For people in substance use disorder (SUD) treatment, gainful employment is strongly linked to better recovery outcomes (Magura & Marshall, 2020). Obtaining and maintaining employment helps clients establish a legal source of income, structure their time, and improve self-esteem, which in turn may greatly reduce substance use and criminal activity. Unemployment and SUDs may be intertwined long before an individual seeks treatment (Center for Substance Abuse Treatment [CSAT], 2000b). But people in recovery who are employed show lower rates of relapse and higher rates of abstinence compared with those who are unemployed (Harrison et al., 2020). The process of finding and keeping a job can be an important part of establishing healthy new behaviors during treatment and recovery. Obtaining advanced education, certification, or licensure can support clients while they establish themselves as a person in recovery (Crutchfield & Güss, 2019). For clients who are employed, being able to improve their employment prospects improves long-term SUD recovery (Sahker et al., 2019).

This Advisory, based on the (2012) Substance Abuse and Mental Health Services Administration’s (SAMHSA) Treatment Improvement Protocol (TIP) 38, Integrating Substance Abuse Treatment and Vocational Services, presents strategies and resources for SUD treatment counselors and clinic directors to improve outcomes for clients in recovery by helping them find and keep employment and deal with workplace stresses. It is directed to programs serving clients who are unemployed, underemployed, or struggling in workplace settings.

Key messages
● Vocational services should be introduced as early as possible in SUD treatment for clients who need and are ready for them, and be an integral component of the entire treatment plan.
● Vocational plans should recognize the challenges posed to clients whose initial options may be limited to low-paying service-sector jobs and gig-based work provided by platforms such as Instacart, TaskRabbit, or Uber.
● SUD treatment programs that do not have a vocational rehabilitation (VR) counselor on staff should establish relationships with local VR counselors to work with clients.
● SUD treatment programs should establish referral relationships with job training programs, community colleges, GED programs, and employers.
● The way VR services are structured will vary according to treatment intensity and setting.
● Clients will need access to online job resources and training in how to use them.