Substance Use Disorder: Vocational Rehabilitation Strategies to Support Quality Employment

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People with disabilities are at a much higher risk for substance use disorders compared to their peers without disabilities.
Substance use disorders occur when the recurrent use of alcohol and/or drugs causes clinically significant impairment, including health problems, disability, and failure to meet major responsibilities at work, school, or home. SAMHSA
Researchers have found that about half of individuals who experience a substance use disorder during their lives will also experience a co-occurring mental health disorder, and vice versa. Rates of substance use disorders in people with traumatic brain injury and spinal cord injury in the United States approach or exceed 50%, as compared to 10% for the general population. Approximately 4.7 million individuals have a co-occurring disability and substance abuse problem.

The Positive Benefits of Employment

People with substance use disorders who are employed experience many positive benefits. They more frequently complete treatment, have lower incidences of relapse, demonstrate less criminal behavior and parole violations, and experience an enhanced quality of life.

Barriers to Employment

Although employment has been identified as one of the key priorities for people with substance use disorder, they still encounter many challenges to finding and keeping employment. Barriers to employment could include:

  • Lack of transportation
  • Probation or treatment program requirements
  • Limited work history
  • Limited education or skill sets
  • Criminal history
  • Stigma or lack of employers understanding

Vocational Rehabilitation Strategies

Consider using these VR strategies to best support people with a substance use disorder find and maintain employment:

Care Coordination

People with a substance use disorder who are employed are more likely to complete treatment and successfully recover from the disorder. Given this, it is important that all involved agencies and service providers openly communicate and collaborate to better support clients in both recovery and reaching their employment goals.

Job Placement

Interest inventories, aptitude tests, or personality tests can be used to identify employment that maximizes job-seekers’ skills and abilities.

Job Search Services

Many people with substance use disorders have limited work experience histories. Providing support to prepare for interviews and respond to questions related to employment gaps or training deficiencies could be beneficial.


Education-focused interventions could help establish skills for people with long histories of unemployment.

Soft Skills Development

Soft skill development could include time management, meeting deadlines, communication, problem solving, and decision-making.


Purchasing needed supplies, such as work uniforms, providing resources for housing and income needs, and supporting community engagement activities could all lead to long-term employment outcomes.

Reducing Stigma

People with substance use disorders could face stigma from both employers and in the community. Advocating to reduce disability-related stigma could increase employment and quality of life outcomes for job seekers.

On-the-Job and Natural Supports

On-the-job supports could enhance job retention for people with substance use disorder. These supports could include:

  • Job coaching to help clients develop work skills and competencies to meet their employment goals.
  • Using a place-and-train model to ensure the worker has sufficient training to complete job-related tasks

Natural supports could come from support groups, family members, social networks, or community-based organizations.

Potential Job Accommodations for Workers with Substance Use Disorders

Take note of these job accommodations that could address common limitation of people with substance use disorders:

Flexible Scheduling

Provide leave or allow for flexible scheduling so employees can attend medical and treatment-related appointments.
Develop a self-paced workload with flexible daily scheduling.


Reduce workplace distractions, implement more frequent breaks, dividing large assignments into smaller tasks, or restructure a job to include only essential functions.

Stress and Fatigue

Use positive reinforcement and praise, provide counseling, modify daily schedules and breaks, adapt supervisory methods, assign individuals to a less stressful or physically demanding job, allow remote work, or implement an ergonomic workstation.


Provide clerical support, keep a to-do list daily, use an electronic organizer, maintain calendars, and provide reminders of important dates or deadlines. Weekly meetings with supervisors to discuss progress and goals and address questions or concerns they raised, as well as providing clear goals, expectations, and consequences in writing could also be helpful.

Exposure to Alcohol or Drugs

Provide workplace supports, implement extra supervision, reassignment to a position that does not involve exposure to drugs or alcohol, and limit mandated social functions that involves exposure to alcohol or drugs.
Source: Information in this article was taken from the Substance Related Disorders 101 - TACQE U webinar.

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