Research on addiction recovery is quite scant compared to the volumes of research on addiction-related pathologies and clinical interventions. Additionally, some of the most important research on addiction recovery is buried in academic journals rarely if ever read by the people who need it most--addiction treatment professionals and people needing, seeking or in recovery. Such is the case of studies on the role of work in addiction recovery.
In 2011, Dieter Henkel of the Institute for Addiction Research at the University of Applied Sciences in Frankfurt, Germany, conducted a comprehensive review of international studies on the relationship between substance use and employment that was published in Current Drug Abuse Reviews (4, 4-27). Henkel drew the following conclusions from his review of more than 130 scientific studies:
- Unemployment, particularly prolonged unemployment, heightens the probability of risky alcohol and other drug (AOD) use and the development of AOD dependencies, with these risks being significantly magnified for young adults.
- AOD problems heighten the risks of losing unemployment and decreasing one's odds of re-gaining employment.
- Those in recovery from AOD problems are at increased risk of losing their jobs and being denied employment due to stigma-related discrimination.
- Unemployment following recovery initiation increases the risk of resuming AOD use and experiencing more severe consequences resulting from resumed use.
- Unemployed men and women are more likely to smoke and to smoke greater quantities--a concern given the greater risks of AOD resumption and mortality for smokers in recovery from other addictions.
Put more affirmatively, stable work lowers the risk of developing AOD problems and is a major factor in enhancing recovery stability and quality of life in long-term recovery. Yet, those who enter recovery without substantial recovery capital face what seem like insurmountable obstacles to gaining and sustaining employment: inadequate education and training, unstable housing, limited mobility (via revocation of driving privileges, limited access to public transportation, or loss of private transportation), a criminal record, and a checkered work history with limited job references. Facing the question of what to do each day with one's time, including work or its alternatives, is a major issue at all stages of recovery.
The threats of unemployment to recovery stability include boredom, anxiety and depression, social isolation, a lack of meaning and purpose, and a progressive depletion of recovery capital (e.g., food, safe housing, and increased exposure to drug-related cues--"people, places and things"). This is not to say that there are no complications related to work in recovery. Such complications can include correcting past AOD-related performance problems, the common propensity for workaholism, interpersonal conflicts in the workplace, work environments that are not conducive to recovery and learning to extinguish money as a trigger for AOD use. But from the scientific evidence available, such threats pale in comparison to the threats of prolonged unemployment.
So here's the question: if employment is such a critical factor in recovery initiation and recovery stability, and if addiction treatment programs really are committed to science-informed addiction treatment; then why do we not see vocational education and training programs integrated as a service option within all addiction treatment programs? Why are purchasers of care not demanding integration of these "ancillary" supports to slow the revolving door of acute addiction treatment and to improve long-term recovery outcomes? Health care reform is bringing much discussion of the tri-directional integration of addiction treatment, mental health and primary health care. It is time we added to that discussion the need for services that help people in recovery build a life in the community. For that we need to move beyond services that "fix" illnesses to the creation of pathways to pro-recovery social networks; recovery-conducive work, shelter, worship and leisure; and pro-recovery volunteerism, community service and advocacy--an extension of recovery from to recovery to. Such services were briefly present in addiction treatment programs of the 1960s and early 1970s but were lost in the medicalization of addiction treatment. In the past decade, that work has begun anew in recovery community centers across the country. It is time such efforts were re-integrated into addiction treatment.