ERIC EJ902498: Psychiatric Disabilities and Substance Abuse Disorder: Psychosocial and Vocational Concerns--Implications for Rehabilitation Professionals

2006·0.07 MB·English

by  ERIC

Psychiatric Disabilities and Substance Abuse Disorder:
Psychosocial and Vocational Concerns- Implications for
Rehabilitation Professionals
Latofia Patterson
Mary Anne Templeton
Abstract Regier, et al. (1990) found that individuals
with psychiatric disabilities were more likely
The purpose of this article is to review the
to have both alcohol or drug abuse disorders
literature on the comorbidity of substance
compared to the norm group. However, it is
abuse and psychiatric disorder. The paper
believed that individuals are often diagnosed
examines the medical, psychosocial, and
with SUD or PD rather than being diagnosed
vocational rehabilitation concerns associated
with both, leading to speculation that the
with substance abuse and psychiatric
number of individuals with both diagnoses is
disorder comorbidity. A greater emphasis is
underreported by mental health professionals
placed on vocational concerns and the role of
(DiNitto & Webb, 1998). One reason for
rehabilitation professionals within this
clients being treated for SUD or PD may be
population.
because some mental health professionals
choose not to work with clients who have
Introduction
both diagnoses (Velasco et al., 2000) or
because certain treatment settings discourage
The impact of drug and alcohol use among giving clients both diagnoses (Menicuci,
individuals with psychiatric disabilities has Wemuth, & Sorenson, 1988).
received increasing recognition (Donat &
Haverkamp, 2004). Substance use disorders According to the American Psychological
(SUD) in the general population are Association, Diagnostic of Statistical
approximately 17%, whereas rates in people Manuel-Text Revision (2000), SUD is
with psychiatric disabilities (PD) are defined as “a maladaptive pattern of
approximately 50% (Sengupta, Drake, & substance use manifested by recurrent and
McHugo, 1998). Valasco, Meyer, & significant adverse consequences related to
Lippmann (2000) argued that when PD and the repeated use of a substance” (p. 198).
SUD are coexistent, the results are often Substance abuse interferes with work,
worse than either disability by itself. The school, and home, contributes to dangerous
concern continues to surface as mental health activities and legal problems, and intensifies
professionals are encountering clients with social or interpersonal problems. Psychiatric
diagnoses of both disorders. Johnson, Brems, disorders encompass multiple psychological
Wells, Theno, & Fisher (2003) found that diagnoses that impact the individual’s
participants that were diagnosed with SUD emotional well being and affect their social
and PD were began using drugs or alcohol at interactions and employment (Hong, 2002).
a younger age and used more often than
those without PD.
The Alabama Counseling Association Journal, Volume 32, Number 2
29 Psychiatric Disabilities
Psychiatric disabilities include: (a) major Psychosocial Implications
depression, (b) bipolar disorders, (c) anxiety,
(d) obsessive-compulsive disorders, (e) The appearance of either SUD or PD is
personality disorders, and (f) schizophrenia accompanied with various psychosocial
(Hong, 2002; Sue & Sue, 2003). Some problems and there is a greater increase when
treatment theories consider SUD and PD to the disorders are comorbid (Drebin et al.,
be equivalent due to similarities in the 2003). SUD is linked with increased
disabilities the chronic nature of both, denial psychiatric symptoms and other difficulties
of the disability, and lack of control over the with daily living activities. Researchers have
disability (DiNitto & Webb, 1998). found multiple social implications of SUD
Individuals diagnosed with SUD and PD are and PD comorbidity, including (a) increased
referred to as substance abuse and likelihood of homelessness (DiNitto &
psychiatric disorder co-morbid or dually Webb, 1998), (b) legal problems (Clark,
diagnosed. Within the scope of this paper Ricketts, & McHugo, 1999), (c) difficulties
co-morbid and dually diagnosed are used with daily functioning (King, Gaines,
interchangeably. The use of these terms Lambert, Summerfelt, & Bickman, 2000),
implies the disabilities are of equal (d) difficulty maintaining employment
importance within the treatment process and (Johnson et al., 2003) and (e) problems in
should not be considered separate diagnoses their personal relationships (King, et al.,
(DiNitto & Webb, 1998; Velasco et al., 2000). 2000). The occurrence of substance abuse
and psychiatric comorbidity is also linked
Medical Implications with increased risk for violence and suicide
(Abou-Saleh, 2004; Drebing, Rosenheck,
Research indicated that numerous medical Schutt, Kasprow, and Penk, 2003; Kinney &
problems associated with individuals who Leaton, 1991; Sengupta et al., 1998).
are dually diagnosed. Substance abuse and
psychiatric disorder comorbidity is linked to Vocational Rehabilitation
poor physical health. Individuals diagnosed
with both disabilities experience higher rates Individuals with SUD and PD generally have
of (a) infections, (b) respiratory problems, (c) less success outcomes within a traditional
cancer, (d) epilepsy, and (e) hypertension rehabilitation setting. The psychosocial
(Crome, 2004). In addition, SUD alone problems associated with this population
affects every organ system and can lead to negatively affect the rehabilitation process.
malnutrition (Kinney & Leaton, 1991). They tend to have lower rates of treatment
Johnson et al. (2003) found that participants adherence and experience poorer outcomes
with SUD and PD were more likely to have than do persons with either psychiatric or
engaged in risky behaviors such at sharing substance abuse use problems alone
needles and having sex in exchange for drugs (Rosenthal & Westreich, 1999; Wolpe,
leading to an increased risk for sexually Gorton, Serota & Sanford, 1993, as cited in
transmitted diseases. Donat & Haverkamp, 2004).
The Alabama Counseling Association Journal, Volume 32, Number 2
Psychiatric Disability 30
Traditionally, individuals diagnosed with PD entered the VR system. Those participants
and SUD have disproportionately received who were diagnosed with both PD and SUD
VR services. It has been a common held were less likely to complete their plan. In
belief that these individuals would not addition, participants diagnosed with PD and
succeed on a job because of habitual SUD were more likely to become competi-
substance abuse. VR counselors have been tively employed than those with PD alone,
more willing to help consumers with PD; but less likely to be competitively employed
however more reluctant to work with dual than those with SUD only.
diagnosis. It was believed that these
individuals were not ready to work and Individuals that are dually diagnosed are
needed to attain abstinence before attempting being referred for vocational counseling at
to work (Becker, Drake, & Naughton, 2005). higher rates and are being encouraged to
The work ethic of these consumers has been work. VR is an important treatment
a legitimate concern for VR counselors. The component for clients with dual diagnoses
main concern has been that of substance use. because it provides people with motivation
SUD may decrease the quality or quantity of for not using substances and helps them
work rather than the overall likelihood of develop a more self-fulfilling life (Muesser,
working (DiNitto & Webb, 1998; Lederman 2004). Work provides structure, self-esteem,
& Schneider, 2002). Individuals with dual finances, and the opportunity to engage with
diagnosis may work fewer hours, lose more people who do not use drugs or alcohol
jobs, change jobs frequently, or often (Becker et al., 2005).
experience less job satisfaction than those
with single disorders (Sengupta et al., 1998). Service Options in the Vocational
Nonetheless, consumers with dual diagnoses Rehabilitation Setting
express great interest in employment.
Sengupta et al. suggested that consumers The goal of vocational rehabilitation is to
with PD consider lack of motivation, mental assist individuals with disabilities in finding
illness, anxiety, and physical problems as appropriate work and become more
impediments to employment opposed to their independent (Maki & Riggar, 1997). To
SUD. reach this goal, VR counselors may provide
education, training, supported employment,
Once individuals diagnosed with SUD and or other necessary services (Velasco et al.,
PD enter the vocational rehabilitation 2000). When working with clients who have
system, there is often a fear ,on the part of the SUD and PD, VR counselors must take into
clinician, that they will not comply with their consideration the implications of both
treatment. However, no conclusive evidence disabilities (Velasco et al.). Success in the
that individuals diagnosed with SUD and PD cases of clients diagnosed with SUD and PD
are non-compliant in the vocational must include the cessation of drug and
rehabilitation (VR) domain (Drebing et al., alcohol abuse as well as management of
2003). In a study that included more than psychiatric symptoms or behaviors (Kelley
25,000 participants, Drebing et al. (2002) & Benshoff, 1999).
found that individuals with PD and SUD
were more likely to be employed when they
The Alabama Counseling Association Journal, Volume 32, Number 2
31 Psychiatric Disability
Several methods are currently being used to Professionals working with individuals who
help VR consumers with dual diagnoses are dually diagnosed need to be highly
achieve vocational success. The most trained in effective service delivery (Kelley
common method used by VR to help these & Benshoff, 1997). In order to work with
consumers is supported employment, which individuals who have PD and SUD,
was included in the Rehabilitation Act, 1986 rehabilitation counselors must understand
amendments (Stensrud & Gillbride, 2004). addiction, psychiatric disabilities, and the
Supported employment has placement as the interplay between them (Kelley & Benshoff,
primary focus, rather than first training and 1997). Integration and treatment teams are
then placing (Stensrud & Gillbride; Gillbride innovative methods of treating individuals
& Hagner, 2005). Supported employment with dual diagnoses. When VR is included in
consists of placing a consumer in a position the treatment team for individuals diagnosed
with a job coach, provided by VR, training with PD and SUD, the needs of the
the consumer on-site and providing additional individual are better met (Drake, Becker,
support to the employer (Stensud & Bond & Mueser, 2003, as cited in Becker et
Gillbride). After the individual is successfully al., 2005). Treatment teams should
working in the position independently, the incorporate preventive and inventive
job coach may return if the consumer is methods of helping consumers manage
having difficulties at work or if the job tasks problems. Services should include teaching
change in some way (Gillbride & Hagner). coping skills to help consumers learn more
how to deal with the emotions or thoughts
Supportive employment provides increased that might lead to increased substance abuse
structure for consumers. It is vital that VR to cope (Mueser, 2004). Incorporating
counselors working with dually diagnosed money management within the treatment
consumers help them find jobs that are plan can help consumers learn how to
appropriate to their treatment management manage money and not spend it frivolously
and recovery (Becker, et. al, 2005). Many on substances (Becker et al., 2005).
individuals who are diagnosed with SUD and
PD are searching for more self-actualizing Conclusion
lives. Although they experience interpersonal
problems associated with their diagnosis, Individuals diagnosed with SUD and PD
they do succeed in employment. They may significantly benefit from VR services. The
need to take gradual steps toward main emphasis of VR is to help qualified
employment and may need constant individuals maximize their employment
encouragement and individualized services potential. Even though substance abuse can
(Becker et al., 2005). Johnson et al. (2003) be a barrier to employment, research has
suggested that counseling should also be shown that it does not deter employment. It
included in treatment planning in order to is only appropriate that all methods of
assist clients with psychosocial issues related services are used to help these individuals
to their disability. control their psychiatric symptoms and
recover from substance abuse. Integrating
VR within a treatment plan provides more
rehabilitative options for consumers. The
The Alabama Counseling Association Journal, Volume 32, Number 2
Psychiatric Disability 32
medical, psychosocial, and vocational needs AUTHOR NOTE
of these consumers are different from
Latofia Patterson is a Rehabilitation
individuals with single disorders; thus, it is
Counselor employed with the Alabama
imperative that treatment teams composed of
Department of Rehabilitation Services.
mental health and rehabilitation work in
Dr. Mary Anne Templeton is an Assistant
unison to address the concerns of this
Professor of Counseling at Troy University.
population. This unique population requires
Correspondence regarding this manuscript
innovative methods of treatment and services.
should be directed to the secondary author at:
College of Education, McCartha Hall, Troy
There has been an increase in rehabilitation
University, Troy, Alabama 36082.
training programs across the country to train
qualified rehabilitation professional, who can
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