mental disorder. (NIDA)
• In the GP, 10% of individuals are alcoholics and 5% are addicted.
• PWD experience SUD at rates 2 to 4 times that of the GP.
• Abuse rates approach or exceed 50% for persons with traumatic brain injuries, spinal cord injuries, or mental illness.
• Individuals with deafness, arthritis, and multiple sclerosis, have substance abuse rates of at least double the GP.
• Approximately 40-50% of persons with spinal cord injuries, orthopedic disabilities, vision impairment, and amputations, can be classified as heavy drinkers.
http://www.hhs.gov/od/about/fact_sheets/substanceabusech26.html
Persons diagnosed with SUD are roughly twice as likely
to have mood and anxiety disorders.
Persons diagnosed with mood or anxiety disorders are
about twice as likely to have SUD. (NIDA)
Co-occurring disorders
• ADD/ADHD and LD• Children and adolescents with psychiatric conditions are at higher risk of abusing drugs than other youth.
• PTSD and depression
• Physically or emotionally traumatized people are at much higher risk of abusing licit, illicit, and prescription drugs.
• 1.5% of veterans had co-occurring serious psychological distress and substance use disorder
• Up to 80% of women seeking treatment for drug abuse report lifetime histories of sexual and/or physical assault.
• PTSD contributes to teen/young adult marijuana abuse/dependence
Disability commonly resulting from SUD
• PTSD • Liver • Heart • HIV • Hepatitis • Brain damage • Physical injury • Other? 20What is vocational rehabilitation?
• Vocational rehabilitation is a service that helpspeople with physical or mental disabilities find
employment and retain it. It usually is offered through state government agencies.
• Eligibility is based on a medically diagnosed disability.
• Voc rehab begins with C&G and VA. Vocational readiness services and training may be provided. Once a person is ready for employment, voc rehab assists with placement.
http://www.ehow.com/facts_5631200_definition-vocational-rehabilitation.html
Vocational components
• Job Seeking Skills• Interviewing
• Applications
• Resume preparation
• Job search techniques
• Job Maintenance
• Social and interpersonal skills
• Work skills
• Work tolerance
• Grooming, hygiene
…vocational components
continued• Job Placement • Current job leads
• Employer contacts
• Job search assistance
• Job coaching
• Resources
• Newspapers (LOL)
• Yellow pages
• Computer access
• Videos, reference books
• Referrals
The first and best referral…
One-Stop
• East Bay Works
• http://www.eastbayworks.org/default.asp • CalJobs
• www.CalJobs.ca.gov
• Job listings and on-site recruitment
• Access to computers, printers, faxes and phones • Free workshops (computer, resume, interview, etc.) • Career exploration
• Labor market information • Videos, books and tutorials • Training program information
• Richmond Works & Richmond Craft
Additional vocational resources
• 2-1-1 • https://www.crisis-center.org/documents/Resource%20Guides/ West%20County%20English.pdf • EDD • DOL ODEP• WID Disability 101 www.DB101.org
• Probation/parole
• County Employment & Human Services dept. • Community College
• Adult Schools
• WOTC http://www.edd.ca.gov/pdf_pub_ctr/de8722.pdf
Possible additional services…
• Insurance benefits (current or prior employment) • SDI • Union • Veteran • Senior or youth • Physical disability • Workers compensation • CalWorks• Ethnic/gender/SES specific resources • Other?
Voc rehab in your SUD program
• Computer access• Indeed http://www.indeed.com
• Opportunity Knocks http://www.opportunityknocks.org/
• Tutorials and related sites http://www.onetonline.org/
• Materials
• Free and low-cost curriculums
• Books/workbooks
• JIST http://jist.emcpublishingllc.com/page-jist/
• EdITS http://www.edits.net/
• Videos
• Computer-based (many free and on-line)
• Volunteer opportunities
• Any business/organization within walking distance
• Social service agencies
• Service and religious organizations
• Referrals
• CBOs, ILCs, recovery-based
How can we integrate?
• TALK ABOUT EMPLOYMENT
• Train existing staff
• ODEP, workshops, other??
• Dedicate physical space to vocational materials/resources • Dedicate programming time to employment activities
• Educational • Therapeutic • Relapse prevention • Accountability? • Treatment Plan • Post-treatment survey • Audience Suggestions 28
• DOR provides services and advocacy resulting in employment, independent living, and equality for individuals with disabilities.
• If you have a disability and you need vocational rehabilitation services, DOR may be able to help you find work and become independent. You and your counselor will develop your vocational rehabilitation program, which includes your employment goal and the services you will need to reach your goal.
http://www.rehab.cahwnet.gov
To be eligible for DOR services…
•have a physical or mental impairment thatsubstantially impedes his/her ability to secure employment
•vocational rehabilitation services are required to prepare for, secure, retain, or regain employment consistent with the applicant's unique strengths, resources, priorities, concerns, abilities,
capabilities, interests, and informed choice
•can benefit from the provision of services in terms of an employment outcome in an integrated setting
Severity of Disability (LSOD)
• Priority for Services - You and your counselor will: • review and discuss information obtained from you and other
sources about your disability,
• agree on how it limits you in six general areas of functioning, including: communication, mobility, interpersonal skills, self care, work tolerance and work skills, and based on this assessment,
• determine your disability priority score that represents the significance of your work-related limitations.
• "most significantly disabled" category served first. • "significantly disabled" category will be served next, • "disabled category" served last
• Waiting list established 1995
Anecdotal DOR information
If you are ready, willing, and able to work (with or without accommodation) • Orientation
• Forms
• What to bring and why
• Intake
• Role of the rehabilitation counselor
• Role of the client
• Informed consent and client choice
I refer, and referred to, frequently:
Substance Use Disorders and Vocational Rehabilitation: VR Counselor’s Desk Reference
• Rehabilitation Research and Training Center on Substance Abuse, Disability and Employment
• http://www.med.wright.edu/sites/default/files/citar/sardi/files/VR_Desk_ Reference.pdf
• TIP 38: Integrating Substance Abuse Treatment and Vocational Services
• SAMHSA, CSAT
• http://store.samhsa.gov/product/TIP-38-Integrating-Substance-Abuse-Treatment-and-Vocational-Services/SMA06-4216 • DOR Consumer Information Handbook
