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Keane, Martin (2013) Vocational training, employment and addiction recovery. Drugnet Ireland , Issue 45, Spring 2013 , pp. 16-17.

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The Report of the working group on drugs rehabilitation1 recommends that measures to improve the employability of current, former and recovering drug users should form a key part of rehabilitation care plans, with the overall aim ‘to maximise the quality of life, re-engagement in independent living and employability of the recovering problem drug user, in line with their aspirations’ (p.21). Action 32 of the National Drugs Strategy2 calls for implementation of the working group’s recommendations. The current Programme for Government3 includes a commitment ‘to assist drug users in rehabilitation through participation in suitable local community employment schemes’ (p.50).  

However, the most up-to-date report on the employment status of people presenting for treatment for drug misuse shows a steady trend downwards.4 According to the authors, there was a ‘drop in the proportion of all cases in employment, from 22% in 2005 to 9% in 2010 (Table 1). This is most likely a reflection of the current economic climate, and highlights the continued importance of social and occupational reintegration interventions as part of the drug treatment process’ (p.2).
 
There was an even greater drop in the proportion of new cases (those presenting for treatment for the first time) who were in employment, from 29.7% in 2005 to 11.7% in 2010.

A comprehensive review of the literature on unemployment and substance use spanning the period 1990–20105 found that (i) problematic substance use increases the likelihood of unemployment and decreases the chances of finding and retaining a job, (ii) unemployment is a significant risk-factor for substance use and the subsequent development of substance use disorders, and (iii) unemployment increases the risk of relapse after treatment.  

The logic of this aspiration to improve employment prospects for individuals affected by the use of drugs is supported by research from the US,6 which found that clients in employment stayed in treatment longer and achieved better outcomes than their unemployed counterparts. There is no ‘gold standard’ in vocational interventions or programmes for any client population or treatment modality in the addiction field, although some initiatives, primarily in the US, have shown promise.
 
Measures taken to improve the employability of recovering drug users in Ireland through Special Community Employment schemes have been reviewed in recent years.7,8,9  All three reviews concluded that the scheme was less focused on improving employability and more inclined to operate in a crisis management mode by providing generic support to recovering drug users.
 
A 2012 review of the literature on vocational training for drug users in treatment10 refers to a 2004 review and synthesis of three decades of research in this area11 and concludes that: ‘Most interventions reviewed were shown to have no significant effects, limited effects or results that were confounded by poor study design’ (p.95). The 2012 review did not uncover any research in the intervening years that disputed this conclusion. Furthermore, the authors highlight the lack of rigorous evaluation of vocational training interventions for recovering drug users in Europe and caution against drawing inferences of transferability from studies undertaken outside the European context. They describe a number of primary studies from within the European context and beyond, but claim that because of differences in approach it is not possible to draw any meaningful conclusions about their effectiveness.
 
Despite the lack of consensus in the literature on ‘what works’ to improve employability among drug users in treatment, there remains a commitment among policy makers and practitioners to support drug users in accessing and maintaining employment. This commitment is important, as the benefits that accrue from being in employment are well documented. For example, one study identified the benefits that can contribute to an individual’s ability to create and sustain a drug-free life.12 According to the authors (p.38), being in paid employment:
 
•      enables the recovering drug user to fill his or her time constructively
•      promotes economic independence
•      helps reintegration to wider society by moving the individual away from the drug-using network and towards drug-free social relationships
•      enhances self-esteem and helps build new sense of self, which protects against relapse
•      conveys status, which acts as an important symbol to the individual of their ability to return successfully to a conventional life.
 
On the other hand, the challenges facing recovering drug users in their attempts to gain employment are well documentedin two studies that highlight the continuing interplay of personal and structural barriers that often prevent recovering drug users from accessing and securing paid employment.13,14
 
 
1.     Working Group on drugs rehabilitation (2007) National Drugs Strategy 2001–2008: rehabilitation. Dublin: Department of Community, Rural and Gaeltacht Affairs. www.drugsandalcohol.ie/6267
2.     Department of Community Rural and Gaeltacht Affairs (2009) National Drugs Strategy (interim) 2009–2016. Dublin: Department of Community, Rural and Gaeltacht Affairs. www.drugsandalcohol.ie/12388
3.     Fine Gael and the Labour Party (2011) Towards recovery: programme for a national government 2011–2016. Dublin: Fine Gael, and the Labour Party. www.drugsandalcohol.ie/14795
4.     Bellerose D, Carew AM and Lyons S (2011) Trends in treated problem drug use in Ireland 2005–2010. HRB Trends Series 12. Dublin: Health Research Board. www.drugsandalcohol.ie/16381
5.     Henkel D (2011) Unemployment and substance use: a review of the literature (1990–2010). Current Drug Abuse Reviews, 4(1): 4–27.
6.     Platt JJ (1995) Vocational rehabilitation of drug abusers. Psychological Bulletin, 117(3): 416–433.
7.     Bruce A (2004) Drugs task force project activity for FÁS Community Employment and Job Initiative participants. Dublin: FÁS. www.drugsandalcohol.ie/6020
8.     Lawless K (2006) Listening and learning: evaluation of special community employment programmes in Dublin North East. Dublin: North Dublin City and County Regional Drugs Task Force. www.drugsandalcohol.ie/6122
9.     Van Hout MC and Bingham T (2011) Holding pattern: an exploratory study of the lived experiences of those on methadone maintenance in Dublin North East. Dublin: Dublin North East Drugs Task Force. www.drugsandalcohol.ie/16231
10. Sumnall H and Brotherhood A (2012) Social reintegration and employment: evidence and interventions for drug users in treatment. Luxembourg: Publications Office of the European Union. www.drugsandalcohol.ie/18596
11. Magura S, Staines G, Blankertz L and Madison E (2004) The effectiveness of vocational services for substance users in treatment. Substance Use and Misuse, 39(13&14): 2165–2213.
12. McIntosh J, Bloor M and Robertson M (2008) Drug treatment and the achievement of paid employment. Addiction Research and Theory, 16(1): 37–45.
13. Bauld L, Hay G, McKell J and Carroll C (2010) Problem drug users’ experiences of employment and the benefit system. Research Report No. 640. Norwich: HM Stationery Office. http://research.dwp.gov.uk/asd/asd5/rports2009-2010/rrep640.pdf
14. Simonson P (2010) Pathways to employment in London: a guide for alcohol and drug services. London: Drugscope.
Item Type:Article
Issue Title:Issue 45, Spring 2013
Date:April 2013
Page Range:pp. 16-17
Publisher:Health Research Board
Volume:Issue 45, Spring 2013
EndNote:View
Accession Number:HRB (Electronic Only)
Subjects:A Substance use, abuse, and dependence > Natural history of substance use > Recovery
L Social psychology and related concepts > Interpersonal interaction and group dynamics > Social support
VA Geographic area > Europe > Ireland
J Health care, prevention and rehabilitation > Rehabilitation > Vocational rehabilitation (employment / occupation)
N Communication, information and education > Education by subject > Substance use education

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