Employment as a Predictor of Substance Abuse Treatment
Melvin, Ann M., Davis, Sharon, Koch, D. Shane, The Journal of Rehabilitation
Predictors of substance abuse treatment completion have the potential to help professionals conduct comprehensive assessments and develop effective treatment plans. According to the Treatment Improvement Protocol (TIP) 38, developed by the Center for Substance Abuse Treatment (CSAT) a part of the Mental Health Services Administration (SAMHSA), research has shown that predictors of substance abuse treatment completion include successful employment, family support, and lack of coexisting mental illness (CSAT, 2000). Specifically, Magura, Staines, Blankertz, and Madison (2004) found clients who were employed or became employed during treatment, completed treatment more often than those who were not employed. However, Sinclair and Olmstead (2004), as cited in West (2008), found only 31% of the substance abuse treatment facilities in the U.S. prioritize employment by offering a vocational counseling component. Coviello, Zanis, Wesnowski, and Domis (2009) added additional support for the importance of incorporating a vocational counseling component in substance abuse treatment. Coviello et al. reported that employment not only attributed to a reduction in drug use but also reduction in crime rates and risky behaviors.
According to the National Institute on Drug Abuse (NIDA), the 12-step addiction treatment model is the most widely used form of treatment within substance abuse programs. The 12-step addiction treatment model is largely based on the Minnesota Model which states the "primary goal of treatment is lifetime abstinence from alcohol and other mood-altering chemicals" whereas personality change is an "ultimate goal." Vocational services are not mentioned in the 12 -step addiction treatment model or the Minnesota Model. Leukefeld, McDonald, Staton, and Mateyoke-Scrivner (2004) discussed the importance of vocational rehabilitation and the trend of these services being secondary among substance abuse treatment programs. Their research indicates clients are more successful in treatment and have longer abstinent rates when they are employed. West (2008) purported that despite the evidence that vocational counseling is a predictor of substance abuse treatment completion, many treatment programs still lack a vocational component. Important to note is that employment has been shown as a predictor of successful treatment completion but this does not indicate a causative relationship.
The Vocational Rehabilitation Act Amendments of 1965 expanded vocational services to include people with substance abuse issues (Maki & Riggar, 1997). Even with the passage of this legislation, vocational counseling and substance abuse counseling remain separated. There is contrast within the separated professions, substance abuse professionals view sobriety as the primary goal that will improve a person's life (Hester & Miller, 2003) whereas vocational rehabilitation professionals view employment as the way to improve quality of life (Wright 1980). Magura and Blankertz (2004) purported there is no clear evidence that vocational counseling is effective when implemented within substance abuse treatment because there is not a standard or clear definition of what vocational counseling means for professionals providing substance abuse treatment. Elliot and Leung (2004) provided one definition, "Vocational rehabilitation (VR) traditionally refers to the provision of some type of service to enhance the employability of an individual who has been limited by a disabling physical condition" (p. 320).
Significance of the Problem
According to the Substance Abuse and Mental Health Services Administration (SAMHSA), 22.3 million people met criteria by the Diagnostic and Statistical Manual (DSM IV-TR) for substance abuse or dependence in 2007 (Walls, Batiste, Moore, & Loy, 2009). Moreover, according to the SAMSHA Treatment Episodes Data Set (TEDS), unemployment rates for those admitted to a substance abuse treatment agency were 33. …