Employment Outcomes for Hard-to-Reach Persons with Chronic and Severe Substance Use Disorders Receiving Assertive Community Treatment

Abstract

Many persons with chronic and severe substance use disorders (SUDs) enter and exit public substance dependence treatment systems with limited benefit, but continue overuse of high-cost health and human services. Less than a third holds jobs, earning income below U.S. federal poverty levels. Long-term integrated substance dependency treatment, rehabilitation, and support services will be essential to resolve substance dependence and employment problems. This single-group program evaluation reports adaptation of Assertive Community Treatment (ACT), a multi-component, team-based service model originally designed for persons with severe mental illnesses and multiple disabilities, for effectiveness with persons with severe SUDs. The ACT model delivers an integrated package of treatment, rehabilitation, and support to reduce substance misuse and increase employment. Of the 35 clients admitted 12 months prior to conclusion of this 2-year service demonstration, only one left treatment prematurely. Generally, clients modestly reduced substance misuse and increased employment. However, the evaluation design and small sample limit inferences of causation and generalizability of these promising outcomes. Persuading states to adopt expensive team-based approaches for this population will require firm evidence of favorable cost-benefit ratios.

• Assertive community treatment
• Treatment team
• Chronic illness care
• Substance use disorders
• Substance dependence treatment
• Drug and alcohol use outcomes
• Employment outcomes

Additional information

Notes on contributors

Paul B. Gold

Paul B. Gold, Ph.D., serves on the faculty in the Department of Psychiatry and Behavioral Sciences of the Medical University of South Carolina (MUSC). His major research interests concern the community integration of persons with serious disabilities arising from substance dependence, mental illness, and their cooccurrence. Over the years, he and Neil Meisler, second author have tested effectiveness ACT and other team-based interventions in assisting persons back into satisfying community life with the support of grants from the U.S. Public Health Service. He also pursues improvement of protection of human subjects in research through serving as a primary reviewer and an associate vice chair of one of MUSC's IRBs, and recently began a line of research in this area.

Neil Meisler

Neil Meisler, M.S.W., also serves on the faculty in the Department of Psychiatry and Behavioral Sciences of MUSC. For the past 20 years in roles of Commissioner (Delaware), Executive Deputy Commissioner (Rhode Island and South Carolina), and as an MUSC researcher, he has implemented, disseminated, and sustained ACT programming and other state-of-the-art rehabilitation practices on statewide basis for persons with serious disabilities arising from substance dependence, mental illness, and their cooccurrence. He currently works as a consultant to several states in their efforts to implement clinical teams operating according to evidence-based practices of ACT, vocational rehabilitation (Individual Placement and Support), integrated treatments for persons with cooccurring mental illness and substance use disorders, and multi-family group psychoeducation.

Deborah DuRoss

Deborah DuRoss, L.M.S.W., served as the SCDAODAS Project Director for the ACT service demonstration, and the principal consultant to Berkeley County's Kennedy Center in its effort to implement the ACT program. Her career activities include roles at the state level in South Carolina as policy maker; and program designer, developer, administrator, and direct service provider. She has served as the leader of ACT teams for agencies in South Carolina, Delaware, and North Carolina, where she now leads an ACT team helping clients with serious disabilities resulting from severe mental illness, substance dependence, and their cooccurrence. A variety of service agencies across the United States have requested her consultation on implementation and improvement of ACT and other programs and operations.

Linda Bailey

Linda Bailey, M.A., works as the Deputy Director at the Ernest E. Kennedy Center, the site of this study. She holds M.A. in Management from Webster University and is a certified Associate Public Manager through South Carolina Budget and Control Board. Her 20 years of career interest have been in Human Services to include adolescent treatment, adult corrections, and community based prevention. She is currently responsible for defining the mission and major goals of the organization. She is also responsible for program design, implementation, and evaluation as well as ensuring organizational accreditation and licensure.