1 INCLUDING VOCATIONAL REHABILITATION IN SUBSTANCE ABUSE TREATMENT H. L. Brostrand, Ph.D., LPCC, CRC Now: Mental Health Vocational Counselor II Contra Costa County, Behavioral Health Services Next week: Associate Professor, CSUS Graduate and Professional Studies in Education August 13, 2014 2 1
3 4 A Love Affair: Unemployment & Relapse (1) Risky alcohol consumption is more prevalent among the unemployed. They are also more likely to be smokers and to have SUD. (2) Problematic substance use increases the likelihood of unemployment and decreases the chance of finding and holding down a job. (3) Unemployment is a significant risk factor for substance use. (4) Unemployment increases the risk of relapse after alcohol and drug addiction treatment. Current Drug Abuse Reviews. 2011 Mar; 4(1):4-27. Unemployment and substance use: a review of the literature (1990-2010). Henkel D. 2
5 Employment statistics in the US (DOL) National Unemployment Rate: 6.5% For those with a disability: 14.5% California unemployment rate: 8.0% With SUD or in recovery:??? http://store.samhsa.gov/product/ready-willing-and-able-to- Work-Employment-for-People-In-Recovery/All-New- Products/SMA12-4676DVD 6 National Unemployment Bachelor's degree Some college or High school Less than a high Hispanic or Latino Asian Black or African White Women Men Persons with no disability Persons with a disability 0 5 10 15 20 25 3
7 Where s the voc rehab in SUD tx?! Title 22 Treatment Standards Assessment of treatment needs in: Vocational counseling and training Job referral and placement Discharge Summary Vocational/educational achievements We surveyed substance treatment facilities in the United States in 2006 From a checklist of 17 vocational components: Sixty-two facilities (40%) provided no job related services whatsoever. Of the 60%, 82% refer clients to the state Department of Rehabilitation for vocational services. 8 Benefits of employment Provides structure Self-esteem Self-efficacy Security Sober relationships Activities (on and off the job) Develop job skills Develop social skills Income! 4
9 Barriers to employment in recovery Continued use/later use Personality/behavioral impairment Poor work histories are common Motivation to work may be low Work ethics, work values Family and social support Conviction record Lack of job skills Economic conditions Discrimination 10 Barriers to job retention in recovery Low paying jobs with few/no fringe benefits Jobs with little/no upward mobility Discrimination Lack of education Fear; Anger; Frustration Poor interpersonal/relationship skills Cognitive impairment Co-existing disabilities Continued use of AOD Return to substance abuse Return to crime 5
11 SUD is a disability The ADA defines disability as: a physical or mental impairment that substantially limits one or more major life activities; or a record of a physical or mental impairment that substantially limited a major life activity; or when a covered entity takes an action prohibited by the ADA because of an actual or perceived impairment. "Disability" under Social Security is based on your inability to work. We consider you disabled if: You cannot do work that you did before; We decide that you cannot adjust to other work because of your medical condition(s); and Your disability has lasted or is expected to last for at least one year or to result in death. 12 DSM-IV Substance Dependency Maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring in 12-month period: Tolerance Withdrawal Substance is often taken in larger amounts or over a longer period than intended. Persistent desire or unsuccessful efforts to cut down/control substance use. A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects. Important social, occupational, or recreational activities are given up or reduced because of substance use. The substance use is continued despite knowledge of having a persistent problem. 6
13 Does the ADA cover SUD? The ADA may protect a qualified alcoholic who can meet the definition of disability. The ADA does not protect an individual who currently engages in the illegal use of drugs, but may protect a recovered drug addict who is no longer engaging in the illegal use of drugs, who can meet the other requirements of the definition of disability, and who is qualified. PAW = disabling symptoms of SUD Symptoms of SUD have a substantial impact on activities of daily living. PAW symptoms, which can last up to two years, usually result in significant impairment in activities of daily living. In addition, without continued treatment (relapse prevention) clients will most likely deteriorate in one or more important areas of life functioning. 14 7
Significantly limiting effects of PAW Interpersonal/relationship skills isolation minimal or no social supports no community ties criminal record stigma emotional instability poor coping skills poor impulse control unassertiveness sexual dysfunction increased stress physical pain irritability shame and guilt low self-confidence childhood trauma side effects of medication 15 Self-care/personal upkeep poor health pessimistic outlook hopelessness isolation listlessness fatigue sleep disorders depressive symptoms emotional overload impaired judgment immaturity impulse control cognitive limitations limited financial resources* never learned how 16 Work limiting symptoms of PAW physical limitations decreased productivity lack of problem-solving skills anxiety impatience cognitive deficits poor memory decreased comprehension slower mental processing distorted perceptions diminished concentration can impact ability to learn and/or perform work functions, to plan, problem solve and/or organize work functions, as well as to meet the required level of functioning on the job. 8
17 Common co-existing disabilities As many as 6 in 10 substance abusers also have at least one other mental disorder. (NIDA) In the GP, 10% of individuals are alcoholics and 5% are addicted. PWD experience SUD at rates 2 to 4 times that of the GP. Abuse rates approach or exceed 50% for persons with traumatic brain injuries, spinal cord injuries, or mental illness. Individuals with deafness, arthritis, and multiple sclerosis, have substance abuse rates of at least double the GP. Approximately 40-50% of persons with spinal cord injuries, orthopedic disabilities, vision impairment, and amputations, can be classified as heavy drinkers. http://www.hhs.gov/od/about/fact_sheets/substanceabusech26.html 18 Persons diagnosed with SUD are roughly twice as likely to have mood and anxiety disorders. Persons diagnosed with mood or anxiety disorders are about twice as likely to have SUD. (NIDA) 9
19 Co-occurring disorders ADD/ADHD and LD Children and adolescents with psychiatric conditions are at higher risk of abusing drugs than other youth. PTSD and depression Physically or emotionally traumatized people are at much higher risk of abusing licit, illicit, and prescription drugs. 1.5% of veterans had co-occurring serious psychological distress and substance use disorder Up to 80% of women seeking treatment for drug abuse report lifetime histories of sexual and/or physical assault. PTSD contributes to teen/young adult marijuana abuse/dependence 20 Disability commonly resulting from SUD PTSD Liver Heart HIV Hepatitis Brain damage Physical injury Other? 10
21 What is vocational rehabilitation? Vocational rehabilitation is a service that helps people with physical or mental disabilities find employment and retain it. It usually is offered through state government agencies. Eligibility is based on a medically diagnosed disability. Voc rehab begins with C&G and VA. Vocational readiness services and training may be provided. Once a person is ready for employment, voc rehab assists with placement. http://www.ehow.com/facts_5631200_definition-vocational-rehabilitation.html 22 Vocational components Job Seeking Skills Interviewing Applications Resume preparation Job search techniques Job Maintenance Social and interpersonal skills Work skills Work tolerance Grooming, hygiene 11
23 vocational components continued Job Placement Current job leads Employer contacts Job search assistance Job coaching Resources Newspapers (LOL) Yellow pages Computer access Videos, reference books Referrals 24 The first and best referral One-Stop East Bay Works http://www.eastbayworks.org/default.asp CalJobs www.caljobs.ca.gov Job listings and on-site recruitment Access to computers, printers, faxes and phones Free workshops (computer, resume, interview, etc.) Career exploration Labor market information Videos, books and tutorials Training program information Richmond Works & Richmond Craft 12
25 Additional vocational resources 2-1-1 https://www.crisis-center.org/documents/resource%20guides/ West%20County%20English.pdf EDD DOL ODEP WID Disability 101 www.db101.org Probation/parole County Employment & Human Services dept. Community College Adult Schools WOTC http://www.edd.ca.gov/pdf_pub_ctr/de8722.pdf 26 Possible additional services Insurance benefits (current or prior employment) SDI Union Veteran Senior or youth Physical disability Workers compensation CalWorks Ethnic/gender/SES specific resources Other? 13
27 Voc rehab in your SUD program Computer access Indeed http://www.indeed.com Opportunity Knocks http://www.opportunityknocks.org/ Tutorials and related sites http://www.onetonline.org/ Materials Free and low-cost curriculums Books/workbooks JIST http://jist.emcpublishingllc.com/page-jist/ EdITS http://www.edits.net/ Videos Computer-based (many free and on-line) Volunteer opportunities Any business/organization within walking distance Social service agencies Service and religious organizations Referrals CBOs, ILCs, recovery-based 28 How can we integrate? TALK ABOUT EMPLOYMENT Train existing staff ODEP, workshops, other?? Dedicate physical space to vocational materials/resources Dedicate programming time to employment activities Educational Therapeutic Relapse prevention Accountability? Treatment Plan Post-treatment survey Audience Suggestions 14
29 DOR provides services and advocacy resulting in employment, independent living, and equality for individuals with disabilities. If you have a disability and you need vocational rehabilitation services, DOR may be able to help you find work and become independent. You and your counselor will develop your vocational rehabilitation program, which includes your employment goal and the services you will need to reach your goal. http://www.rehab.cahwnet.gov 30 To be eligible for DOR services have a physical or mental impairment that substantially impedes his/her ability to secure employment vocational rehabilitation services are required to prepare for, secure, retain, or regain employment consistent with the applicant's unique strengths, resources, priorities, concerns, abilities, capabilities, interests, and informed choice can benefit from the provision of services in terms of an employment outcome in an integrated setting 15
31 Severity of Disability (LSOD) Priority for Services - You and your counselor will: review and discuss information obtained from you and other sources about your disability, agree on how it limits you in six general areas of functioning, including: communication, mobility, interpersonal skills, self care, work tolerance and work skills, and based on this assessment, determine your disability priority score that represents the significance of your work-related limitations. "most significantly disabled" category served first. "significantly disabled" category will be served next, "disabled category" served last Waiting list established 1995 32 Anecdotal DOR information If you are ready, willing, and able to work (with or without accommodation) Orientation Forms What to bring and why Intake Role of the rehabilitation counselor Role of the client Informed consent and client choice 16
I refer, and referred to, frequently: Substance Use Disorders and Vocational Rehabilitation: VR Counselor s Desk Reference Rehabilitation Research and Training Center on Substance Abuse, Disability and Employment http://www.med.wright.edu/sites/default/files/citar/sardi/files/vr_desk_ Reference.pdf TIP 38: Integrating Substance Abuse Treatment and Vocational Services SAMHSA, CSAT http://store.samhsa.gov/product/tip-38-integrating-substance- Abuse-Treatment-and-Vocational-Services/SMA06-4216 DOR Consumer Information Handbook http://www.dor.ca.gov/vred/handbook-docs/handbook-large.pdf 33 17