Background: Many individuals with severe Substance Use Disorders (SUD) want to work. This study explores the experiences of what gaining employment represents for patients receiving Individual Placement and Support (IPS) early in their SUD treatment.

Methods: Semi-structured interviews were conducted among 17 patients in specialized SUD treatment who received IPS through participating in a randomized trial. Interviews were thematically analyzed in an interdisciplinary group.

Results: The analysis generated three main themes: Employment promoting positive change in self-experience, where employment was described as improving well-being, confidence, health stability and awareness of personal challenges; Employment as a bridge for reconnecting with society, where work was experienced to enable social participation, feelings of usefulness and identity reconstruction; and Employment as a risk factor for destabilization and relapse showing how employment could have negative impacts, and potentially trigger substance use.

Conclusion: Gaining employment during SUD treatment can support both personal development and social integration but may also involve risks. Tailored employment support that responds to the complexities of SUD and is delivered through interwoven collaboration between health care and employment support services may improve treatment outcomes. This has important implications for future policy and service development and warrants further exploration.