Substance Abuse Treatment and Vocational Services

1
Substance Abuse Treatment and Vocational Services

• Anne M. Herron, Directo
• Division of State and Community Assistance
• Center for Substance Abuse Treatment
• Substance Abuse and Mental Health Services
  Administration
• U.S. Department of Health and Human Services

2
Current SituationNational Household Survey on
Drug Abuse, 2001

• Estimated 15.9 million Americans age 12 years and
  older are current drug users in 2001
• 10.8 of youths 12-17 were current users
• 18.8 of adults age 18-25 were current users

3
Current Situation cont.10th Special Report to
the US Congress on Alcohol and Health, June 2000

• 14 million Americans 7.4 of the population
  meet the diagnostic criteria for alcohol abuse or
  dependence.
• Over ½ of American adults have a close family
  member who has or has had alcoholism.
• Approximately 1 in 4 children under 18yrs is
  exposed to alcohol abuse or dependence in the
  family.

4
Current Situation cont.

• In 2001, over 1.6 million people were served in
  the Addiction Treatment system in the U.S.
  (approx. 15,000 programs)
• Achieving recovery and becoming self supporting
  are critical to maintaining recovery.

5
Does Employment Improve Treatment?

• Employment has been positively correlated with
  retention in treatment.
• Years of research show the best predictors of
  successful substance abuse treatment are
• Gainful employment
• Adequate family support
• Lack of coexisting mental illness

6
Does Treatment Improve Employment?

• In a study of California residents with SUDs,
  improvements in employment rates were as high as
  60 from admission to discharge.
• In a study in Missouri, employment rates improved
  by 136 from admission to discharge.
• In Ohio, there was a 60 decline in absenteeism
  among working clients in treatment.
• Pavetti et al., 1997 Young, 1994 Young and
  Gardner, 1997 Johnson et al., 1998

7
Does Treatment Improve Employment? (After
Treatment)

• 5,700 participants followed in the year after
  treatment, 18.7 increase in employment
• In Oregon, clients increased weekly earnings from
  154 to 278 in 3yrs after treatment.
• In Kansas, earnings were 33 times higher after
  completing treatment.
• NTIES- CSAT, 1997 Legal Action Center, 1997
  Young, 1996.

8
Not undereducated, underemployed

• The average educational level of individuals with
  substance use disorders is comparable to the
  general U.S. population.
• Individuals with substance use disorders are far
  more likely to be unemployed or underemployed.

9
SAMHSAs Vision and Mission

• A life in the community for everyone
• Building resilience and facilitating recovery

10
SAMHSA/CSAT Functions

• SAPT block grant is the cornerstone of states
  substance abuse programs
• Accounts for 51 of public funds expended for
  prevention and treatment
• Changing block grant into performance partnership
  to offer states greater flexibility to use
  federal funds and create accountability systems
  built on performance.
• One performance element proposed, is improved
  employment status.

11
Laws the Substance Abuse Counselor should be
familiar with

• Personal Responsibility and Work Opportunity
  Reconciliation Act of 1996
• Mandatory work requirements (w/i 2yrs)
• Time limits (max. 5 years)
• Drug testing (positive test sanction)
• Drug felony ban (states can opt out)
• Probation/parole violation ban

12
Laws the Substance Abuse Counselor should be
familiar with

• Contract with America Advancement Act (1996)
• Substance Use Disorders removed as qualifying
  disabling conditions
• Representative payee required (if individual is
  also addicted)
• Mandatory referral to treatment

13
Laws the Substance Abuse Counselor should be
familiar with

• Adoption and Safe Families Act of 1997
• Focus on permanency placement of children
• States must begin proceedings to terminate
  parental rights when children have been in foster
  care for 15 of most recent 22 months.

14
Laws the Substance Abuse Counselor should be
familiar with

• Workforce Investment Act of 1998
• one-stop and work first
• Assessment, information and job search help
  available to everyone
• Intensive services available
• Training services available if determined
  necessary

15
How vocational services are incorporated into
treatment

• Residential or high-structure programs
• Prevocational testing and work skills evaluations
• Work adjustment training
• Activities of daily living
• Formal vocational training/services
• Goal setting, plan development

16
How vocational services are incorporated into
treatment

• Outpatient or day treatment
• Vocational assessments
• Education about work and job seeking (job clubs)
• Incorporate vocational issues into treatment
  sessions (authority, anger management, chain of
  command, time management, etc)
• Post employment job retention strategies

17
What are the problems?

• Personal
• Addiction, physical and/or mental disabilities
• Unrealistic expectations/attitudes
• Work disincentives
• Health benefits, move from welfare-based income,
  loss of income, access to supportive services.

18
What are the problems?

• Interpersonal
• Competing family responsibilities
• Inadequate social supports
• Lack of positive modeling
• Staffing
• No Voc Services available (on site or referral)
• Inadequate funding (preparation or retention)
• Lack of commitment to Voc Services

19
What are the problems?

• Structural
• Stigma and bias
• Inadequate pay or benefits
• Limited options (criminal or other history)
• Incomplete preparation
• Few jobs available
• Limited (if any) transportation, child care,
  schools, housing

20
Recovery MonthNational Alcohol and Drug
Addiction Recovery Month

• Induce all levels of American society and the
  nations public and private sectors to work
  towards enhancing addiction treatment access,
  availability and quality
• Join the Voices for Recovery Celebrating Health
• www.recoverymonth.gov

21
SAMHSA/CSAT Information

• Treatment Improvement Protocol 38
• Integrating Substance Abuse Treatment and
  Vocational Services
• Quick Guide for Clinicians
• Quick Guide for Administrators
• KAP Keys for Clinicians

22
SAMHSA/CSAT Information

• www.samhsa.gov
• 800-729-6686 for publication ordering or
  information on funding opportunities
• 800-487-4889 TDD line
• 800-662-HELP SAMHSAs National Helpline