This article describes four alternative models for the role of client work in substance dependency treatment. The most common model is Work as a Positive Outcome, which conceptualizes work (employment) as a desirable outcome of treatment. The Work Infusion Model conceptualizes work as a therapeutic factor in treatment. The Contingent Sanctions Model requires clients to work to avoid undesirable consequences, such as losing treatment. The Work as Reinforcement Model offers paid work as a reward for treatment adherence. This article discusses whether either standard substance dependency treatment or vocational services within treatment programs increase client employment, whether clients want to work, and whether sufficient services are available. The empirical support for each model of client work is summarized. Critical issues that must be addressed in this area are outlined.

The Role of Work in Substance Dependency Treatment: A Preliminary Overview

According to 2007 statistics reported by the Substance Abuse and Mental Health Services Administration (SAMHSA, 2008), there were an estimated 22.3 million individuals in the U.S. aged 12 or older (9% of the population) who met the DSM-IV diagnostic criteria for either substance abuse or dependence. Of those 22.3 million, 15.5 million were classified with alcohol abuse or dependence, 3.7 million were classified with drug abuse or dependence, and approximately 3.2 million had abuse or dependence on both alcohol and drugs. The present study examines employment outcomes and workplace accommodation issues for individuals with substance abuse disorders. Rehabilitation Services Administration (RSA) client service records show the types of employment successfully rehabilitated individuals have attained. Workplace accommodation information, however, is not included in the RSA case-closure record (RSA-911 form). Given the importance of workplace accommodations, data from the Job Accommodation Network (JAN) have been incorporated to provide a more complete picture of the services needed for individuals with substance abuse disorders to retain employment. Thus, the focus of the current article is on approaches to serving individuals with substance abuse disorders, drawn from two databases. Analyses are conducted to examine the rates of successful employment outcomes (case closures) of clients with either alcoholism or drug addictions who were served by the State/Federal Vocational Rehabilitation System across three years (1996, 2000, 2004). A primary reason for selecting 1996 as the first year for the RSA data was that the available JAN database spanned 1996 to 2005. Counselors in the Rehabilitation Services Administration (RSA) provide counseling and employment-related services to individuals with disabilities to obtain employment and live more independently (Rehabilitation Services Administration, 2006). Analyses are conducted to examine the prevalence of accommodation inquiries made to the Job Accommodation Network (JAN) for clients with substance abuse (alcoholism or drug addiction). JAN is a free resource for information regarding job accommodations and Title I of the ADA. The service is available free of charge to anyone, but the majority of inquiries (68%) are from employers and individuals with disabilities. JAN averages about 32,000 telephone inquiries (cases) per year and provides one-on-one consultation (and follow-up materials and communications, as necessary) to each person about all aspects of job accommodation, including the accommodation process, effective accommodation options, funding sources for accommodations, product information, disability awareness, and legal rights and responsibilities under the employment provisions of the ADA. The following research questions are investigated: 1. What are the demographic characteristics for individuals with substance abuse disorders (Alcoholism vs Drug Addiction) who received Vocational Rehabilitation services? 2. Are there differences between clients (consumers) with Alcoholism vs Drug Addiction, in terms of Vocational Rehabilitation services received and outcome (rehabilitated vs not rehabilitated)? 3. What occupations were involved for those Vocational Rehabilitation consumers whose outcomes were successful (rehabilitated)? 4. In the JAN case data for substance abuse calls from 1996 to 2005, what are the relative proportions of (a) Causative Factor, (b) Caller Industry, (c) Job Function, and (d) Issue Discussed? 5. What commonalities link the findings from the RSA cases to the findings from the JAN cases on substance abuse disorders? In the workplace, individuals with substance abuse disorders often exhibit difficulties with attendance, concentration, staying organized, meeting deadlines, handling stress, and maintaining stamina during the workday (Batiste, 2005a; 2005b). The obligation to provide accommodations for people with substance abuse under the ADA can be confusing to employers because the obligation differs somewhat from the obligation to accommodate employees with other types of disabilities. …

Vocational Rehabilitation and Job Accommodations for Individuals with Substance Abuse Disorders

Current and future changes in American society and the field of rehabilitation are highlighted in a demonstrated need for rehabilitation education to develop a more responsive, proactive, futuristic approach to the professional preparation and development of rehabilitation professionals. A proposed futuristic model of rehabilitation education, withfoci on identified learning modules and educational approaches, is offered in a learning continuum from bachelors degree level through continuing education.

A Futuristic Model of Rehabilitation Education

Numerous studies have focused on the predictors of successful closure of state-federal vocational rehabilitation (VR) applicants. However, there appears to be only one study focused solely on the predictors of employment with persons who were deemed eligible for services based on their alcohol or drug abuse diagnosis. This retrospective study examined the predictors of employment among this population. A sample of 940 persons with a primary or secondary diagnosis of alcohol or drug abuse and a closure status of 26 or 28 was randomly selected from the 2005 Rehabilitation Service Administration (RSA) 911 data. A combination of consumer characteristics, VR service variables, and work disincentives predicted employment. Knowledge of these predictors suggests ways for counselors to better serve consumers via accurate assessment, appropriate planning, and efficient case coordination.

Predictors of Successful Closure in the State-Federal Vocational Rehabilitation System: Findings from a Sample of Persons with Disability and Substance Use Disorders

The purpose of this qualitative, phenomenological study was to examine the subjective experiences of six recovering addicts as they reflected on how their interactions with others facilitated or impeded their healing from addiction. The study involved in-depth interviews with six participants who had recovered from their extensive substance abuse histories. Seven themes common to all participants included losses/gains, support/discouragement, understanding/misunderstanding, belonging/not belonging, meaning/ meaninglessness, hope/hopelessness, and negative/positive perceptions of self and others. Implications for counselling addicts during the recovery process are discussed based on these findings.

https://cjc-rcc.ucalgary.ca/article/download/58821/44298

The Perceived Role of Others in Facilitating or Impeding Healing from Substance Abuse

This research was initiated to determine if differences exist in the attitudes of vocational rehabilitation counselors toward substance abusing clients. Using the Substance Abuse Attitude Survey (SMS), ninety-one vocational rehabilitation counselors were surveyed regarding their beliefs and attitudes toward substance abuse and substance abusers. Results comparing those counselors with and without training in substance abuse issues found those with trainning reported significantly more positive attitudes than their non-trained counterparts in only two areas. However, the attitudes of all counselors were found to be somewhat negative.

James H. Miller

Papers

Comparisons of Vocational Rehabilitation Counselors' Attitudes Toward Substance Abusers

Traditional versus Experiential Model for Counselor Education