Demographic and Vocational Rehabilitation Service Correlates of Employment Outcomes in People With Substance Use Disorders During COVID-19

Abstract

This study examined the demographic and vocational rehabilitation (VR) service correlates of employment outcomes (achievement of competitive employment, hourly wage, and weekly hours) among individuals with substance use disorders (SUDs) during the COVID-19 pandemic, using the U.S. Rehabilitation Services Administration Case Services Report (RSA-911) database for fiscal year 2020. Data from 9,536 individuals were analyzed. Hierarchical logistic regression and hierarchical linear regression analyses revealed that multiple demographic and VR service variables were significantly associated with achievement of competitive employment, hourly wage, and weekly work hours at exit. Particularly, having a vocational training license/certificate, employment at Individualized Plan for Employment, and having an associate or bachelor’s degree were the strongest demographic correlates of more positive employment outcomes; while short-term job supports, maintenance, and other services were the strongest VR service correlates of more positive employment outcomes. Implications of the findings were discussed to promote VR service outcomes for people with SUD in the postpandemic era.

Keywords

vocational rehabilitation substance use disorder employment COVID-19 hourly wage weekly work hours

Get full access to this article

View all access options for this article.

References

Akinola

O. A.

Horsman

E. N.

Dunkley

(2021). Correlates of vocational outcomes of youth with co-occurring mental illness and substance use disorders: Evidence from a vocational rehabilitation program. The Australian Journal of Rehabilitation Counselling, 27(2), 110–121. https://doi.org/10.1017/jrc.2021.9

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.).

Americans with Disabilities Act National Network. (2023). https://adata.org/

Baloch

N. A.

Jennings

W. G.

(2021). Examining vocational rehabilitation services provided to incarcerated persons with disabilities. Criminal Justice Policy Review, 32(3), 268–283. https://doi.org/10.1177/0887403420913621

Barati

Bashirian

Mohammadi

Moeini

Mousali

Afshari

(2023). An ecological approach to exploring factors affecting substance use relapse: A systematic review. Journal of Public Health, 31(1), 135–148. https://doi.org/10.1007/s10389-020-01412-x

Bertz

J. W.

Panlilio

L. V.

Stull

S. W.

Smith

K. E.

Reamer

Holtyn

A. F.

Toegel

Kowalczyk

W. J.

Phillips

K. A.

Epstein

D. H.

Silverman

Preston

K. L.

(2022). Being at work improves stress, craving, and mood for people with opioid use disorder: Ecological momentary assessment during a randomized trial of experimental employment in a contingency-management-based therapeutic workplace. Behaviour Research and Therapy, 152, 104071–104071. https://doi.org/10.1016/j.brat.2022.104071

Braunstein

W. B.

Powell

B. J.

McGowan

J. F.

Thoreson

R. W

. (1983). Employment factors in outpatient recovery of alcoholics: A multivariate study. Addictive Behaviors, 8(4), 345–351.

Bordin

E. S.

(1979). The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy: Theory, Research & Practice, 16(3), 252–260. https://doi.org/10.1037/h0085885

Brickham

Kim

J. H.

Gonzalez

Rosenthal

(2016). Vocational outcomes of people with alcohol abuse/dependence who received state vocational rehabilitation services. Journal of Vocational Rehabilitation, 45(3), 267–279. https://doi.org/10.3233/JVR-160828

10.

Choe

Baldwin

M. L.

Song

(2020). A hierarchy of stigma associated with mental disorders. The Journal of Mental Health Policy and Economics, 23(2), 43–54.

11.

Cook

P. J.

Kang

Braga

A. A.

Ludwig

O’Brien

M. E.

(2015). An experimental evaluation of a comprehensive employment-oriented prisoner re-entry program. Journal of Quantitative Criminology, 31, 355–382. https://doi.org/10.1007/s10940-014-9242-5

12.

Corrigan

P. W.

McCracken

S. G.

(2005). Place first, then train: An alternative to the medical model of psychiatric rehabilitation. Social Work, 50(1), 31–39. https://doi.org/10.1093/sw/50.1.31

13.

Corrigan

P. W.

Morris

S. B.

Michaels

P. J.

Rafacz

J. D.

Rüsch

(2012). Challenging the public stigma of mental illness: A meta-analysis of outcome studies. Psychiatric Services, 63(10), 963–973. https://doi.org/10.1176/appi.ps.201100529

14.

Cortes

G. M.

Forsythe

(2023). Heterogeneous labor market impacts of the COVID-19 pandemic. ILR Review, 76(1), 30–55. https://doi.org/10.1177/00197939221076856

15.

Czeisler

M. É.

Lane

R. I.

Petrosky

Wiley

J. F.

Christensen

Njai

Weaver

M. D.

Robbins

Facer-Childs

E. R.

Barger

L. K.

Czeisler

C. A.

Howard

M. E.

Rajaratnam

S. M. W.

(2020). Mental health, substance use, and suicidal ideation during the COVID-19 pandemic. Morbidity and Mortality Weekly Report, 69(32), 1049–1057. https://doi.org/10.15585/mmwr.mm6932a1

16.

Daly

M. C.

Buckman

S. R.

Seitelman

L. M.

(2020). The unequal impact of COVID-19: Why education matters. FRBSF Economic Letter, 17, 1–5.

17.

Domash

Summers

L. H.

(2022). How tight are US labor markets? (Working Paper No. 29739). National Bureau of Economic Research.

18.

Donnell

C. M.

Mizelle

N. D.

Zheng

(2009). Consumers of vocational rehabilitation services diagnosed with psychiatric and substance use disorders. Journal of Rehabilitation, 75(3), 41–49.

19.

Ethridge

Dowden

A. R.

Brooks

Kwan

Harley

(2020). Employment and earnings among ex-offenders with disabilities: A multivariate analysis of RSA-911 data. Journal of Vocational Rehabilitation, 52(3), 279–289. https://doi.org/10.3233/JVR-201077

20.

Giesen

J. M.

Hierholzer

(2016). Vocational rehabilitation services and employment for SSDI beneficiaries with visual impairments. Journal of Vocational Rehabilitation, 44(2), 175–189. https://doi.org/10.3233/JVR-150789

21.

Harrison

Krieger

M. J.

Johnson

H. A.

(2020). Review of individual placement and support employment intervention for persons with substance use disorder. Substance Use & Misuse, 55(4), 636–643. https://doi.org/10.1080/10826084.2019.1692035

22.

Hassel

Nordfjærn

Hagen

(2013). Psychological and interpersonal distress among patients with substance use disorders: Are these factors associated with continued drug use and do they change during treatment? Journal of Substance Use, 18(5), 363–376. https://doi.org/10.3109/14659891.2012.685122

23.

Heinemann

A. W.

Moore

Lazowski

L. E.

Huber

Semik

(2014). Benefits of substance use disorder screening on employment outcomes in state-federal Vocational Rehabilitation programs. Rehabilitation Counseling Bulletin, 57(3), 144–158. https://doi.org/10.1177/0034355213503908

24.

Hogue

Dauber

Dasaro

Morgenstern

(2010). Predictors of employment in substance-using male and female welfare recipients. Journal of Substance Abuse Treatment, 38(2), 108–118. https://doi.org/10.1016/j.jsat.2009.09.003

25.

Hollar

(2008). The relationship between substance abuse disorders and unsuccessful case closures in vocational rehabilitation agencies. Journal of Applied Rehabilitation Counseling, 39(2), 25–29. https://doi.org/10.1891/0047-2220.39.2.25

26.

Iwanaga

Chan

Tansey

T. N.

Strauser

Ritter

Bishop

Brooks

(2019). Working alliance and stages of change for employment: The intermediary role of autonomous motivation, outcome expectancy and vocational rehabilitation engagement. Journal of Occupational Rehabilitation, 29, 315–324. https://doi.org/10.1007/s10926-018-9787-5

27.

Jemberie

W. B.

Williams

J. S.

Eriksson

Gronlund

Nilsson

M. B.

Padyab

Priest

K. C.

Sandlund

Snellman

McCarty

Lundgren

L. M.

(2020). Substance use disorders and COVID-19: Multi-faceted problems which require multi-pronged solutions. Perspective, 11(714), 1–9. https://doi.org/10.3389/fpsyt.2020.00714

28.

Laudet

Magura

Vogel

H. S.

Knight

E. L.

(2004). Perceived reasons for substance misuse among persons with a psychiatric disorder. American Journal of Orthopsychiatry, 74(3), 365–375. https://doi.org/10.1037/0002-9432.74.3.365

29.

Laudet

White

(2010). What are your priorities right now? Identifying service needs across recovery stages to inform service development. Journal of Substance Abuse Treatment, 38(1), 51–59. https://doi.org/10.1016/j.jsat.2009.06.003

30.

Lusk

S. L.

(2018). Predictors of successful vocational rehabilitation closure among individuals with substance and alcohol use disorders: An analysis of Rehabilitation Services Administration data 2010–2014. Alcoholism Treatment Quarterly, 36(2), 224–237. https://doi.org/10.1080/07347324.2017.1420433

31.

Lusk

S. L.

Koch

L. C.

Paul

T. M.

(2016). Recovery-oriented vocational rehabilitation services for individuals with co-occurring psychiatric disabilities and substance use disorders. Rehabilitation Research, Policy, and Education, 30(3), 243–258. https://doi.org/10.1891/2168-6653.30.3.243

32.

Lusk

S. L.

Veale

F. R.

(2018). Increasing successful vocational rehabilitation outcomes for individuals with substance use disorders. Journal of Applied Rehabilitation Counseling, 49(1), 4–10. https://doi.org/10.1891/0047-2220.49.1.4

33.

Lustig

D. C.

Strauser

D. R.

Dewaine Rice

Rucker

T. F.

(2002). The relationship between working alliance and rehabilitation outcomes. Rehabilitation Counseling Bulletin, 46(1), 24–32. https://doi.org/10.1177/00343552020460010201

34.

Mack

Jones

C. M.

Ballesteros

M. F.

(2017). Illicit drug use, illicit drug use disorders, and drug overdose deaths in metropolitan and nonmetropolitan areas—United States. American Journal of Transplantation, 17(12), 3241–3252. https://doi.org/10.1111/ajt.14555

35.

Magura

Marshall

(2020). The effectiveness of interventions intended to improve employment outcomes for persons with substance use disorder: An updated systematic review. Substance Use and Misuse, 55(13), 2230–2236. https://doi.org/10826084.2020.1797810

36.

Mamboleo

Kaya

Meyer

Kamnetz

Bezyak

Chan

(2015). Vocational rehabilitation services and outcomes for individuals with arthritis in the United States. Journal of Vocational Rehabilitation, 42(2), 131–139. https://doi.org/10.3233/JVR-150730

37.

Manuel

Yuan

Herman

D. B.

Svikis

D. S.

Nichols

Palmer

Deren

(2017). Barriers and facilitators to successful transition from long-term residential substance abuse treatment. Journal of Substance Abuse Treatment, 74, 16–22. https://doi.org/10.1016/j.jsat.2016.12.001

38.

Martinson

McDonald

Berninger

Wasserman

(2021). Building evidence-based strategies to improve employment outcomes for individuals with substance use disorders (OPRE Report 2020-171). Office of Planning, Research, and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services.

39.

Mayo Clinic. (2022). COVID-19: Long-term effects. https://www.mayoclinic.org/diseases-conditions/coronavirus/in-depth/coronavirus-long-term-effects/art-20490351

40.

McAweeney

Keferl

Moore

Wagner

(2008). Predictors of successful closure in the state-federal vocational rehabilitation system: Findings from a sample of persons with disability and substance use disorders. Journal of Applied Rehabilitation Counseling, 39(2), 30–36. https://doi.org/10.1891/0047-2220.39.2.30

41.

McCoy

Comerford

Metsch

L. R.

(2007). Employment among chronic drug users at baseline and 6-month follow-up. Substance Use & Misuse, 42(7), 1055–1067. https://doi.org/10.1080/10826080701409982

42.

McDonald

Day

J. C.

(2010). Race, gender, and the invisible hand of social capital. Sociology Compass, 4(7), 532–543. https://doi.org/10.1111/j.1751-9020.2010.00298.x

43.

Melvin

Davis

Koch

D. S.

(2012). Employment as a predictor of substance abuse treatment. The Journal of Rehabilitation, 78(4), 31–37.

44.

Miguel

A. Q. C.

Kiluk

B. D.

Roos

C. R.

Babuscio

T. A.

Nich

Mari

J. J.

Carroll

K. M.

(2019). Change in employment status and cocaine use treatment outcomes: A secondary analysis across six clinical trials. Journal of Substance Abuse Treatment, 106, 89–96. https://doi.org/10.1016/j.jsat.2019.09.002

45.

Modini

Joyce

Mykletun

Christensen

Bryant

R. A.

Mitchell

P. B.

Harvey

S. B.

(2016). The mental health benefits of employment: Results of a systematic meta-review. Australasian Psychiatry: Bulletin of the Royal Australian and New Zealand College of Psychiatrists, 24(4), 331–336. https://doi.org/10.1177/1039856215618523

46.

Morgan

A. J.

Reavley

N. J.

Ross

San Too

Jorm

A. F.

(2018). Interventions to reduce stigma towards people with severe mental illness: Systematic review and meta-analysis. Journal of Psychiatric Research, 103, 120–133.

47.

DiNitto

D. M.

Powers

D. A.

(2020). Spillover effects of job skills training on substance misuse among low-income youths with employment barriers: A longitudinal cohort study. American Journal of Public Health, 110(6), 900–906. https://doi.org/10.2105/AJPH.2020.305631

48.

Park

(2021). Predicting sociodemographic characteristics, medical insurance, employment status, and vocational rehabilitation service factors influencing cancer survivors’ employment outcomes within the Rehabilitation Services Administration (RSA-911) database [Doctoral dissertation, University of Wisconsin-Madison]. ProQuest Dissertations & Theses Global.

49.

Perkins Collaborative Resource Network (n.d.). Career Pathways Systems. https://cte.ed.gov/initiatives/career-pathways-systems

50.

Pete

J. P.

Diallo

Kaya

Brooks

Allen

Bezyak

Chan

(2015). Vocational rehabilitation as a public health intervention for young African American men with substance use disorders. Journal of Vocational Rehabilitation, 43(2), 149–157. https://doi.org/10.3233/JVR-150764

51.

Petry

Andrade

L. F.

Rash

C. J.

Cherniack

M. G.

(2014). Engaging in job-related activities is associated with reductions in employment problems and improvements in quality of life in substance abusing patients. Psychology of Addictive Behaviors, 28(1), 268–275. https://doi.org/10.1037/a0032264

52.

Phillips

Paul

Fahy

Dowling-Hetherington

Kroll

Moloney

Duffy

Fealy

Lafferty

(2020). The invisible workforce during the COVID-19 pandemic: Family carers at the frontline. HRB Open Research, 3, 24. https://doi.org/10.12688/hrbopenres.13059.1

53.

Rehabilitation Services Administration. (2019). Instructions for the completion of the case service report (RSA-911) for the State Vocational Rehabilitation Services Program and the State Supported Employment Services Program. https://rsa.ed.gov/sites/default/files/subregulatory/pd-19-03.pdf

54.

Richardson

Epp

(2016). Substance use disorders, employment and the return to work. In Schultz

I. Z.

Gatchel

R. J.

(Eds.), Handbook of return to work (pp. 667–692). Springer.

55.

Roberts

Rogers

Mason

Siriwardena

A. N.

Hogue

Whitley

G. A.

Law

G. R.

(2021). Alcohol and other substance use during the COVID-19 pandemic: A systematic review. Drug and Alcohol Dependence, 229, 109150. https://doi.org/10.1016/j.drugalcdep.2021.109150

56.

Sahker

Ali

S. R.

Arndt

(2019). Employment recovery capital in the treatment of substance use disorders: Six-month follow-up observations. Drug and Alcohol Dependence, 205, 107624–107624. https://doi.org/10.1016/j.drugalcdep.2019.107624

57.

Sherba

Coxe

K. A.

Gersper

B. E.

Linley

J. V.

(2018). Employment services and substance abuse treatment. Journal of Substance Abuse Treatment, 87, 70–78. https://doi.org/10.1016/j.jsat.2018.01.015

58.

Shoag

Veuger

(2021). Ban-the-box measures help high-crime neighborhoods. The Journal of Law and Economics, 64(1), 85–105. https://doi.org/10.1086/711367

59.

Sinakhone

J. K.

Hunter

B. A.

Jason

L. A.

(2017). Good job, bad job: The employment experiences of women in recovery from substance abuse. Work: Journal of Prevention Assessment, & Rehabilitation, 57(2), 289–295. https://doi.org/10.3233/WOR-172552

60.

Singh

Jaggi

A. S.

(2013). A review on renal toxicity profile of common abusive drugs. The Korean Journal of Physiology & Pharmacology, 17(4), 347–357. https://doi.org/10.4196/kjpp.2013.17.4.347

61.

Sprong

M. E.

Melvin

Dallas

Koch

D. S.

(2014). Substance abuse and vocational rehabilitation: A survey of policies and procedures. Journal of Rehabilitation, 80(4), 4–9.

62.

Substance Abuse and Mental Health Services Administration. (2012). Results from the 2011 National Survey on Drug Use and Health: Summary of national findings (NSDUH Series H-44, HHS Publication No. (SMA) 12-4713). https://www.samhsa.gov/data/sites/default/files/Revised2k11NSDUHSummNatFindings/Revised2k11NSDUHSummNatFindings/NSDUHresults2011.htm

63.

Substance Abuse and Mental Health Services Administration. (2019). Key substance use and mental health indicators in the United States: Results from the 2019 National Survey on Drug Use and Health. https://www.samhsa.gov/data/sites/default/files/reports/rpt29393/2019NSDUHFFRPDFWHTML/2019NSDUHFFR1PDFW090120.pdf

64.

Substance Abuse and Mental Health Services Administration. (2020). Highlights for the 2020 National Survey on Drug Use and Health. https://www.samhsa.gov/data/sites/default/files/2021-10/2020_NSDUH_Highlights.pdf

65.

Substance Abuse and Mental Health Services Administration. (2021a). Integrating vocational services into substance use disorder treatment. https://store.samhsa.gov/sites/default/files/SAMHSA_Digital_Download/pep20-02-01-019.pdf

66.

Substance Abuse and Mental Health Services Administration. (2021b). Key substance use and mental health indicators in the United States: Results from the 2021 National Survey on Drug Use and Health. https://www.samhsa.gov/data/sites/default/files/reports/rpt39443/2021NSDUHFFRRev010323.pdf

67.

Substance Abuse and Mental Health Services Administration. (2023a). Overview of the impacts of long COVID on behavioral health. https://store.samhsa.gov/sites/default/files/pep23-01-00-001.pdf

68.

Substance Abuse and Mental Health Services Administration. (2023b). Substance abuse and mental health data archive. https://pdas.samhsa.gov/#/

69.

Sung

Muller

Jones

J. E.

Chan

(2014). Vocational rehabilitation service patterns and employment outcomes of people with epilepsy. Epilepsy Research, 108(8), 1469–1479. https://doi.org/10.1016/j.eplepsyres.2014.06.016

70.

Torres

Frain

Tansey

T. N.

(2019). The impact of motivational interviewing training on rehabilitation counselors: Assessing working alliance and client engagement. A randomized controlled trial. Rehabilitation Psychology, 64(3), 328–338. https://doi.org/10.1037/rep0000267

71.

U.S. Bureau of Labor Statistics. (2022). Effects of the coronavirus COVID-19 pandemic (CPS). United States Department of Labor. https://www.bls.gov/cps/effects-of-the-coronavirus-covid-19-pandemic.htm

72.

Visher

C. A.

Debus-Sherrill

S. A.

Yahner

(2011). Employment after prison: A longitudinal study of former prisoners. Justice Quarterly, 28(5), 698–718. https://doi.org/10.1080/07418825.2010.535553

73.

Walls

R. T.

Batiste

L. C.

Moore

L. C.

Loy

(2009). Vocational rehabilitation and job accommodations for individuals with substance abuse disorders. Journal of Rehabilitation, 75(4), 35–44.

74.

Walton

Hall

M. T.

(2016). The effects of employment interventions on addiction treatment outcomes: A review of the literature. Journal of Social Work Practice in the Addictions, 16(4), 358–384. https://doi.org/10.1080/1533256X.2016.1235429

75.

Wang

Q. Q.

Kaelber

D. C.

Volkow

N. D.

(2021). COVID-19 risk and outcomes in patients with substance use disorders: Analyses from electronic health records in the United States. Molecular Psychiatry, 26(1), 30–39. https://doi.org/10.1038/s41380-020-00880-7

76.

West

S. L.

(2008). The utilization of vocational rehabilitation services in substance abuse treatment facilities in the US. Journal of Vocational Rehabilitation, 29(2), 71–75.

77.

The White House. (2023). The labor supply rebound from the pandemic. https://www.whitehouse.gov/cea/written-materials/2023/04/17/the-labor-supply-rebound-from-the-pandemic/

78.

Xiao

Zhou

(2020). Connecting vocational rehabilitation policy and practice: A national study on substance use disorders. The Journal of Rehabilitation, 86(1), 54.