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 work outcomes after completing vocational programs compared to those receiving either substance use treatment or vocational counseling interventions alone [4,20].

A central theme across four types of intervention programs described in this review is consumer-centered recovery planning. Many consumers are unable to capitalize on employment opportunities and secure jobs after completing substance use treatment [4]. Researchers [20] 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 research literature, vocational counseling and substance use treatment are conceptualized and tested separately. The current study builds on previous literature [11,12] indicating that these services should be inseparable. Similarly, employment rates have improved among those completing both programs successfully [11,40]. This study 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 [37,38,40]. 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 (e.g., 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 [33] found significant decreases in employment, drug, and family issue levels according to the ASI-5 in manual-based interventions. Two manual-based studies found that 55% and 70% of participants who completed the program were employed in competitive jobs, respectively [34,36].

This review 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 [42]. The studies in this review provide 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 [42,43]. 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 [44]. However, contrary to our buoyant hopes, recent research 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 [25,45].

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 [46]. Adamson and Sellman [47] suggested that because unemployment is predictive of a poor treatment outcome for SUDs, treatment may be improved by directly addressing unemployment. Based on a systematic review of the literature, the authors identified employment, as an indicator of social functioning, to be among the most consistent univariate predictors of treatment outcome. Furthermore, Melvin and colleagues [48] 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 studies have investigated vocational counseling services for populations with SUDs or psychiatric disorders [49]. 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 [50], and consumers’ post-treatment employment status has been disregarded or minimized as a treatment outcome measure [51].