INTEREST IN AND OBSTACLES TO PURSUING WORK AMONG UNEMPLOYED DUALLY DIAGNOSED INDIVIDUALS

Abstract

Employment status is commonly used as a sign of stability in recovery and an outcome variable for substance abuse treatment and research. However, there has been little attention in the literature on the topic of work for the dually diagnosed (i.e., persons diagnosed with both substance use and mental health disorders). Data collected in 1999 are presented on expressed interest in and perceived barriers to pursuing work and on the utilization of vocational rehabilitation (voc-rehab) services among unemployed members of a dual recovery self-help fellowship (N = 130). While members generally expressed high interest in working, they also cited multiple obstacles to attaining and maintaining employment. A path model was specified and tested. Significant contributors to interest in working were substance use status and physical health rating. Consistent with our hypotheses, mental health symptoms and greater perceived obstacles (e.g., stigma, fear of failure, and insufficient skills) were significant contributors to perceived difficulty in pursuing work, whereas substance use, physical health, and recency of employment were not. Finally, those who perceived less difficulty in pursuing work were more likely to utilize voc-rehab services, and men were more likely than women to use these facilities; interest in work was not significantly associated with utilizing voc-rehab services. The roles of mental health disorders and substance use in relation to pursuit of employment are discussed, as well as that of perceived obstacles such as stigma. The paper addresses the setting of realistic vocational goals and possible strategies to mitigate barriers to increased employment of dually diagnosed individuals.

• Employment
• Dual-diagnosis
• Comorbidity
• Recovery
• Entitlement

RESUMEN

El interés en el trabajo se utiliza comúnmente como muestra de la estabilidad en la recuperación y como un resultado para el tratamiento y la investigación del abuso de la sustancia. Sin embargo, ha habido poca atención en la literatura en el asunto del trabajo para dual-diagnosticado (uso de la sustancia y los desórdenes mentales). Se presentan datos sobre el interés expresado adentro y barreras percibidas a perseguir el trabajo y en la utilización de los servicios vocacionales de la rehabilitación entre miembros de un grupo de auto-ayude de recuperación (N = 130). Mientras que los miembros expresaron generalmente alto interés en el trabajo, también citaron obstáculos múltiples a lograr y mantener un empleo. Un modelo causal fue especificado y probado. Los contribuidores significativos al interés en el trabajo eran estatus del uso de la sustancia y grado fisico de la salud. Constantes con nuestras hipótesis, síntomas mentales y mayores obstáculos percibidos (e.g., stigma, miedo del fracaso y habilidades escasas) eran los contribuidores significativos a la dificultad percibida en perseguir el trabajo, mientras que no eran el uso de la sustancia, la salud fisica y el recency del empleo. Finalmente, los que percibió menos dificultad en perseguir el trabajo eran más probable utilizar sevicios vocacionales, al igual que hombres; el interés en trabajo no fue asociado perceptiblemente a utilizer servicios vocacionales. Discutamos el papeles de los desórdenes de la salud mental y del uso de la droga en lo referente a perseguir el empleo, así como el deobstáculos percibidos tales como stigma. El papel trata como fijar metas vocacionales realistas y de estratėegias posibles para atenuar barreras al empleo.

RÉSUMÉ

L’emploi parmi les utilisateurs de drogue est généralement considéré comme un signe de stabilité et comme un indice de resultat par les programmes de traitement et par la recherche. Cependant, le sujet du travail pour les utilisateurs de drogue qui ont une maladie psychiatrique n’a pas ete couvert dans la littérature. Des données sont présentées sur l’intérêt dans le travail, les barrières a l’emploi et l’utilisation des services professionnels de réadaptation parmi les membres sans emploi d’un groupe d’aide mutuelle de recuperation de drogue et maladie psychiatrique (N = 130). Bien que les participants aient exprimé un niveau d’intérêt dans le travail élevé, ils ont également cité des obstacles multiples à trouver et à garder un emploi. Un modèle de causation statistique est defini et testé. Les contribuants significatifs à l’intérêt dans le travail étaient l’utilisation de drogue et l’evaluation personelle de l’etat de sante physique. Conformément à nos hypothèses, les symptômes psychiatriques et la perception de plus nombreux obstacles a l’emploi (par exemple, le stigma, la crainte de de ne pas reussir et des qualifications insuffisantes) étaient les contribuants significatifs à la perception de difficulte à poursuivre un emploi, tandis que l’utilisation de substance, la santé physique et l’histoire d’emploi ne l’étaient pas. Finalement, les participants qui ressentaient moins de difficulté a poursuivre un emploi, de même que les hommes, étaient plus aptes a utiliser des services vocationels de readaptation; l’intérêt dans le travail n’etait pas sensiblement associé a l’utilisation des services vocationels. En conclusion, nous discutons le role de l’utilisation de la drogue et des maladies mentales, ainsi que celui de barrieres telles que le stigma, dans le domaine de l’emploi. L’article adresse la definition de buts professionnels réalistes et des stratégies possibles pour minimiser les barrières à l’emploi.

Additional information

Notes on contributors

Alexandre B. Laudet

Alexandre B. Laudet, Ph.D., a social psychologist, joined NDRI in 1994. Her research interests include the process of recovery from addiction over time—particularly after treatment—and factors contributing to the maintenance of lifelong recovery, such as affiliation with 12-step groups. She is also interested in cross-cultural perspectives on addiction and recovery.

Stephen Magura

Stephen Magura, Ph.D., C.S.W., is Director of the Institute for Treatment and Services Research at NDRI. He has designed and directed clinical trials of substance use interventions, treatment outcome studies, health services research, social epidemiology studies, HIV prevention research, and policy analysis. He has published more than 100 articles and authored/edited several books and special journal issues, including Experimental Therapeutics in Addiction Medicine and Program Quality in Substance Dependency Treatment.

Howard S. Vogel

Howard S. Vogel, C.S.W., C.A.S.A.C., is the Executive Director of Double Trouble in Recovery. Mr. Vogel has recently been appointed Deputy Director of Dual-Diagnosed Affairs at the Mental Health Empowerment Project, Inc., in New York State. He is a graduate of Hunter Graduate School of Social Work, holds a C.A.S.A.C. from the Office of Alcoholism and Substance Abuse in New York State, and is currently a consultant for NDRI.

Edward L. Knight

Edward L. Knight, Ph.D., received his Ph.D. in Sociology in 1979 from the Graduate Faculty of the New School for Social Research in New York. He is a researcher with several National Institutes of Mental Health (NIMH)-funded research centres. He trains mental health professionals in recovery in serious mental illness, rehabilitation, and mutual support, run by peers, not professionals. He consults with managed care companies and mental health state authorities. He is diagnosed with schizophrenia and has been homeless.