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Vocational rehabilitation and job accommodations for individuals with substance abuse disorders.

According to 2007 statistics reported by the Substance Abuse and Mental Health Services Administration (SAMHSA, 2008), there were an estimated 22.3 million individuals in the U.S. aged 12 or older (9% of the population) who met the DSM-IV diagnostic criteria for either substance abuse or dependence. Of those 22.3 million, 15.5 million were classified with alcohol abuse or dependence, 3.7 million were classified with drug abuse or dependence, and approximately 3.2 million had abuse or dependence on both alcohol and drugs.

The present study examines employment outcomes and workplace accommodation issues for individuals with substance abuse disorders. Rehabilitation Services Administration (RSA) client service records show the types of employment successfully rehabilitated individuals have attained. Workplace accommodation information, however, is not included in the RSA case-closure record (RSA-911 form). Given the importance of workplace accommodations, data from the Job Accommodation Network (JAN) have been incorporated to provide a more complete picture of the services needed for individuals with substance abuse disorders to retain employment. Thus, the focus of the current article is on approaches to serving individuals with substance abuse disorders, drawn from two databases. Analyses are conducted to examine the rates of successful employment outcomes (case closures) of clients with either alcoholism or drug addictions who were served by the State/Federal Vocational Rehabilitation System across three years (1996, 2000, 2004). A primary reason for selecting 1996 as the first year for the RSA data was that the available JAN database spanned 1996 to 2005.

Counselors in the Rehabilitation Services Administration (RSA) provide counseling and employment-related services to individuals with disabilities to obtain employment and live more independently (Rehabilitation Services Administration, 2006). Analyses are conducted to examine the prevalence of accommodation inquiries made to the Job Accommodation Network (JAN) for clients with substance abuse (alcoholism or drug addiction). JAN is a free resource for information regarding job accommodations and Title I of the ADA. The service is available free of charge to anyone, but the majority of inquiries (68%) are from employers and individuals with disabilities. JAN averages about 32,000 telephone inquiries (cases) per year and provides one-on-one consultation (and follow-up materials and communications, as necessary) to each person about all aspects of job accommodation, including the accommodation process, effective accommodation options, funding sources for accommodations, product information, disability awareness, and legal rights and responsibilities under the employment provisions of the ADA.

The following research questions are investigated:

1. What are the demographic characteristics for individuals with substance abuse disorders (Alcoholism vs Drug Addiction) who received Vocational Rehabilitation services?

2. Are there differences between clients (consumers) with Alcoholism vs Drug Addiction, in terms of Vocational Rehabilitation services received and outcome (rehabilitated vs not rehabilitated)?

3. What occupations were involved for those Vocational Rehabilitation consumers whose outcomes were successful (rehabilitated)?

4. In the JAN case data for substance abuse calls from 1996 to 2005, what are the relative proportions of (a) Causative Factor, (b) Caller Industry, (c) Job Function, and (d) Issue Discussed?

5. What commonalities link the findings from the RSA cases to the findings from the JAN cases on substance abuse disorders?

In the workplace, individuals with substance abuse disorders often exhibit difficulties with attendance, concentration, staying organized, meeting deadlines, handling stress, and maintaining stamina during the workday (Batiste, 2005a; 2005b). The obligation to provide accommodations for people with substance abuse under the ADA can be confusing to employers because the obligation differs somewhat from the obligation to accommodate employees with other types of disabilities. The difference mainly arises from the general rule that employers do not have to provide accommodations to enable an employee to continue abusing substances. For example, the ADA requires employers to consider providing flexible work schedules for employees with disabilities who are experiencing problems related to their disabilities (e.g., an employee with multiple sclerosis who cannot work late because of fatigue, or an employee with Crohn's disease who needs frequent restroom breaks). However, if the current abuse of substances is causing the problems, under the ADA, the employer does not have to provide accommodations to address those problems. In addition, employers are not required under the ADA to accommodate employees with substance abuse by allowing them to violate conduct rules (e.g., working under the influence of illegal drugs). On the other hand, employers may need to consider accommodations related to treatment of the addiction, such as leave time for rehabilitation or a flexible schedule to attend AA meetings.

In a systematic review, Adamson, Sellman, and Frampton (2009) found that, for patients with alcohol use disorders, one of the "key predictors" of drinking-related outcome was previous employment (during the baseline period). There is evidence lending support to vocational services being incorporated into substance-abuse treatment (Deren & Randell, 1990; Durkin, 2002; Leshner, 2001; SAMHSA, 2000). Employment has been shown to be beneficial for retention in treatment programs and moderating relapse occurrence (Platt, 1995; Wolkstein & Spiller, 1998). Wolkstein, Bausch, & Weber, 2000 suggested that relevant topics to be included in treatment for substance abuse are the importance of work (independence, income, respect), pre-treatment factors (employment history, education, social milieu), treatment goals (realistic employment, drugs/alcohol), services (basic employment training, problem-solving skills, job placement), integrated rehabilitation model (vocational, economic, social, psychological, legal, spiritual), and post-employment services (job coaching, ongoing counseling for employment retention and sobriety). Unemployment and vocational instability constitute a theme emphasized by rehabilitation professionals and researchers (e.g., Brown & Saura, 1996; Gorske, Daley, Yenerall, & Morrow, 2006; Magura, 2003; Rehabilitation Research and Training Center on Substance Abuse and Disability, 1996; Renwick & Krywonis, 1992).

In addiction-treatment evaluation research, employment has been viewed as both a desired outcome and an element of treatment (e.g., income, self-esteem, integration into mainstream society). Barriers that may work against the vocational rehabilitation client with substance use disorders include: job-related barriers (e.g., lack of education or training), attitudinal barriers (e.g., employer bias), program-level barriers (e.g., poor vocational services), medical and emotional barriers (e.g., continued alcohol or drug use), and family and societal barriers (e.g., disincentives from public financial support) (Platt, 1995). Misconceptions about the nature of substance abuse as a disability may create additional barriers, not only for the client, but also for the counselors working with these individuals. These misconceptions may be decreased by providing additional training to vocational rehabilitation counselors in the area of substance abuse (Greer & Walls, 1997; West & Miller, 1999). The present research considers the address of barriers through rehabilitation services and job accommodations for consumers with alcoholism or drug addiction.

Method

Participants

Individual case data were investigated from two disability-related databases (RSA and JAN). Archived data were examined to gather information on vocational rehabilitation outcomes and job accommodations for individuals with substance abuse disorders. The data consisted of cases where individuals were dealing with drug addiction or alcoholism.

The RSA records included all applicants for State/Federal Vocational Rehabilitation services in 1996, 2000, and 2004 who had a primary disability of alcohol abuse or dependence or drug abuse or dependence, termed alcoholism and drug addiction for purposes of this research. Since all client records in those years were used, all states and territories of the United States were included. The Vocational Rehabilitation cases in the RSA-911 form database contain information on such data elements as: (1) demographics of the client (e.g., age, gender, education), (2) disabling condition of the client (e.g., drug abuse or dependence), (3) services received by the client (e.g., technical-school training, job-search assistance), (4) case outcome for the client (e.g., rehabilitated to competitive employment, not-rehabilitated case outcome), and (5) occupational outcome (e.g., construction, motor freight). The Vocational Rehabilitation cases in the RSA-911 database for clients with alcoholism or drug addiction totaled 29,063 in 1996, totaled 36,529 in 2000, and totaled 35,473 in 2004.

The second database contained JAN case records. The case records of JAN for the time period of 1996-2005 (all years) included a total of 1,365 cases concerning accommodations for individuals with substance abuse issues (not necessarily the primary disability). Descriptive data were collected on each "case" (inquiry) handled (primarily via telephone, but often involving follow-up e-mail or information sent by the JAN consultant to the inquirer by U.S. mail). The data elements collected by skilled JAN consultants from the Employee (or potential employee), the Employer, or the Rehabilitation Professional included: (1) caller industry, (2) job functions, and (3) tasks to be accommodated, (4) limitations, (5) causative factors, and (6) issues/concerns.

Results

Research Question 1

What are the demographic characteristics for individuals with substance abuse disorders (Alcoholism vs Drug Addiction) who received Vocational Rehabilitation services? Descriptive statistics (e.g., frequencies and percentages) are used, rather than inferential statistics (e.g., chi-square), in addressing the research question because even slight differences with such large samples consistently yield statistically significant differences. For example, an analysis of Referral Source by Case Closure Outcome (for the 35,473 drug and alcohol vocational rehabilitation cases in 2004) yields Chi-Square (8, N = 35,473) = 95.3, p < .0001, a highly significant result. The numbers of alcohol versus drug cases are presented in Table 1 for Gender, Age, and Education. Consistently across the categories listed in Table 1, there were more drug addiction cases than alcoholism related cases (about 60% drug addiction to 40% alcoholism). Across the three time periods (1996, 2000, and 2004), 26% of alcoholism cases involved female clients, and 74% involved male clients. For the drug-related cases, 31% involved female clients and 69% involved male clients. In total, 57% of female clients were rehabilitated, and 55% of male clients were rehabilitated (Table 1).

The age of these clients tended to be less than 46 years (nearly 80%) (Table 1). Client ages were partitioned into six age ranges, which included (a) less than 26, (b) 26 to 35, (c) 36 to 45, (d) 46 to 55, (e) 56 to 65, and (f) greater than 65. Across all three time periods more of the clients were in the 36 to 45 age range (40%) than in any other age range. The clients with drug addiction tended to be younger than those clients with alcoholism. For example, in the less than 26 age category across the three time periods, the percentages were 11%, 12%, and 13% for drug addiction cases compared to 8%, 7%, and 6% for alcoholism cases. Across 1996 and 2000 and 2004, there were 31% who had not achieved a high school diploma, 47% who had graduated high school, and 21% who had some post-secondary training. The alcoholism cases (48% high school graduates) and drug addiction cases (47% high school graduates) were similar in educational achievement. The frequencies associated with these percentages are presented in Table 1.

Research Question 2

Are there differences between clients (consumers) with Alcoholism vs Drug Addiction in terms of Vocational Rehabilitation services received an outcome (rehabilitated vs not rehabilitated)? Of the 29,063 individuals with a substance abuse disorder served in 1996, 54% achieved a successful rehabilitation outcome. In 2000, 57% of the 36,529 clients were rehabilitated. In 2004, 51% of the 35,473 persons were rehabilitated. In Table 2, these percentages are partitioned by the primary disability (alcoholism versus drug addiction). The two types of disabling conditions show remarkable consistency in each year (54% versus 53% in 1996, and 57% versus 57% in 2000, and 52% versus 51% in 2004) (Table 2). Of the clients who were rehabilitated, approximately 90% were "competitively employed" upon completion of services.

In 1996, there were 15,608 consumers with substance abuse disorders who were rehabilitated and 13,455 who were not rehabilitated. In that year, there was relative equality between the percentages of rehabilitated versus not rehabilitated consumers who received: (1) Assessment (82% vs. 82%), (2) Restoration Services (30% vs. 24%), (3) College Training (11% vs. 12%), (4) Business-Vocational Training (13% vs. 11%), (5) Adjustment Training (22% vs. 17%), (6) On-the-Job Training (5% vs. 2%), (7) Transportation (41% vs. 44%), and (8) Maintenance (31% vs. 24%). However, there were relatively greater differences for rehabilitated versus not rehabilitated clients who received: (1) Job Finding Services (38% vs. 20%) and (2) Job Placement Services (27% vs. 11%). The reader should note, however, that Job Finding Services and Job Placement Services usually are provided near the end of the rehabilitation process after unsuccessful clients have dropped out, and when those who have made good progress are nearing the end of rehabilitation training and intervention.

In 2000, there were 20,945 consumers with substance abuse disorders who were rehabilitated and 15,584 who were not rehabilitated. In that year, there was relative equality between the percentages of rehabilitated versus not rehabilitated consumers who received: (1) Assessment (69% vs. 68%), (2) Restoration Services (36% vs. 32%), (3) College Training (9% vs. 10%), (4) Business-Vocational Training (13% vs. 11%), (5) Adjustment Training (20% vs. 18%), (6) On-the-Job Training (4% vs. 3%), (7) Transportation (45% vs. 38%), and (8) Maintenance (26% vs. 21%). However, there were relatively greater differences for rehabilitated versus not rehabilitated clients who received: (1) Job Finding Services (43% vs. 26%) and (2) Job Placement Services (36% vs. 18%).

In 2004, there were 18,150 consumers with substance abuse disorders who were rehabilitated and 17,323 who were not rehabilitated. In that year, there was relative equality between the percentages of rehabilitated versus not rehabilitated consumers who received: (1)Assessment (60% vs. 68%), (2) Restoration Services (46% vs. 48%), (3) College Training (7% vs. 9%), (4) Business-Vocational Training (14% vs. 13%), (5) Adjustment Training (2% vs. 2%), and (6) On-the-Job Training (3% vs. 2%). However, there were relatively greater differences for rehabilitated versus not rehabilitated clients who received: (1) Job Finding Services (34% vs. 21%), (2) Job Placement Services (36% vs. 18%), (3) Transportation (47% vs. 35%), and (4) Maintenance (27% vs. 16%).

In 1996, the mean case costs were $1,856 for individuals successfully rehabilitated and $1,031 for those who were not rehabilitated. In 2000, the mean case costs were $2,458 for consumers successfully rehabilitated and $1,571 for those who were not rehabilitated. In 2004, the mean case costs were $2,465 for clients successfully rehabilitated and $1,736 for those who were not rehabilitated. Thus, the cost of a not rehabilitated case averaged about two-thirds (63%) of the cost for a rehabilitated case.

Research Question 3

What occupations were involved for those Vocational Rehabilitation consumers whose outcomes were successful (rehabilitated)? They showed remarkable consistency in occupational outcomes across the three time periods: (1) Service Occupations remained the top category with (2) Clerical and Sales Occupations and (3) Structural Work Occupations essentially tied in second and third place, based on one-digit Dictionary of Occupational Titles (DOT) Codes. Table 3 indicates the 20 most prevalent occupations for alcoholism and drug addiction cases achieving vocational rehabilitation. Those data represent "occupation at case closure" documented by two-digit Dictionary of Occupational Titles (DOT) codes. As noted in Table 3, Food and Beverage Preparation and Service was the most prevalent employment outcome across the three time periods. In addition, more than 2,000 consumers gained employment in Construction (e.g., carpenter, plumber), Packaging and Materials Handling (e.g., hoisting and conveying), Building and Related Services (e.g., janitor, pest control), Stenography/Typing/Filing-Related (e.g., secretary, file clerk), Miscellaneous Personal Services (e.g., stewardess, baggage handler), Motor Freight (e.g., dump truck driver, trailer truck driver), and Miscellaneous Sales (e.g., auctioneer, rental clerk).

Research Question 4

In the JAN case data for substance abuse calls from 1996 to 2005, what are the relative proportions of(a) Causative Factor, (b) Caller Industry, (c) Job Function, and (d) Issue Discussed? In the JAN database, there were 1,365 total cases concerning job accommodations and the Americans with Disabilities Act (ADA) for substance abuse disorders involving drug addiction and alcoholism from 1996 to 2005. In Table 4, the numbers of cases are summarized by who contacted JAN. Results show that the point of contact was: Employees (n = 475), Employers (n = 806), and Rehabilitation Professionals (n = 87). These job accommodation cases are subdivided by Causative Factor, identified as drug addiction, alcoholism, or both (combined drug and alcohol abuse disorders). There were 715 cases concerning alcoholism, 333 cases concerning drug addiction, and 320 cases concerning both (Table 4).

The second section of Table 4 presents the caller's industry. The most frequent cases involving the Employee calling with questions about job accommodations (or related issues) were from: Local Government, Health Care and Social Services, Transportation, Manufacturing, Merchant Wholesalers, and State Government. The most frequent cases involving the Employer inquiring about job accommodations (or related issues) were from: Health Care and Social Services, Local Government,

Business Support Services, Manufacturing, State Government, and Federal Government. The most frequent cases involving Rehabilitation Professionals inquiring about job accommodations (or related issues) for a client involved: Educational Services, Hospitals, Federal Government, and Health Care and Social Services. Some of these categories included more than one business specialty (e.g., truck transportation, rail transportation, air transportation, represented as "Transportation") (Table 4).

The third section of Table 4 displays the job function of the individual in question. Employees with substance abuse disorders were most concerned about the following job functions: Attending Work (travel to/from), exhibiting appropriate Interpersonal Skills, Working Safely, and Tolerating Stress. The most frequent Employer concerns about job functions for their employees with substance abuse disorders were: Attending Work (travel to/from), exhibiting appropriate Interpersonal Skills, Working Safely, and Working at Full Production Level. The most prevalent job function concerns of Rehabilitation Professionals in relation to their clients with substance abuse disorders were: exhibiting appropriate Interpersonal Skills, Attending Work (travel to/from), Concentrating on Work/Task, and Tolerating Stress. Thus, the concerns about particular job functions were remarkably consistent for the employees with substance abuse disorders, employers who contacted JAN regarding an employee, and rehabilitation professionals who contacted JAN regarding a client (Table 4).

The fourth section of Table 4 lists Issue Discussed. The most prevalent issues discussed between Employees with drug addiction, alcoholism, or both and the JAN consultants were ADA issues, including the rights of an employee and the responsibilities of the employer, whether the impairment was a disability, what is involved with filing a disability discrimination complaint, referral to an enforcement agency (EEO & EEOC), and the accommodation of modifying a schedule. Additionally, the inquiry often involved a discussion about whether legislation other than the ADA (e.g., state laws) may also apply. Employers who contacted JAN also were most concerned about ADA issues, including the rights of an employee and the responsibilities of the employer, whether the impairment was a disability, what is involved with filing a disability discrimination complaint, and the accommodations of modifying a schedule and acquiring a service to perform a job. Discussions often also involved other legislation besides the ADA (e.g., state laws) that may apply. For Rehabilitation Professionals, topics most commonly discussed were ADA issues, including the rights of an employee and the responsibilities of the employer, whether the impairment was a disability, whether an employer could give a drug and/or alcohol test during the pre-employment stage of the application process, and the accommodation of acquiring a service to perform a job. Other relevant legislation besides the ADA (e.g., state laws) also was discussed when applicable (Table 4). When of relevance to a job accommodation, functional limitations also were discussed by the JAN consultant with the inquirer (caller). Those limitations may include stress intolerance, organizing/prioritizing, control of anger/emotions, concentration, decreased stamina, and tardiness.

Examples of Employee and Employer cases were selected from the JAN database. They were not selected randomly. Rather, these four cases were selected with purpose to illustrate the diversity of issues concerning job accommodations for consumers with substance abuse disorders. They are described briefly in the following paragraphs.

Employee Case 1 involved an employee who was just fired from his job and wanted to know if alcoholism is considered a disability under the ADA. According to the caller (inquirer), the employer told him that he was terminated for not welding joints properly (from back to as many as six months). The employee, however, believed that the reason for his termination was that he recently had a car accident and was cited for driving under the influence (DUI). The JAN consultant advised the caller that because the employer had only 12 employees, employees were not covered under the ADA. In addition, the consultant provided the phone number for the state civil rights agency in order for the person to see if any state laws addressed his termination. Case details were: (1) The causative factor was alcoholism, (2) the limitations were attentiveness and concentration, and (3) the job function was concentration on work tasks and details.

Employee Case 2 involved an employee who contacted JAN after completing a detox program for cocaine addiction. The employee said he did not use drugs at work and did not know if the employer was aware that his attendance and performance problems were related to his drug addition. The JAN consultant discussed with the caller how an employee with a disability can be held to the same standards as other employees, how an individual who engages in illegal use of drugs is not protected under the ADA, and that there is a distinction under the ADA between people who are currently illegally using drugs and people who have illegally used drugs in the past. The consultant followed up by referring him to information on drug addition and the ADA.

Employer Case 1 involved an employer who contacted JAN over a drug testing issue. The employer recently had an employee who tested positive for drug use. The employee verified to the testing agency that he was in a supervised methadone maintenance treatment program. Upon receipt of this information, the testing agency changed this employee's test result to negative. The employer was concerned that this may lead to unfair or inconsistent interpretation of drug testing and results. The JAN consultant suggested that the employer examine the reason for the test. A test to determine illegal drug use would not affect this employee, as he was in a supervised and prescribed methadone maintenance program. However, it was suggested that if testing was to identify drugs that may cause safety problems, then the employer would need to determine whether a safety problem existed due to the employee's methadone use.

Employer Case 2 involved a call to JAN from an employer who recently hired an individual who subsequently got a DUI while off the job. The employee then disclosed an addiction to alcohol. The employer inquired if this person was protected under the ADA. The JAN consultant informed the employer that the ADA does not protect an employee from needing to comply with workplace conduct rules. Thus, if it was the employer's policy to terminate employees for DUIs, then termination of this employee was permitted. The consultant also informed the caller that the ADA prohibits employers from more severely disciplining employees (e.g., for being late) on the basis of alcoholism than for other reasons. Testing issues were discussed with the employer as were the ADA guidelines related to drug testing.

Research Question 5

What commonalities link the findings from the RSA cases to the findings from the JAN cases on substance abuse disorders? Although the two datasets are from different agencies and measure different constructs, the nature of the disorders and their implications have potential relationships between the datasets. The results of the analyses from Table 4 indicate that the primary Issue Discussed in the JAN cases was ADA. This was true for the Rehabilitation Professionals, the Employers, and the Employees. Society is reluctant to see drug or alcohol abuse as a disability, and employers often want to know what is legal or illegal in their interaction with such employees. Usually, from a different standpoint, Rehabilitation Professionals and Employees also are concerned about the following issues. (1) Does the person have a disability, and is he or she protected (covered) by the ADA? (2) What accommodations have to be considered (e.g., leave time, modified schedule)? (3) Is the employer required to provide accommodations for the consequences of drug or alcohol use (e.g., hangover, DUI)? (4) When can employers test for presence of illegal drugs or alcohol (e.g., when the employee is acting strange, unable to concentrate, staggering, smelling like an illegal substance)?

In addition to seeking advice on what is necessary (legally required) to be done, employers often wish to know how they (and the company) can help this employee. Employers may try to assist by referring the individual to Vocational Rehabilitation or by facilitating self-referral to Vocational Rehabilitation. In the 2004 RSA database, there were 2,437 Self-Referrals and 5,305 Other-Referrals (including employers) for alcohol cases. Similarly, there were 3,660 Self-Referrals and 11,406 Other Referrals (including employers) for drug cases. These referrals from these two sources were far more numerous than the referrals to Vocational Rehabilitation from any other referral source (Schools, Post-Secondary Institutions, Medical Personnel/Institutions, Welfare, Community Rehabilitation Programs, Social Security Programs, or One Stop Employment/Training Centers). Although it is impossible to determine from the RSA-911 data how many employers were involved in the referrals of their employees to receive Vocational Rehabilitation services, the interactions of employers with JAN consultants provide clear evidence of substantial involvement and concern.

In the JAN case data for substance abuse calls, the job function most frequently addressed was "attend work, travel to/from." This was true for both employees (people with disabilities who were working or not working) and employers. Similarly, in the RSA case data for substance abuse cases, "Transportation" was one of the most often provided services. For instance, 47% of those rehabilitated and 35% of those not rehabilitated received transportation services (overall 41%) in 2004. Even though there is no direct linkage between the JAN database and the RSA database, both sources contribute to understanding the concerns and interventions. Transportation is a commonality. For the RSA-911 data, success versus non-success for substance abuse cases was found to be related to transportation as well as a number of other variables (listed below). A multiple regression analysis (Tabachnick & Fidell, 2001) was computed in which case outcome (rehabilitated versus not-rehabilitated) was the criterion (dependent) variable. Most of the variables in this analysis were dichotomous, which are often termed "dummy variables" (Tabachnick & Fidell, 2001). The overall multiple regression model for the 2004 RSA data yielded F (16, 35345) = 170.65, p < .0001, a statistically significant result. Individual predictor (independent) variables that demonstrated a statistically significant relationship to a successful case outcome were Greater Education Level (p < .0001), Self-Support (p < .0001), Occupational-Vocational Training (p < .001), On-the-Job Training (p < .0001), Other Training, e.g., GED (p < .0001), Job Search Assistance (p < .0001), Job Placement Assistance (p < .0001), Monetary Maintenance (p < .0001), and as noted previously, Transportation Services (p < .0001). Thus, both transportation and job variables (job training, job search, and job placement) show strong linkages between the data of consumers served by RSA and JAN.

Discussion

Vocational Rehabilitation (including services such as vocational assessment, post-secondary and/or vocational training, job placement, supported employment, job accommodations) is a potential vehicle for linking the documented value of gainful employment to the substance abuse recovery process. There were 101,065 Vocational Rehabilitation clients (consumers) in the present research. More than half of these individuals achieved successful rehabilitation. Regardless of gender, age, and education, somewhat more than half the people with alcoholism and drug addition achieved successful employment outcomes. That criterion requires the individual to be employed for a minimum of 90 days. Thus, the provision of Vocational Rehabilitation services was a substantial intervention with the consumers included in the analyses of the current study.

A report from the Rehabilitation Services Administration (2006) found Vocational Rehabilitation clients with substance-use disorders had fewer functional limitations in "gross motor function" and fewer limitations in "cognitive function" than consumers with vision impairment, hearing impairment, orthopedic impairment, non-orthopedic-physical impairment, mental illness, mental retardation, and learning disability. But the craving, loss of control, and physical dependence pose severe challenges. These challenges, however, have been demonstrated to be reduced through employment concepts, employment training, and employment, which can interact with residential, medication, or substance-free outpatient therapies (e.g., Adamson, Sellman, & Frampton, 2009; Durkin, 2002; Magura, 2003; Wolkstein, Bausch, & Weber, 2000). Vocational Rehabilitation can assist in substituting productive endeavor for counterproductive substance abuse. But because of the variety of relationships among type of substance abuse, degree of dependence, form of therapy, employment type, and other variables, there is, by no means, a single success equation.

As shown in the present research with JAN data, job accommodations can assist with improving employment outcomes, which are targeted to reduce the limitations that the employee with substance abuse is experiencing. Job functions most affected by substance abuse include attendance, concentration, stress or fatigue, organization, and exposure to alcohol or drugs (Batiste, 2005a; Batiste, 2005b). Job accommodations for attendance issues include: (1) providing leave or flexible scheduling for medical treatment and counseling and (2) developing a self-paced workload with the ability to modify a daily schedule if needed. Job accommodations for maintaining concentration include: (1) reducing workplace distractions, (2) moving to a private work area, (3) implementing frequent breaks, (4) dividing large assignments into smaller tasks, and (5) restructuring a job to include only essential functions. Job accommodations for stress or fatigue include: (1) using positive reinforcement and praise, (2) providing counseling and employee assistance programs, (3) modifying daily schedules and breaks, (4) modifying supervisory methods, (5) assigning individual to a less stressful or physically demanding job, (6) working from home, and (7) implementing an ergonomic workstation. Job accommodations for organization include: (1) providing clerical support, (2) keeping a daily to-do list, (3) using an electronic organizer, (4) maintaining calendars, (5) providing reminders of important dates or deadlines, (6) having weekly meetings with supervisor on goals, progress, questions, and concerns, and (7) implementing clear goals, expectations, and consequences in writing. Job accommodations for exposure to alcohol or drugs in the workplace include: (1) providing workplace supports, (2) implementing extra supervision, (3) reassigning to a position that does not involve exposure to drugs or alcohol, and (4) limiting mandated social functions with exposure (Batiste, 2005a; 2005b).

Limitations in the present research are (a) lack of exact service specifications and job accommodation details for the RSA services with the Vocational Rehabilitation consumers and (b) lack of follow-up data to determine the effects of job accommodations discussed in JAN cases. Job accommodations allow many individuals with disabilities to be successful in the workplace, but it is difficult to determine just how many. The number of potential scenarios (cause, degree, industry, job function, issue/concern) is huge, but the derived principles of job accommodations that are sensitive to needs and sensible for productivity are broadly beneficial. Similarly, on the Vocational Rehabilitation side of this study, there are no tightly controlled experimental conditions. Regardless of that, however, more than half of the RSA clients were rehabilitated.

Recommendations

Implications are reflective of both success and failure. The data analyzed for the State-Federal Vocational Rehabilitation program revealed 17,000 people with "alcohol abuse or dependence" who were not rehabilitated and 29,000 people with "drug abuse or dependence" who were not rehabilitated. Although the numbers on the opposite side (rehabilitated) remain encouraging across the years, what can be done to further assist these people (not rehabilitated) gain or regain productive lives? The following suggestions are based on evidence (a) from current findings (Research Questions 1, 2, 3, 4, and 5) and (b) from previous literature (e.g., Adamson, Sellman, & Frampton, 2009; Batiste, 2005a; 2005b; Charles, 2004; Comerford, 1999; Drake, Mueser, Burnette, & McHugo, 2004; Durkin, 2002; Friedman, 1993; Gorske, et al., 2006; Magura, 2003; Platt, 1995; SAMHSA, 2000; Schottenfeld, Pascale, & Sokolowski, 1992; Veach, Remley, Kippers, & Sorg, 2000; Wehman, Targett, Yasuda, & Brown, 2000; Wolkstein, Bausch, & Weber, 2000). (a) Recognize that functional limitations vary (e.g., interpersonal and safety). (b) Make workplace accommodations that directly impinge on limitations related to job functions (e.g., attend work was the primary function). (c) Publicize funding sources for workplace accommodations (e.g., VR and other programs). (d) Assist employers in providing appropriate job accommodations (e.g., JAN). (e) Make the laws (regulations) as clear as possible on rights and responsibilities (e.g., ADA confusing for substance abuse). (f) Assist all concerned in understanding the legal requirements (e.g., ADA primary issue). (g) Provide training to counselors and therapists to reduce misconceptions and increase effective strategies (e.g., Tables 1, 2, 3). (h) Keep contact current between counselors and consumers in order to reduce "unable to locate or contact" case-closure outcomes (e.g., assessment, maintenance, and adjustment). (i) Help people who are unemployed set realistic employment goals (e.g., Table 3). (j) Provide individuals in recovery with work-related skills (e.g., Tables 3, 4). (k) Assist them with monetary maintenance, vocational training, job-finding services, job-placement services, and on-the-job training (e.g., VR services received). (1) Give employees post-employment services (e.g., VR transition to employer). (m) Consider attention to attendance, transportation, concentration, stress/fatigue, organization, and substances in the workplace (e.g., Table 4). These implications can make continuing and increasing contributions to reversing the debilitating effects for individuals with substance abuse disorders.

References

Adamson, S. J., Sellman, J. D., & Frampton, C. M. A. (2009). Patient predictors of alcohol treatment outcome: A systematic review. Journal of Substance Abuse Treatment, 36(1), 75-86.

Batiste, L. C. (2005a). Accommodation and compliance series: Employees with drug addiction. Retrieved May 22, 2006, from http://www.jan.wvu.edu/media/drugadd.html

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Richard T. Walls

West Virginia University

Lucas C. Moore

West Virginia University

Linda C. Batiste

West Virginia University

Beth Loy

West Virginia University

Richard T. Walls, Ph.D., Professor of Educational Psychology and Morgantown, WV 26506-6122 Email: richard.walls@mail,wvu.edu
Table 1
Demographic Characteristics (Gender; Age, Education)
by Disability in 1996, 2000, and 2004 for Vocational
Rehabilitation Consumers

                       1996                        2000
               Alcohol        Drug         Alcohol        Drug

Gender
  Male       8,546(74%)    11,728(67%)   10,112(73%)   15,724(69%)
  Female     3,066(26%)    5,723(33%)    3,657(27%)    7,036(31%)

Age
  < 46       9,410(81%)    15,868(91%)   10,141(74%)   19,062(84%)
  > 45       2,202(19%)    1,583(9%)     3,628(26%)    3,698(16%)

Education
  < H.S.     3,417(29%)    5,575(32%)    4,075(30%)    8,039(35%)
  H.S.       5,667(49%)    8,316(48%)    6,653(48%)    10,516(46%)
  > H.S.     2,528(22%)    3,560(20%)    3,041(22%)    4,205(19%)

Total        11,612        17,451        13,769        22,760

                      2004
               Alcohol        Drug

Gender
  Male       9,211(75%)    15,992(69%)
  Female     3,079(25%)    7,191(31%)
Age
  < 46       8,064(66%)    17,863(77%)
  > 45       4,226(34%)    5,320(23%)
Education
  < H.S.     3,151(26%)    7,036(30%)
  H.S.       5,805(47%)    11,168(48%)
  > H.S.     3,334(27%)    4,979(22%)

Total        12,290        23,183

Note: The percentages are for column subsets.
For example, 1996, Alcohol, Gender: Male (74%)
+ Female (26%) = 100%

Table 2
Case Closure Status by Disability and Year
for Vocational Rehabilitation Consumers

                                 1996

Case Closure Outcome     Alcohol        Drug

Rehabilitated          6,278(54%)    9,330(53%)

Not Rehabilitated      5,334(46%)    8,121(47%)

                                 2000

Case Closure Outcome     Alcohol        Drug

Rehabilitated          7,882(57%)    13,063(57%)

Not Rehabilitated      5,887(43%)    9,697(43%)

                                 2004

Case Closure Outcome     Alcohol        Drug

Rehabilitated          6,330(52%)    11,820(51%)

Not Rehabilitated      5,960(48%)    11,363(49%)

Note: "Not Rehabilitated" included only
those cases in which eligibility had
been determined, a rehabilitation plan
had been developed, and services had
been initiated, but the individual did
not achieve a successful rehabilitation
outcome. Of the clients who were
"Rehabilitated," about 90% were
"competitively employed." The
percentages in the table are for the
columns.

Table 3
Top Occupational Outcomes for Alcohol
Abuse Achieving Vocational Rehabilitation
(1996 plus 2000  and Drug Abuse Cases plus 2004)

                                                     Number
                                                       of
Occupation Category                                  Persons

1. Food & Beverage Preparation & Service              5,063
2. Construction                                       4,547
3. Packaging & Materials Handling                     2,597
4. Building & Related Service                         2,442
5. Stenography, Typing, Filing, & Related             2,059
6. Misc. Personal Service                             2,054
7. Motor Freight                                      2,023
8. Misc. Sales                                        2,005
9. Computing & Account Recording                      1,848
10. Medicine & Health                                 1,266
11. Managers & Officials                              1,234
12. Electrical Assembling, Installing, & Repairing    1,154
13. Mechanics & Machinery Repairing                   1,108
14. Life Sciences                                     1,087
15. Structural Work                                   1,077
16. Barbering, Cosmetology, & Related Service           969
17. Misc. Professional, Technical, & Managerial         913
18. Lodging & Related Service                           895
19. General Industry Mechanics & Repairing              838
20. Information & Message Distribution                  836

Note: Each Occupational Category represents
Occupational Titles (DOT) code. For example,
"Food and Beverage Preparation and Service
31 is the  a two-digit Dictionary of DOT
code for Occupations."

Table 4
Job Accommodation Network (JAN) Case Data for Substance Abuse Calls

                                                      Caller
                                                       Type       Rehab
                                       Employees     Employers    Pros
Causative Factor

  Alcoholism                              268           420        27
    Drug Addiction                        121           188        24
    Both Alcoholism & Drug Addiction       86           198        36
        Total                             475           806        87

Caller Industry
  Business Support Services                4            24          1
    Colleges & Trade Schools               0             8          0
    Educational Services                   12           14          3
    Federal Government                     12           19          2
  Financial & Insurance Services           4             9          0
  Food & Beverage                          3            12          0
    Health Care & Social Services          25           68          2
    Hospitals                              3             5          3
    Local Government                       32           29          0
  Manufacturing                            16           23          0
    Merchant Wholesalers                   14            5          1
    Recreation                             4             8          0
    State Government                       14           20          0
    Telecommunications                     12            4          1
    Transportation                         19           11          1
    Other                                  34           27          1
        Total                             208          286         14

Job Function
    Adjust to Schedule Change              7             1          0
    Attend Work, Travel to/from            78           94          3
    Communicate with Others                3             6          0
    Concentrate on Work/Task               20           22          3
  Drive or Operate Vehicle                 12           10          1
    Interpersonal Skills                   44           92         11
  Tolerate Stress                          35           25          3
    Work at Full Production Level          28           45          2
    Work Safely                            38           83          2
      Total                               274          404         25
Issue Discussed
  Accommodation                            12           84          6
    Acquire Service to Perform Job         39           62          7
    Flexible Leave                         33           46          1
    Limited Scheduling                     16           23          0
    Modifying Work Schedule                50          137          2
    Reassignment to Vacant Position        13           24          1
    ADA                                   389          707         59
    Complaint Process                      65            1          2
    Definition of Terms                    25           35          2
    Definition of Disability               80          211         10
    EEO & EEOC Referral                    59           10          1
    Pre-Employment Stage Inquiries         18           17          8
    Rights & Responsibilities             101          173         12
    Other Employment Legislation           55           55          9
    JAN Web Page Referral                  8            32          2
    State Human Rights Referral            31            9          3
    Other Information
    (e.g., housing, insurance)             46           48          0
      Total                             1,072        1,717        140

Note 1: "Employees" included individuals with disabilities
who currently were working, as well as individuals with
disabilities who currently were not working.

Note 2: The Employees, the Employers, and the Rehabilitation
Professionals were not linked. Although it is possible that
some were calling about the same issue or incident, there
were no links among the cases.
COPYRIGHT 2009 National Rehabilitation Association
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2009 Gale, Cengage Learning. All rights reserved.

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