Academic journal article The Journal of Rehabilitation

Consumers of Vocational Rehabilitation Services Diagnosed with Psychiatric and Substance Use Disorders

Academic journal article The Journal of Rehabilitation

Consumers of Vocational Rehabilitation Services Diagnosed with Psychiatric and Substance Use Disorders

Article excerpt

"Substance abuse is the most common and clinically significant co-morbid disorder among adults with severe mental illness" (Drake, Becker & Bond, 2003). Serious or severe mental illness (SMI) is terminology typically utilized to identify individuals with a psychiatric diagnosis, as defined in the Diagnostic and Statistical Manual Version IV Text Revision (DSM-IV TR; American Psychiatric Association, 2000), which is persistent in duration, and also which may cause behavioral functioning which interferes substantially with the primary activities of daily living (Bond & Campbell, 2008). In 2003, there were an estimated 19.6 million adults aged 18 or older with serious mental illness (SMI), representing 9.2 percent of all adults (Substance Abuse and Mental Health Services Administration; SAMHSA, 2004). The 2003 SAMHSA National Survey on Drug Use and Health also indicated a high correlation between SMI and substance dependence or abuse. According to this report, among adults with SMI in 2003, 21.3 percent (4.2 million) were dependent on or abused alcohol or illicit drugs. The prevalence of persons with co-occurring disorders is apparent.

Individuals with a psychiatric disorder appear to be at an increased risk for having a co-morbid substance use disorder. Previous studies indicate that at minimum, at least 20% of all persons with mental disorders have met the criteria for a substance use disorder at some time in their past and that experiencing a mental disorder increased the odds of having a substance use disorder by 2.7 times (Evans & Sullivan, 2001; Hollar, 2008; Robinson, 2005). Individuals abusing or dependent on drugs or alcohol can develop symptoms similar to those seen in many psychiatric disorders, including psychotic symptoms, depression, anxiety, mood swings, isolation and withdrawal (Evans & Sullivan; Twamley, Jeste, & Lehman, 2003). Therefore, engaging persons with dual diagnoses in treatment and counseling can be especially difficult. In addition, many dually diagnosed persons have enhanced challenges with efforts to comply with treatment or to benefit from standard interventions because of the complications of both illnesses.

Employment and the nature of work are important, if not essential, to the lives of most people. Beyond the economic compensation associated with employment, a sense of productivity, contribution and worth tend to be associated with work. Employment also appears to be an effective intervention to facilitate positive recovery outcomes. A NIDA funded research project (DA11240-01, P.I. Alexandre Laudet, Ph.D.) found that medical treatment and symptom control are key factors to recovery for persons who are dually-diagnosed, but long-term rehabilitation must also include vocational services (Laudet, Magura, Vogel & Knight, 2000). This study also indicated employment as a key area of importance to participants and an important goal. Moreover, in a study examining psychosocial approaches to people with dual diagnoses, Drake & Mueser (2000) identified employment as a key support in the movement toward recovery.

Over a decade ago, the National Alliance for the Mentally Ill (NAMI; Noble, Honberg, Hall & Flynn, 1997) reported on the relative dearth of employment success for the population of persons with SMI within the vocational rehabilitation system. This research confirmed the reality of low employment rates and provides evidence that persons with severe mental illness experience less success at becoming vocationally rehabilitated than most other persons with disabilities (Rogers, Anthony, Toole, & Brown, 1991). NAMI (2004) contended that the state-federal public rehabilitation program has failed through their service delivery program to increase the employment rates of persons with severe mental illness. More recently, an Institute on Rehabilitation Issues (Dew & Alan, 2005) report on vocational rehabilitation for persons with psychiatric disabilities stated, "this serious public health challenge is under-recognized as a public health burden" (p. …

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