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Abstract
The nationally representative Alcohol and Drug Services Study (ADSS, 1996–1999) is used to examine employment counseling's impact on treatment participation and on postdischarge abstinence and employment. Employment counseling (EC) is among the more frequently received ancillary services in substance user treatment. The ADSS study sample showed it was received by 13% of all (N = 988) nonmethadone outpatient clients, and 42% of the 297 clients with a need for it. Clients who received needed EC (met need) are compared to clients who did not receive needed EC (unmet need). Met-need clients had significantly longer treatment duration and greater likelihood of employment postdischarge than unmet-need clients. Both groups were as likely to complete treatment and be abstinent at follow-up. Implications are discussed. Future needed research and unresolved critical issues are also noted.
Notes
aThe journal's style utilizes the category substance abuse as a diagnostic category. Substances are used or misused; living organisms are and can be abused. Editor's note.
Additional information
Notes on contributors
Sharon Reif
Sharon Reif, Ph.D., is a Senior Research Associate at the Schneider Institute for Health Policy at Brandeis University. Dr. Reif received her Ph.D. in social policy from the Heller School for Social Policy and Management at Brandeis University; her dissertation examined the role of ancillary services in substance user treatment outcomes. She received a training grant from the National Institute of Alcohol Abuse and Alcoholism (NIAAA) while in the doctoral program at the Heller School. She has over 14 years of experience in the field of “substance abuse” research, including project management, client interviews, data analysis, and manuscript preparation. Recently, Dr. Reif was the project manager for an RWJ grant covering ongoing analyses of the Alcohol and Drug Services Study (ADSS), with a focus on the specialty substance user treatment system, and the clients within that system. This work stemmed out of her participation under the original contract to conduct and perform analyses for ADSS. In addition, Dr. Reif is currently the project manager on a CSAT study of the relationship of financing and cost issues with access to substance user treatment. Her primary research interests center around what happens to clients during and following substance user treatment.
Constance M. Horgan
Constance M. Horgan, Sc.D. (Health Policy and Management, Johns Hopkins University), is a Professor at the Heller School for Social Policy and Management, Brandeis University and Director of the Center for Behavioral Health within its Schneider Institute for Health Policy. She has over 25 years of experience in health policy analysis and services research in both academic and government settings, and has been involved in numerous health surveys. She has focused her attention on studying how “substance abuse” and mental health services are financed, organized, and delivered in the public and private sectors. In 1990, Dr. Horgan founded the Substance Abuse Group at the Schneider Institute for Health Policy and codirected its first National Institute on Drug Abuse (NIDA) funded center on health services research. She directs a National Institute for Alcohol Abuse and Alcoholism (NIAAA) doctoral training program and teaches courses in child health policy and “substance abuse” policy. Dr. Horgan was the principal investigator for the recently completed Alcohol and Drug Services Study (ADSS). She also leads several studies on managed behavioral health care and codirects the Brandeis/Harvard Center on Managed Care funded by the National Institute on Drug Abuse (NIDA). Dr. Horgan is the lead author of Substance Abuse: The Nation's Number One Health Problem. She has directed studies for Substance Abuse and Mental Health Services Administration (SAMHSA), Agency for Healthcare Research and Quality (AHRQ), Health Care Financing Administration (HCFA), National Institute of Mental Health (NIMH), NIDA, NIAAA, and foundations, including Robert Wood Johnson. Dr. Horgan has written numerous articles and served on expert panels and advisory committees for federal agencies, professional associations, and academic and community task forces. As part of the Center for Substance Abuse Treatment's National Treatment Plan, she chaired the panel on connecting services and research.
Grant A. Ritter
Grant A. Ritter, Ph.D., is a Senior Research Scientist at the Schneider Institute for Health Policy at Brandeis University. Dr. Ritter holds a doctorate from Cornell University in mathematics and a master's degree in biostatistics from Medical College of Virginia. At Brandeis’ Schneider Institute for Health Policy, he has had extensive experience in the management and statistical analysis of large datasets for both cross-sectional and longitudinal studies. Most recently, Dr. Ritter has been the lead statistician for the SAMHSA—funded Alcohol and Drug Services Study (ADSS). In this capacity he has been responsible for all methodological aspects of the study, including design of its multistage sampling plan, quality control and data reliability, analyses of collected data, and analysis of the impact of incentive payment on response rates. Previous to ADSS, Dr. Ritter served as lead Institute statistician on a number of Healthcare Financing Administration (HCFA) evaluation and technical assistance projects, including the SHMO (1992), Models for Medicare Payment System Reform Based on GVPS (1995), the ORD demonstration on GVPS (1996), The Development of Hierarchical Coexisting Conditions and Procedures (1996), and the Prospective Payment Per Visit for Medicare Home Health Services Demonstration (1995). Dr. Ritter is also coordinator of computer programming and data management for Brandeis’ Schneider Institute for Health Policy and is responsible for the storage, maintenance, and security of secondary data at the Institute.
Christopher P. Tompkins
Christopher P. Tompkins, Ph.D., is an Associate Professor at the Schneider Institute for Health Policy. Dr. Tompkins has directed many projects related to the financing, organization and evaluation of health, mental health, and substance abuse treatment services. Dr. Tompkins directed a CSAT and CMHS study of the managed behavioral health carve-out in Arizona, and led the analysis of private sector managed care and fee-for-service data in research sponsored by CMHS. Dr. Tompkins was the Study Leader for the alcohol and other drug Target Population in a SAMHSA study of Managed Care and Vulnerable Populations. Currently, he is directing a CSAT analysis of access to substance abuse treatment services, and a NIDA study developing prospective payment systems for substance user services.