Substance Use Disorders Recovery with a Focus on Employment and Education

2021·2.9 MB·English

EVIDENCE-BASED RESOURCE GUIDE SERIES

Substance Use Disorders
Recovery with a Focus on
Employment and
Education
Substance Use Disorders Recovery with a
Focus on Employment and Education
Acknowledgments
This report was prepared for the Substance Abuse and Mental Health Services Administration (SAMHSA)
under contract number HHSS2832017000651I/HHSS28342001T with SAMHSA, U.S. Department of Health
and Human Services (HHS). Thomas Clarke served as contracting officer representative.
Disclaimer
The views, opinions, and content of this publication are those of the authors and do not necessarily reflect the
views, opinions, or policies of SAMHSA or HHS. Nothing in this document constitutes a direct or indirect
endorsement by SAMHSA or HHS of any non-federal entity’s products, services, or policies, and any
reference to non-federal entity’s products, services, or policies should not be construed as such.
Public Domain Notice
All material appearing in this publication is in the public domain and may be reproduced or copied
without permission from SAMHSA. Citation of the source is appreciated. However, this publication
may not be reproduced or distributed for a fee without the specific, written authorization of the Office of
Communications, SAMHSA, HHS.
Electronic Access
This publication may be downloaded from http://store.samhsa.gov.
Recommended Citation
Substance Abuse and Mental Health Services Administration: Substance Use Disorders Recovery with a
Focus on Employment and Education. HHS Publication No. PEP21-PL-Guide-6 Rockville, MD: National
Mental Health and Substance Use Policy Laboratory. Substance Abuse and Mental Health Services
Administration, 2021.
Originating Office
National Mental Health and Substance Use Policy Laboratory, Substance Abuse and Mental Health Services
Administration, 5600 Fishers Lane, Rockville, MD 20857, HHS Publication No. PEP21-PL-Guide-6.
Nondiscrimination Notice
SAMHSA complies with applicable federal civil rights laws and does not discriminate on the basis of race,
color, national origin, age, disability, or sex.
SAMHSA cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza,
color, nacionalidad, ni edad.

Substance Use Disorders Recovery with a Focus on Employment and Education I
Acknowledgements
Evidence-Based Resource Guide
Series Overview

The Substance Abuse and Mental Health Services The Evidence-Based Resource Guide Series is a
Administration (SAMHSA), and specifically, the comprehensive and modular set of resources
National Mental Health and Substance Use Policy intended to support health care providers, health care
Laboratory, is pleased to fulfill the charge of the 21st system administrators, and community members
Century Cures Act to disseminate information on meet the needs of individuals at risk for,
evidence-based practices (EBPs) and service delivery experiencing, or recovering from SUD, SMI, and
models to prevent substance misuse and help SED.
individuals with substance use disorders (SUD),
Each guide is developed with input from expert panels
serious mental illnesses (SMI), and serious emotional
made up of federal, state, and non-governmental
disturbances (SED) get the treatment and support that
participants. These panels provide input based on their
they need.
knowledge of health care systems, implementation
An important focus for SAMHSA is supporting science, EBPs, provision of services, and policies that
sustained recovery from SUD through the use of foster change.
employment mechanisms. This guide reviews the
Panels include a unique group of accomplished
literature and science; examines best practices; identifies
scientists, providers, and administrators from provider
key components of peer-reviewed models that affect
and community organizations, federal and state
policies and programs; and identifies challenges and
agencies as well as persons with lived experience.
gaps in implementation.
Research shows that implementing EBPs requires a
Individuals in treatment and recovery can vary in many
multipronged approach. This guide is one piece of an
ways. They experience different mental health and
overall approach to implement and sustain change.
substance use conditions; may have co-occurring
Users of these guides are encouraged to review the
disorders; live in diverse parts of the country; and/or
SAMHSA Website for additional tools and technical
may experience a variety of socio-economic factors that
assistance opportunities.
can help or hinder recovery. All these factors can
complicate evaluating the effectiveness of SUD services,
treatments, and supports.
But despite these variations, there is evidence to support
that appropriate programming may reduce SUD, lessen
mental health symptoms, and improve quality of life.

1 Substance Use Disorders Recovery with a Focus on Employment and Education
Evidence-Based Resource Guide Series Overview
Content of the Guide FOCUS OF THE
GUIDE
This guide contains a foreword and five chapters. The chapters are modular
and do not need to be read in order. Each chapter is designed to be brief and
Sustained recovery from SUD
accessible to SUD and other health care providers, health care system
is significantly tied to
administrators, community members, and others working to meet the needs of
individuals at risk for, experiencing, or recovering from SUD. meaningful and purposeful
work-life balance.
FW Evidence-Based Resource Guide Employment is an important
Series Overview factor for achieving sustained
recovery and financial
Introduction to the series.
independence.
1 Issue Brief
This guide provides an
Overview of the topic, the importance of the issue, overview of issues, challenges,
challenges, approaches for providing employment
policies, and practices related
supports, and policy considerations.
to employment for individuals in
recovery. It summarizes the
2 What Research Tells Us
state of the science through an
An evidence review of the effectiveness of employment evidence review of the known
supports for individuals experiencing SUD.
effectiveness of programs
providing employment supports
3 Elements that Improve Program to individuals with SUD. Finally,
Effectiveness the guide provides expert panel
consensus recommendations of
Examples of programs and program elements that
improve supported employment program effectiveness. key program elements to
support individuals with
4 Guidance for Selecting and employment-related recovery.
Implementing Evidence-Based
Practices and Programs
Practical information to consider when selecting
and implementing employment programs.
5 Resources for Quality
Improvement and Evaluation
Guidance and resources for performance monitoring,
process evaluation and monitoring outcomes for the
purpose of quality improvement.
Substance Use Disorders Recovery with a Focus on Employment and Education 2
Evidence-Based Resource Guide Series Overview
Issue Brief

The purpose of this guide is to provide an overview of
issues, challenges, policies, and practices related to
employment and workforce training for individuals in
recovery from a substance use disorder (SUD). SUD occurs
when an individual’s continuous drug or alcohol misuse
leads to “clinically significant impairment."1 Symptoms can
include severe health problems, disability, and a failure to
meet responsibilities at work, school, or home.1 SUD
impacts individuals, families, and communities by
contributing to a loss in productivity, greater incidence of
criminal justice involvement, and an increased burden on
the health care system.1
The 2019 National Survey on Drug Use and Health
(NSDUH) shows that 20.4 million individuals 12 and older
experienced SUDs and more than 9.5 million have both a
SUD and mental illness.2 Additionally, more than 2.1
million people in the United States suffered from an opioid
use disorder (OUD) related to prescription opioids, and over
260,000 had an OUD related to heroin.3 Illicit drug use also
accounted for $49 billion in reduced participation in the
workforce.4 Prescription opioid misuse alone accounted for
an estimated $7.9 billion in lost employment or reduced
compensation.5
Recovery from SUD can be a difficult, but achievable
journey.6 Recent research indicates that sustained recovery
is significantly tied to meaningful and purposeful work-life
balance.7, 8 Employment is an important element for
sustaining recovery and maintaining financial
independence.
3 Substance Use Disorders Recovery with a Focus on Employment and Education
Issue Brief
Key Definitions Employment is reported as a top life priority by people in all stages of
recovery.12-14 These individuals often can and want to work regardless of
where they are in the recovery process.
Substance Use Disorder:
Recurrent use of alcohol and/or
Work is one of the best predictors of positive outcomes for individuals
drugs causing clinically
with SUD. Individuals who are employed compared to those
significant impairment such as
unemployed are more likely to demonstrate:13, 15, 16

health-related problems and/or
an inability to meet daily (cid:131) Lower rates of recurrence
responsibilities at work, school,
or home.9 (cid:131) Higher rates of abstinence
(cid:131) Less criminal activity
Recovery: A process of change
through which individuals (cid:131) Fewer parole violations
improve their health and
wellness, live self-directed lives, (cid:131) Improvements in quality of life
and strive to reach their full
(cid:131) More successful transition from long-term residential treatment
potential.6
back to the community.
Work: Purposeful activity that A longitudinal study of Government Performance and Results Act
produces something of economic
(GPRA) survey data indicated that clients who are employed while in
or social value such as goods or
treatment are significantly more likely to successfully complete
services.10
treatment than unemployed clients.17 Regardless of whether work is
paid or volunteer, individuals who work are more likely to reduce
Supported Employment:
their substance use18-20 and better able to maintain sobriety.21
Programs that support
competitive employment based
on worker preferences with
ongoing individualized services
for persons with the most severe
disabilities.11
Abstinence-Enforced
Employment Supports:
Programs aimed at promoting
abstinence and lifestyle changes
with competitive employment as
a secondary goal. Clients are
required to pass alcohol and/or
drug screening to participate in
work and may receive other
behavioral incentives.
Education Supports: A range
of supportive services provided
along with employment services

that help individuals consider
and pursue the training needed
to achieve their work goals.
Substance Use Disorders Recovery with a Focus on Employment and Education 4
Issue Brief
Challenges to Obtaining
Employment
A number of potential barriers to employment may exist
for persons with SUD such as:7, 22-25
(cid:131) Lack of job skills/lower education attainment
(cid:131) Poor work history
(cid:131) Poor interpersonal skills/motivation to work
(cid:131) Lack of transportation
(cid:131) Lack of childcare
(cid:131) Lack of identification such as a birth certificate,
driver’s license
(cid:131) Continued substance misuse/recurrence
(cid:131) Criminal history
(cid:131) Employer lack of understanding about SUD
(cid:131) Scheduling conflicts with probation and treatment
requirements
Policy Considerations
Recovery-Friendly Employment Policies
Peer Support and Peer-Recovery
Specialists/Navigators
Recent estimates indicate that close to half of employed
individuals who are engaged in private SUD treatment are Recovery and Recurrence
in recovery.26 Many employers have long understood the
As more individuals in recovery enter or re-enter the
value of peer support and personal experience as a
workforce, employers need to review and consider
strength for employees. For example, an increased
policies for dealing with employee substance use,
number of hospitals nationwide are hiring individuals in
misuse, recovery, recurrence, and reintegration. Some
recovery as peer recovery coaches.27
employers may be inclined to immediately terminate
In 2018, the U.S. Department of Labor launched a two- employees who return to use or show early signs of
phase, multi-year approach to address the economic and potential recurrence in order to manage risk for their
workforce impacts associated with the opioid crisis. The business. However, many other employers recognize the
resulting National Health Emergency demonstration grant financial benefit to retaining quality staff and have opted
projects help states support individuals in recovery from to create recovery-friendly employment policies.
OUD to return to work as peer recovery specialists or peer
Partners for Recovery: Supporting Our Greatest
recovery navigators. With grant funding, states are

Resource26 is a SAMHSA toolkit that outlines
providing training and employment services to individuals
recommendations, guidelines, sample policies, scripts,
seeking careers in healthcare professions related to SUD,
and other resources for SUD treatment providers to
mental health treatment, and pain management. An
promote recovery-friendly employment policies
implementation evaluation is underway with results
internally and externally.
expected in 2021.

Substance Use Disorders Recovery with a Focus on Employment and Education
5
Issue Brief
Suggestions include: Client-Operated Businesses
(cid:131) Creating a corporate culture that Numerous examples exist of individuals in recovery
acknowledges the reality of employee use and starting their own businesses that serve as second-chance
misuse of alcohol and drugs and offers a vision workplaces for others in recovery. Examples include:
of recovery support and wellness.
(cid:131) DV8 Kitchen
(cid:131) Providing policies and resources that (cid:131) Coast to Coast Computer Products
support prevention.
(cid:131) Creative Matters
(cid:131) Providing supportive intervention
(cid:131) Sober Network
policies such as allowing employees to take a
leave of absence to seek treatment, use sick leave (cid:131) Ricketyroo
to attend recovery groups, receive support
(cid:131) Sober Vacations International
through a strong Employee Assistance Program,
and access to health insurance with SUD

treatment benefits.
Drug-Free Workplaces
With the exception of federal contractors, grantees and
safety- and security-sensitive industries, most private
employers are not legally required to have a drug-free
workplace policy. However, some organizations choose
to incorporate Drug-Free Workplace policy components
to prevent substance misuse and develop policies that
allow them to use discretion when responding to
incidences. For example, Belden, a manufacturing
company in Richmond, Indiana, started Pathways to
Employment, a SUD program for potential employees
denied positions because they failed a drug test.
Participants who successfully complete the program and
commit to maintaining a substance-free lifestyle are
eligible to get a job at Belden.

Recovery-Friendly Workplace
At least five states have started initiatives that encourage
businesses to employ people in recovery, adopt recovery-
oriented employment policies, and share that information
for the benefit of community.28 New Hampshire’s
“Recovery Friendly Workplace Initiative” provides
technical assistance, guidelines, and resources to
workplaces to foster a supportive recovery environment
as well as linkage to public health networks and recovery
provider organizations across the state.29
Private, non-profit organizations have also developed
websites to connect recovery-friendly workplaces with
potential employees. For example, the National H.I.R.E
Network helps ex-offenders and individuals in recovery
connect with potential employers.

Substance Use Disorders Recovery with a Focus on Employment and Education
6
Issue Brief
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Issue Brief