Vocational Counseling for Adults with Substance Use Disorders

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This entry is adapted from the peer-reviewed paper 10.3390/ijerph19084674

Vocational counseling is useful in developing substance use disorder (SUD) recovery plans. The process of vocational counseling begins with job preparation and placement based on the assessment of job interest. Additionally, continuous training and assessment are required to improve employability and a transition from job preparation to entering the workforce.

substance use disorders effectiveness of vocational counseling interventions

1. Introduction

The National Survey on Drug Use and Health ^[1] indicated that 19.7 million Americans aged 12 or older had substance use disorder (SUD) in 2017. Researchers indicated that 40% to 50% or more of those with SUDs have co-occurring psychiatric disorders, which cause more complex challenges among those with the disorder and for society ^[2]^[3]. People who overused alcohol and used illicit drugs showed common issues (for example, hospitalization, unemployment, and mental health problems) and a failure to fulfill major role obligations at work, school, or home.

Hogue and colleagues ^[4] indicated that one major burden for people with SUDs is unemployment or underemployment, which is critically related to economic independence and stable community lives. Sigurdsson and colleagues reported that the employment rate of those with SUDs is 40%, while the U.S. employment rate is about 90% ^[5]. Moreover, those with co-occurring psychiatric disorders have even lower employment rates at 25%. According to an analysis of treatment admissions data from 1993 to 2006, people with SUDs have one of the lowest employment rates among those with different types of disabilities in the U.S. ^[6]. Regardless of the characteristics of those with SUDs (for example, age, education level, gender, and economic status), this issue has required specialized support for over two centuries ^[7]. The economic cost of substance use issues was estimated at $193 billion in 2014 ^[8] and $500 billion in 2020 ^[9] and includes lost productivity, criminal justice costs, and healthcare costs. These costs continue to increase due to service complexity, including family, vocational, medical, and social issues ^[10].

In order to reduce the severity of these issues, researchers have developed and evaluated multidisciplinary recovery processes ^[11]^[12]. As members of multidisciplinary teams, for example, vocational rehabilitation counselors who provide substance abuse/addiction and vocational counseling services help to reduce substance use behaviors and improve employability ^[13]. With the aid of vocational rehabilitation counselors, those with SUDs can face their issues directly, develop skills, and build support systems for prolonged success and recovery. However, vocational counseling services have not traditionally been focused on in the substance use field, and researchers have placed emphasis on substance use treatments to reduce consumers’ substance use symptoms and behaviors without considering employment ^[14]. It evaluates and synthesizes the evidence for vocational counseling interventions’ impact on SUD services and co-occurring disorders.

2. The Effect of Vocational Counseling Interventions for Adults with Substance Use Disorders

The goal of vocational counseling interventions for consumers with SUDs and co-occurring psychiatric disorders is to help them have physically and mentally healthier independent lives. In order to achieve this goal, vocational rehabilitation counselors provide interventions focusing on vocational exploration, plan development, vocational assessment, and job placement. These interventions involve examining a variety of potential occupational goals and providing employment choices for consumers. As explored previously, the intervention should lead to changes in physical and psychological symptom severity, vocational skills, and employment outcomes. The evidence from 11 studies indicates that vocational counseling interventions are a likely fit for substance use treatment. Specifically, consumers who attend coordinated interventions do, overall, show fewer physical and psychological symptoms and more positive outcomes after completing vocational programs compared to those receiving either substance use treatment or vocational counseling interventions alone ^[4]^[15].

A central theme across four types of intervention programs described is consumer-centered recovery planning. Many consumers are unable to capitalize on employment opportunities and secure jobs after completing substance use treatment ^[4]. It ^[15] was emphasized that being vocationally underprepared is the primary reason that consumers have fewer employment opportunities. Although they completed substance use treatment successfully, they showed serious underemployment and unemployment rates. Insufficient job readiness and lack of vocational skills are critical barriers, while their SUDs are significantly decreased.

Moreover, according to the current one, vocational counseling and substance use treatment are conceptualized and tested separately. The current one builds on previous ^[11]^[12] indicating that these services should be inseparable. Similarly, employment rates have improved among those completing both programs successfully ^[11]^[16]. It was found increasing evidence that the results of two combined models (supported employment plus skills training and incorporated substance abuse treatment) show better employment outcomes than the other two models, which focused on only one intervention as a vocational service ^[16]^[17]^[18]. From this result, it can be reasoned that when receiving incorporated interventions, consumers might have higher self-efficacy expectations for possible treatment outcomes, such as reduced substance use symptoms and high employability, allowing them to maintain healthier and independent lifestyles. Because many consumers have histories of failure in the management of alcohol/drug use issues and their jobs, SUDs and vocational counseling interventions not only are effective in promoting alcohol/drug abstinence but also promote employability and job maintenance.

In addition, the evidence indicates that manual-based programs (for example, Helping Offenders Work, Work-it-out, and the Job Club Counselor’s Manual) show better employment outcomes than other vocational counseling programs. In the collected data, the efficacy of non-manual programs is mixed, while manual-based programs show clear results in post-treatment and follow-ups. Butler and colleagues ^[19] found significant decreases in employment, drug, and family issue levels according to the ASI-5 in manual-based interventions. Two manual-based one found that 55% and 70% of participants who completed the program were employed in competitive jobs, respectively ^[20]^[21].

It was found evidence for the effectiveness of vocational counseling and the necessity of incorporating interventions in SUDs and co-occurring fields. People who provide vocational counseling services have been educated and trained to provide recovery services to consumers ^[13]. These professionals are knowledgeable in the medical and psychosocial aspects of SUDs and life care management. These knowledge areas lead to holistic recovery planning for consumers to return to home, school, work, and their communities. Specifically, vocational rehabilitation counselors are well-suited and well-trained to improve consumers’ motivation and interest in employment ^[22]. It was provided a direct path to expand the roles of vocational rehabilitation counselors and the usability of incorporated interventions in SUDs and co-occurring fields.

Although researchers’ suggestions on the usefulness of vocational counseling and integrative interventions in the field of SUD and co-occurrence continue to emerge, current services still focus on reducing alcohol and/or drug use or abstinence from alcohol ^[22]^[23]. One hopeful sign is that public awareness of drug addiction has increased, and the government has begun to take an interest in the recovery of drug addicts and their social participation and employment. Due to these social changes, cursory attention has been placed on multidimensional treatment approaches for SUDs, such as vocational counseling services to address employment-related concerns ^[24]. However, contrary to the buoyant hopes, recently it focused on integrative interventions with vocational counseling is still limited. Many researchers believe that for recovery from SUD to be sustainable, treatment options must shift to incorporate services beyond those solely for alcohol and/or drug use reduction or abstinence. For example, the application of vocational counseling as an ancillary treatment intervention after completing SUD treatment is supported by the significant role of employment in the disability and recovery process ^[25]^[26].

Incidences of SUDs are associated with employment. A greater percentage of unemployed adults 18 or older are classified with SUDs, even though the average educational level of individuals with SUDs is comparable to that of the general population ^[27]. Adamson and Sellman ^[28] suggested that because unemployment is predictive of a poor treatment outcome for SUDs, treatment may be improved by directly addressing unemployment. It was identified employment, as an indicator of social functioning, to be among the most consistent univariate predictors of treatment outcome. Furthermore, Melvin and colleagues ^[29] cited evidence that gainful employment is one of the strongest and most consistent predictors of post-treatment success and sobriety maintenance, with employed individuals more likely to engage in treatment, complete treatment, and remain substance-free after treatment.

Despite the apparent benefits of employment to consumers with SUDs and psychiatric disorders, few strategies that incorporate vocational counseling services into standard treatment have been developed. Kim ^[11] indicated that because many substance abuse clinicians are unfamiliar with both the theory and practical benefits of vocational counseling, the addition of vocational content to treatment has not occurred. Although various vocational interventions have been attempted in clinical settings, few empirically driven longitudinal ones have investigated vocational counseling services for populations with SUDs or psychiatric disorders ^[30]. Due to the paucity of studies, the development and integration of vocational interventions into SUD treatment has been slow. Moreover, while researchers have focused their efforts on exploring how to maximize the effects of standard treatment to reduce SUD and psychiatric issues, alternative interventions such as vocational counseling services have been neglected ^[31], and consumers’ post-treatment employment status has been disregarded or minimized as a treatment outcome measure ^[32].

References

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1. Introduction

2. The Effect of Vocational Counseling Interventions for Adults with Substance Use Disorders

References