CRPBRIEF Your Source for Issues and Trends in Community Rehabilitation This project is in part supported under a grant from the Department of Education. However, the contents do not necessarily represent the policy of the Department of Education and endorsement by the Federal Government should not be assumed. Vol. 4, No. 3 July 2005 Substance Abuse and Employment Substance abuse is often cited as a major reason why persons with disabilities do not get or maintain a job. It is clearly a major concern of employers. Despite this, employment IS just as possible for persons with this disability as with any other. We invited Dr. Dennis Moore, Ed.D., of Wright State University (WSU), to examine the issue of substance abuse and employment in this edition of the CRP Brief. Dr. Moore serves as an Associate Professor in the Department of Community Health at WSU, where he is also Director of the SARDI/RRTC on Drugs and Disability. BACKGROUND The use and abuse of alcohol and other drugs affect many people and have wide- ranging consequences. One area of concern is the impact substance use disorders can have on the workforce and employment options for people. It has been estimated that at least 20% of all persons in vocational rehabilitation have an active or very recent substance abuse problem. Recovery from substance use disorders can be challenging, even with professional support and excellent treatment resources. The National Institute on Alcohol Abuse and Alcoholism cites evidence that 90% of alcohol dependent individuals experience at least one relapse in the four years following treatment. The same rates exist for people who are drug dependent. However, national statistics repeatedly show that chemical dependency treatment is successful in assisting with recovery, and employment rates for persons exiting treatment are far better than before they began the process. The employment specialist can play a vital role in assisting with recovery and self- sufficiency. IMPLICATIONS FOR CONSUMERS A disability, for purposes of vocational rehabilitation, is defined as a physical or mental impairment that limits one’s ability to carry out normal day-to-day activities. The functional limitations related to substance use disorders may include: § Physical health problems that co-exist with a substance use. Alcohol and other drugs have negative impacts on most body organs, including the central nervous system. Detoxification from drugs of abuse also causes health problems. Presenting co-existing conditions can include: o reduced stamina; and/or o co-existing medical conditions such as HIV/AIDS, major infections of the heart, hepatitis, tuberculosis, or undocumented traumatic brain injuries. § Impaired cognition. Studies are uncovering the impact on the brain, including changes in neurotransmitter levels. Neurotransmitters regulate our moods and feelings. If neurotransmitter levels are out of balance, people can become emotionally stressed or be easily frustrated or depressed. The good news is that neurotransmitter levels often normalize following recovery, but some persons may require medication in order to assist with this process. The functional limitations associated with substance dependence include: o Low frustration tolerance when learning complex tasks; o Inappropriate emotional responses to supervision; o Inability to handle multiple tasks in stressful environments; o Lack of motivation and initiative; o Lack of concentration; and o Impaired memory. § Emotional instability that negatively affects social relationships. For example, someone who is easily frustrated may be verbally aggressive to other people. Also, some people have never had role models for how to interact with others in the workplace. The treatment program can provide guidance in dealing with emotions and responding appropriately to others. Some functional limitations associated with impaired social abilities include: o Lack of skills to be a member of a workplace team; o Low tolerance for authority; o Poor impulse control; o Being overly dependent on others to make decisions or communicate needs; and o Lack of job seeking skills. § Inadequate social skills due to lack of work experience. Many people have poor or underdeveloped work histories. The functional limitations may include: o Lack of knowledge of workplace expectations; o Inability to obtain a position with benefits in the current job market; o Undeveloped or underutilized problem solving strategies; and o Limited skills to support maintenance of employment (housing, budgeting, transportation, etc.). § Consequences that occur when people abuse alcohol and other drugs. The activity itself can create problems in vocational rehabilitation. These include: o Loss of driving privileges due to DUI which limits transportation options; o Felony records due to drug involvement which result in convictions and restrict employment options; and o Overwhelming feelings of guilt, anxiety and hopelessness. The Americans with Disabilities Act (ADA) (ADA) prohibits discrimination against “qualified individuals with disabilities.” This includes applicants for employment who have experienced substance use disorders. However, there are some restrictions to when and how the ADA covers persons with substance dependence. § If a person is currently engaged in the illegal use of drugs, he or she is not considered a “qualified individual with a disability” protected by the ADA when the employer takes action on the basis of drug use. Example: if a person is given a drug test as part of ongoing performance evaluations and it shows cocaine use, he or she could be fired if the employer prohibits such use. (However, this person still qualifies for rehabilitation services under the provisions of the Rehabilitation Act in many cases.) § A person who currently uses alcohol is protected by the ADA if that person is qualified to perform the essential functions of the job. In fact, an employer may be required to provide an accommodation to an alcoholic. However, if the use of alcohol causes problems in the workplace or conduct on the job, an employer can discipline, discharge or deny employment to an alcoholic. An employer also may prohibit the use of alcohol in the workplace and can require that employees not be under the influence of alcohol. A good resource for understanding substance dependence (including alcoholism) from the perspective of an employer is Employing and Accommodating Persons with Histories of Alcohol and Drug Abuse, produced by the Program on Employment and Disability at Cornell University (http://www.thebody.com/ada/pdfs/drugalc.pdf). This article also details a number of job-related accommodations that might be necessary for someone in recovery. Not every consumer will have all the limitations associated with substance use disorders. Every person is different and may present other barriers to employment. What is essential is that rehabilitation practitioners and consumers focus on what makes being healthy and successfully employed possible. RELEVANCE FOR CRPS Persons with substance abuse histories may need services beyond substance dependence treatment, including assistance with employment. Community rehabilitation programs can be critically important for this effort. In fact, research has shown that persons in recovery from substance dependence have some of the highest rates for success in the VR system. The challenge, of course, is to assist consumers in truly addressing their substance abuse issues. This challenge is best addressed chemical dependency treatment, and VR – with each partner focusing on the larger goal of sobriety for economic independence. Research findings at the RRTC on Subsuggested several issues that require special attention. These include awareness of potential ment, judgment issues, and difficulty in followments remediate over a period of months or of chemical dependency treatment that have been shown to be effective include case management, housing stabilization, and peer support. the chances for recovery from substance dependence, and an acceptance of the consumer role successful outcomes. Employment services most associated with successful rehabilitation of substance dependence include assessment, transportation, maintenance, and skills training. It is also important to consider the nature, severity and job-relatedness of past convictions – as well as the age of the consumer at the time of previous employment relative to their latest substance abuse episodes. The consumer also likely will need assistance in understanding the nature and consequences of drug testing in the work place and how and when to request accommodations from future employers. practices that have been used successfully are job coaching and supported employment, even among persons with the most severe conditions. injuries, current drivers’ license status and use of medications are often included if legally appropriate. The questions must be answered address these questions can be very important. For instance, it is recommended that rehabilitation practitioners have consumers check their state and federal records. Sometimes records will show arrests and convictions. If an arrest did not lead to a conviction, it will be important to clean up the record with officials if possible. A rehabilitation practitioner should practice job interviews with consumers and utilize outside comfortable responding to a variety of people and situations while presenting a positive (while honest) picture. What if the consumer refuses to address substance abuse issues even though the counselor strongly suspects that there is a problem? Even in the era of “client choice”, it is the role and responsibility of the counselor to identify and address barriers to employment. This can be done a number of different ways, sometimes in combination. The techniques that a counselor may find most effective in working with the resistant consumer can include requesting a professional substance abuse assessment, drug testing, contingency contracts associated with support networks oriented toward recovery (such as A.A., or Narcotics Anonymous), more regular office appointments to serve as a check warranted – enrollment in a chemical dependency treatment program. Community rehabilitation programs have an investment in developing capacity for serving people who have substance abuse disorders. On one hand, the services provided by a CRP can be an excellent adjunct to other treatment efforts. On the other hand, the programs also encounter substance use disorders among consumers referred by other agencies. Resources are available to support efforts to train staff and develop program capacities. Substance Abuse, Disability & Employment (http://www.med.wright.edu/citar/sardi/ rrtc.html) Employing and Accommodating Persons with Histories of Alcohol and Drug Abuse (http:// www.thebody.com/ada/pdfs/drIdeas for Accommodating Persons with Alcoholism (http://www.jan.wvu.edu/media/ alcohol.html) by a partnership involving the consumer, stance Abuse, Disability, and Employment have neurocognitive deficits, such as memory impairing multi-step directions. Some of these impairyears following recovery. Particular components Not surprisingly, positive perceptions of in recovery, are also positively correlated with Two Questions on criminal history, job-related honestly, but professional guidance in how to people to role play. The consumer needs to be the rehabilitation plan, involvement in peer- on consumer progress and sobriety, and when SUMMARY Websites and Other Resources Rehabilitation Research & Training Center on ugalc.pdf) Region VI CRP-RCEP PO Box 311456 Denton, TX 76203-1456 71954 Meeting the continuing education needs of community rehabilitation providersMeeting the continuing education needs of community rehabilitation providersMeeting the continuing education needs of community rehabilitation providersMeeting the continuing education needs of community rehabilitation providersMeeting the continuing education needs of community rehabilitation providersThe CRP Briefis published 3 times a year by the Region VI CRP-RCEP and is also available on our website: www.crp.unt.edu For more information contact: Linda Holloway, Editor, University of North Texas - Region VI CRP-RCEP PO Box 311456, Denton, TX 76203-1456 940/565-4000 Visit Our WebsiteTechnical Assistance Manual: Title I of the ADA – Drug and Alcohol Abuse (http:// www.jan.wvu.edu/links/ADAtam1.html#VIII) Accommodation & Compliance Series: Employees with Drug Addiction (http:// www.jan.wvu.edu/media/drugadd.html) Special Edition of Working Out for People with Criminal Histories (http:// www.instituteofliving.org/Programs/Rehab/ October_2004.pdf) Integrating Substance Abuse Treatment and Vocational Services (http:// www.ncbi.nlm.nih.gov/books/ bv.fcgi?rid=hstat5.chapter.68228)