Substance            Abuse and Mental Health Services Administration
 

Center for Substance Abuse Treatment
 

Integrating Substance

Abuse Treatment and

Vocational Services

Treatment Improvement Protocol (TIP) Series

38
 

 

 

Integrating 

Substance 

Abuse 

Treatment and 

Vocational 

Services 

Treatment Improvement Protocol (TIP) Series 

38 

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 

Substance Abuse and Mental Health Services Administration 

Center for Substance Abuse Treatment 

1 Choke Cherry Road 

Rockville, MD 20857 
         

         

       

           

           

           

  

               

             

           

               

             

             

             

           

         

       

   

             

           

               

           

               

         

               

             

         

         

           

   

       

         

       

       

         

   

           

           

         

   

   

     

         

         

           

         

     

       

     

               

  

Acknowledgments

This publication was prepared under contract

number 270‐05‐0013 for the Substance Abuse

and Mental Health Services Administration

(SAMHSA), U.S. Department of Health and

Human Services (HHS). Sandra Clunies, M.S.,

ICADC, served as the Contracting Officer’s

Representative.

Disclaimer

The opinions expressed herein are the views of

the consensus panel members and do not

necessarily reflect the official position of

SAMHSA or HHS. No official support of or

endorsement by SAMHSA or HHS for these

opinions or for the instruments or resources

described are intended or should be inferred.

The guidelines presented should not be

considered substitutes for individualized client

care and treatment decisions.

Public Domain Notice

All materials appearing in this volume except

those taken directly from copyrighted sources

are in the public domain and may be

reproduced or copied without permission from

SAMHSA or the authors. Citation of the source

is appreciated. However, this publication may

not be reproduced or distributed for a fee

without the specific, written authorization of the

Office of Communications, SAMHSA, HHS.

Electronic Access and Printed Copies

This publication may be ordered from or

downloaded from SAMHSA’s Publications

Ordering Web page at http://store.samhsa.gov.

Or, please call SAMHSA at 1‐877‐SAMHSA‐7 (1‐

877‐726‐4727) (English and Español).

Recommended Citation

Center for Substance Abuse Treatment.

Integrating Substance Abuse Treatment and

Vocational Services. Treatment Improvement

Protocol (TIP) Series, No. 38. HHS Publication

No. (SMA) 12‐4216. Rockville, MD: Substance

Abuse and Mental Health Services

Administration, 2000.

Originating Office

Quality Improvement and Workforce

Development Branch, Division of Services

Improvement, Center for Substance Abuse

Treatment, Substance Abuse and Mental Health

Services Administration, 1 Choke Cherry Road,

Rockville, MD 20857.

HHS Publication No. (SMA) 12‐4216

First Printed 2000

Revised 2002, 2003, 2006, 2010, 2012, and 2014

ii
Contents 

What Is a TIP?..........................................................................................................................................................vii 

Editorial Advisory Board........................................................................................................................................ ix 

Consensus Panel ...................................................................................................................................................... xi 

Foreword.................................................................................................................................................................. xiii 

Executive Summary and Recommendations...................................................................................................... xv 

Recommendations............................................................................................................................................ xvii 

Chapter 1—The Need for Vocational Services .....................................................................................................1 

Employment as a Goal..........................................................................................................................................2 

Challenges to Employing Clients in Treatment ................................................................................................3 

Vocational Issues...................................................................................................................................................6 

Treatment and Employment................................................................................................................................9 

National Trends Affecting Employment..........................................................................................................11 

Chapter 2—Vocational Programming and Resources .......................................................................................17 

Vocational Rehabilitation Counseling..............................................................................................................17 

Screening and Assessment.................................................................................................................................19 

Vocational Counseling .......................................................................................................................................27 

Prevocational and Ongoing Services................................................................................................................29 

Training and Education......................................................................................................................................30 

Employment Services .........................................................................................................................................33 

Overview of Vocational Resources...................................................................................................................36 

Chapter 3—Clinical Issues Related to Integrating Vocational Services ........................................................47 

Incorporating Vocational Services ....................................................................................................................47 

Competency Areas for Employment................................................................................................................52 

Developing the Treatment Plan ........................................................................................................................62 

Case Studies .........................................................................................................................................................69 

Chapter 4—Integrating Onsite Vocational Services..........................................................................................75 

Planning an Integrated Program.......................................................................................................................76 

iii 
Contents 

Implementing and Operating the Integrated Program..................................................................................80 

Outcomes .............................................................................................................................................................87 

Uniform Data Collection....................................................................................................................................88 

Chapter 5—Effective Referrals and Collaborations ..........................................................................................91 

Collaboration as the Cornerstone of Effective Referral..................................................................................91 

Authentically Connected Referral Networks ..................................................................................................96 

Building an Authentically Connected Referral Network ..............................................................................99 

Chapter 6—Funding and Policy Issues ..............................................................................................................101 

Managed Care Contracts as a Funding Source .............................................................................................101 

Impact of Policy and Funding Shifts ..............................................................................................................102 

Future Considerations ......................................................................................................................................108 

Federal and State Funding Sources ................................................................................................................110 

Endnotes.............................................................................................................................................................116 

Chapter 7—Legal Issues .......................................................................................................................................119 

Part I: Discrimination in Employment and Employment-Related Services ..............................................119 

Part II: The Revolution in Rules Governing Public Assistance...................................................................132 

Part III: Confidentiality of Information About Clients.................................................................................135 

A Final Note.......................................................................................................................................................151 

Endnotes.............................................................................................................................................................151 

Chapter 8—Working With the Ex-Offender .....................................................................................................153 

Barriers to Employment: What the Offender Brings to the Process ...........................................................154 

Barriers to Employment: What Society Brings to the Process.....................................................................160 

Program Examples............................................................................................................................................164 

Endnotes.............................................................................................................................................................164 

Appendix A—Bibliography .................................................................................................................................167 

Appendix B—Resources: Tools and Instruments ............................................................................................179
 

Appendix C—Published Resource Materials ...................................................................................................191
 

Internet Sites ......................................................................................................................................................192
 

Software..............................................................................................................................................................192
 

Appendix D—Addiction Severity Index ...........................................................................................................193
 

Appendix E—State Employment Agencies .......................................................................................................205
 

Appendix F—Federal Funding Sources .............................................................................................................211
 

Appendix G—Sample Individualized Written Rehabilitation Program .....................................................217
 

Appendix H—Resource Panel .............................................................................................................................221
 

iv 
 

Contents 

Appendix I—Field Reviewers .............................................................................................................................223
 

Figures 

1-1 Challenges to Employment .........................................................................................................................4 

1-2 Strategies for Promoting Employment ......................................................................................................8 

2-1 Vocational Services Provided to a Residential Treatment Facility ......................................................19 

2-2 Vocational Information From Initial Screen............................................................................................21 

2-3 Assessment Tools .......................................................................................................................................26 

2-4 Prevocational Counseling Activities ........................................................................................................30 

2-5 Job Search Resources: America’s Job Bank on the Internet...................................................................34 

2-6 Vocational Opportunities of Cherokee, Inc.: Rehabilitation Facility Providing 

Primarily Onsite Services ..........................................................................................................................37 

2-7 The Michigan Drug Addiction and Alcoholism Referral and Monitoring Agency: 

A Case Management Model......................................................................................................................39 

2-8 Combating Alcohol and Drugs Through Rehabilitation and Education (CADRE)...........................41 

2-9 The Texas Workforce Commission: Project RIO (Re-Integration of Offenders) ................................42 

2-10 Basic Materials for a Vocational Reference Library ...............................................................................44 

3-1 Early-Stage Vocational Issues and Approaches .....................................................................................50 

3-2 Answering Questions Related to Substance Use History—A Sample Scenario ................................57 

4-1 Steps for Planning an Integrated Program..............................................................................................76 

4-2 Job Clubs......................................................................................................................................................83 

4-3 Focus on Client Outcomes: The Future for Substance Abuse Treatment Providers .........................89 

5-1 Data-Matching Software............................................................................................................................94 

5-2 Steps for Establishing an Authentically Connected Network ..............................................................95 

5-3 Characteristics of Authentically Connected Referral Networks ..........................................................98 

6-1 Agency Self-Assessment Categories ......................................................................................................105 

7-1 Americans With Disabilities Act and Rehabilitation Act Protections ...............................................125 

7-2 Services Provided Under the Workforce Investment Act of 1996......................................................126 

7-3 Sample Consent Form..............................................................................................................................138 

7-4 Making a Referral to a Vocational or Training Program.....................................................................143 

8-1 A Program That Addresses Women’s Issues........................................................................................160 

8-2 Summary of Program Examples.............................................................................................................166 

F-1 Federal Funding Sources .........................................................................................................................212 

F-2 Federal Sources of Discretionary, Time-Limited Project Grants........................................................216 

v 

       

             

               

         

                 

       

           

         

                   

         

           

       

     

           

       

       

           

             

       

             

             

           

           

           

What Is a TIP?
 

Treatment Improvement Protocols (TIPs)

are developed by the Substance Abuse

and Mental Health Services

Administration (SAMHSA) within the U.S.

Department of Health and Human Services

(HHS). Each TIP involves the development of

topic‐specific best‐practice guidelines for the

prevention and treatment of substance use and

mental disorders. TIPs draw on the experience

and knowledge of clinical, research, and

administrative experts of various forms of

treatment and prevention. TIPs are distributed

to facilities and individuals across the country.

Published TIPs can be accessed via the Internet

at http://store.samhsa.gov.

Although each consensus‐based TIP strives

to include an evidence base for the practices it

recommends, SAMHSA recognizes that

behavioral health is continually evolving, and

research frequently lags behind the innovations

pioneered in the field. A major goal of each TIP

is to convey ʺfront‐lineʺ information quickly but

responsibly. If research supports a particular

approach, citations are provided.

vii

     

                     

                 

         

     

     

   

     

         

   

       

           

   

   

   

   

     

           

         

   

       

   

         

         

         

     

   

           

       

   

   

       

         

           

   

       

     

   

         

           

       

   

         

       

   

         

       

    

           

   

     

       

           

   

Editorial Advisory Board

Note: The information given indicates each participantʹs affiliation during the time the board was

convened and may no longer reflect the individualʹs current affiliation.

Karen Allen, Ph.D., R.N., C.A.R.N.

Professor and Chair

Department of Nursing

Andrews University

Berrien Springs, Michigan

Richard L. Brown, M.D., M.P.H.

Associate Professor

Department of Family Medicine

University of Wisconsin School of Medicine

Madison, Wisconsin

Dorynne Czechowicz, M.D.

Associate Director

Medical/Professional Affairs

Treatment Research Branch

Division of Clinical and Services Research

National Institute on Drug Abuse

Rockville, Maryland

Linda S. Foley, M.A.

Former Director

Project for Addiction Counselor Training

National Association of State Alcohol and

Drug Abuse Directors

Director

Treatment Improvement Exchange Project

Washington, D.C.

Wayde A. Glover, M.I.S., N.C.A.C. II

Director

Commonwealth Addictions Consultants and

Trainers
 

Richmond, Virginia
 

Pedro J. Greer, M.D.

Assistant Dean for Homeless Education

University of Miami School of Medicine

Miami, Florida

Thomas W. Hester, M.D.

Former State Director

Substance Abuse Services

Division of Mental Health, Mental

Retardation and Substance Abuse

Georgia Department of Human Resources

Atlanta, Georgia

James G. (Gil) Hill, Ph.D.

Director

Office of Substance Abuse

American Psychological Association

Washington, D.C.

Douglas B. Kamerow, M.D., M.P.H.

Director

Center for Practice and Technology

Assessment

Agency for Health Care Policy and Research

Rockville, Maryland

Stephen W. Long

Director

Office of Policy Analysis

National Institute on Alcohol Abuse and

Alcoholism
 

Rockville, Maryland
 

ix
 

 

 

 

 

 

 

Editorial Advisory Board 

Richard A. Rawson, Ph.D. 

Executive Director 

Matrix Center and Matrix Institute on 

Addiction 

Deputy Director, UCLA Addiction Medicine 

Services 

Los Angeles, California 

Ellen A. Renz, Ph.D. 

Former Vice President of Clinical Systems 

MEDCO Behavioral Care Corporation 

Kamuela, Hawaii 

Richard K. Ries, M.D. 

Director and Associate Professor 

Outpatient Mental Health Services and Dual 

Disorder Programs



Harborview Medical Center 

Seattle, Washington 

Sidney H. Schnoll, M.D., Ph.D. 

Chairman 

Division of Substance Abuse Medicine 

Medical College of Virginia 

Richmond, Virginia 

x 
   

                           

                   

         

       

   

   

     

   

   

       

     

     

         

         

   

         

   

       

   

   

   

   

     

   

   

     

   

   

       

     

       

     

           

           

       

       

     

   

           

           

   

     

       

   

     

   

Consensus Panel

Note: The information given indicates each participantʹs affiliation during the time the panel was

convened and may no longer reflect the individualʹs current affiliation.

Chair

Nancy K. Young, M.S.W., Ph.D.

Director

Children and Family Futures

Irvine, California

Workgroup Leaders

Leslie Chernen, Ph.D.

Project Director

Brown University

Rhode Island Public Health Foundation

Providence, Rhode Island

Sidney Gardner, M.P.A.

Director

California State University – Fullerton

Center for Collaboration for Children

Irvine, California

Margaret K. Glenn, Ed.D., C.R.C.

Assistant Professor

School of Allied Health Professions

Counseling

Virginia Commonwealth University

Richmond, Virginia

Gale Saler, M.Ed., C.R.C.‐M.A.C., C.P.C.

Deputy Executive Director

Second Genesis

Bethesda, Maryland

Terry Soo‐Hoo, Ph.D.

Clinic Director

Assistant Professor

Counseling Psychology Department

University of San Francisco

San Francisco, California

Diana D. Woolis, Ed.D.

Senior Research Associate

Program Demonstration

National Center on Addiction and Substance

Abuse at Columbia University
 

New York, New York
 

Panelists

Diana D. Woolis, Ed.D.

Judith Arroyo, Ph.D.

Project Director

COMBINE

University of New Mexico Center on

Alcoholism, Substance Abuse, and
 

Addictions
 

Albuquerque, New Mexico
 

Yvonne F. Bushyhead, J.D.

Executive Director

Vocational Opportunities of Cherokee

Cherokee, North Carolina

xi
 

 

 

 

 

Consensus Panel 

Alfanzo K. Dorsey, M.S.W. 

State Treatment Director 

Social Rehabilitation Services 

Kansas State Alcohol and Drug Abuse 

Services



Topeka, Kansas 

Eduardo Duran, Ph.D. 

Clinical Supervisor 

Behavioral Health



Rehobeth Hospital



Gallup, New Mexico 

Paul Ingram, M.S.W. 

President/CEO



Administrative Branch



PBA, Inc. – The Second Step 

Pittsburgh, Pennsylvania



Tim Janikowski, Ph.D., C.R.C. 

Associate Professor 

Rehabilitation Counselor Training Program 

Rehabilitation Institute 

Southern Illinois University 

Carbondale, Illinois 

Gloster Mahon, M.S. 

Project Manager 

Illinois Jobs Advantage Project 

Chicago, Illinois 

Angela G. Rojas-Dedenbach, M.A. 

Director 

Michigan Jobs Commission Rehabilitation 

Services



Lansing, Michigan 

Alex Trujillo, M.S. 

Clinical Counselor 

Counseling and Therapy Services 

University of New Mexico Student 

Health Center 

Albuquerque, New Mexico



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Foreword
 

The Substance Abuse and Mental Health

Services Administration (SAMHSA) is the

agency within the U.S. Department of

Health and Human Services that leads public

health efforts to advance the behavioral health of

the nation. SAMHSA’s mission is to reduce the

impact of substance abuse and mental illness on

America’s communities.

The Treatment Improvement Protocol (TIP)

series fulfills SAMHSA’s mission to reduce the

impact of substance abuse and mental illness on

Americaʹs communities by providing evidence‐

based and best practices guidance to clinicians,

program administrators, and payers. TIPs are the

result of careful consideration of all relevant

clinical and health services research findings,

demonstration experience, and implementation

requirements. A panel of non‐Federal clinical

Pamela S. Hyde, J.D.

Administrator

researchers, clinicians, program administrators,

and patient advocates debates and discusses their

particular area of expertise until they reach a

consensus on best practices. This panel’s work is

then reviewed and critiqued by field reviewers.

The talent, dedication, and hard work that TIPs

panelists and reviewers bring to this highly

participatory process have helped bridge the gap

between the promise of research and the needs of

practicing clinicians and administrators to serve,

in the most scientifically sound and effective ways,

people in need of behavioral health services. We

are grateful to all who have joined with us to

contribute to advances in the behavioral health

field.

Substance Abuse and Mental Health Services Administration

Daryl W. Kade

Acting Director

Center for Substance Abuse Treatment

Substance Abuse and Mental Health Services Administration

xiii

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Executive Summary and 

Recommendations



Employment has been positively 

correlated with retention in treatment. 

By holding a job, a client establishes a 

legal source of income, structured use of time, 

and improved self-esteem, which in turn may 

reduce substance use and criminal activity. 

Years of research show that the best predictors 

of successful substance abuse treatment are 

Gainful employment 

Adequate family support 

Lack of coexisting mental illness 

Unemployment and substance abuse may be 

intertwined long before an individual seeks 

treatment. Although the average educational 

level of individuals with substance abuse 

disorders is comparable to that of the general 

U.S. population, people who use substances are 

far more likely to be unemployed or 

underemployed than people who do not use 

substances. According to the U.S. Census 

Bureau, employment rates for the non– 

substance-using population ranged from 72.3 

percent in 1980 to 76.8 percent in 1991. 

However, employment rates of the population 

with substance abuse problems before 

admission or at admission to treatment have 

remained at relatively stable, low levels since 

1970, ranging from 15 to 30 percent. Most of the 

research on the employment rates of persons 

with substance abuse disorders has focused on 

opiate-dependent persons (usually heroin), and 

employment rates for other substance users may 

vary. The data clearly indicate the need for 

interventions to improve employment rates 

among this population in treatment and 

recovery. 

Two major reform efforts have affected the 

substance abuse treatment field: health care 

reform and welfare reform. Both of these 

reforms highlight the role of vocational training 

and employment services in substance abuse 

treatment. Under the cost-saving initiatives of 

health care reform (i.e., managed care), 

treatment providers face demands to reduce 

length of care and still produce cost-effective, 

positive outcomes. Treatment providers must 

also attempt to match a client’s individual needs 

to an appropriate level of care. Recent welfare 

reform efforts, which limit benefits and impose 

strict work requirements, stress vocational 

rehabilitation for people with substance abuse 

disorders in an effort to move clients off welfare 

and into work. 

Treatment providers will need to learn how 

to operate under the imperatives of these two 

major reform efforts. Because of their increasing 

emphasis on efficacy and outcomes, welfare and 

health care reforms promise to enhance the 

availability and provision of not only substance 

abuse treatment services but also necessary 

supporting services, including vocational 

rehabilitation. Substance abuse treatment that is 

cost-effective and shows verifiable positive 

xv 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Executive Summary and Recommendations 

outcomes is the ultimate goal. However, this 

goal cannot be achieved unless all the client’s 

service needs are met, and this will occur only 

through the integration of treatment and 

wraparound services, including vocational 

counseling and employment services. 

Vocational counseling is an effective way to 

refocus substance users toward the world of 

work. Employment subsequently serves as a 

means of (re)socialization and integration into 

the non–substance-using world. 

This Treatment Improvement Protocol is 

intended for providers of substance abuse 

treatment services. However, it can also be of 

use to vocational rehabilitation (VR) staff, social 

service workers, and all who are involved in 

arranging for and providing vocational and 

substance abuse treatment services. The TIP 

introduces vocational issues and concepts and 

describes how these can be incorporated into 

substance abuse treatment. While the alcohol 

and drug counselor is not expected to achieve 

complete mastery of vocational counseling, she 

should acquire at least rudimentary skills in 

providing vocational services and be able to 

recognize when her client should be referred to a 

VR counselor. 

The Consensus Panel for this TIP drew on its 

considerable experience in both the vocational 

rehabilitation and substance abuse treatment 

fields. Panel members included representatives 

from all aspects of vocational rehabilitation and 

substance abuse treatment: VR specialists, 

alcohol and drug counselors, academicians, State 

government representatives, and legal counsel. 

The TIP is organized into eight chapters. 

Chapter 1 provides an overview of the need for 

vocational services and discusses how 

employment and substance abuse treatment are 

interconnected. Challenges to employing clients 

in substance abuse treatment and strategies for 

promoting employment are discussed. The 

chapter also contains an overview of Federal 

and State legislative reforms and trends that 

have a deep impact on substance abuse 

treatment and the need for integrating 

employment services into substance abuse 

treatment. 

Chapter 2 introduces the elements of 

vocational programming, such as screening and 

assessment tools, vocational counseling, 

prevocational services, training and education, 

and employment services. The roles of the VR 

counselor and vocational evaluator are 

discussed. A section on resources provides an 

overview of the vocational resources that are 

available for substance abuse treatment clients. 

Chapter 3 focuses on the clinical issues 

related to integrating vocational services into 

substance abuse treatment. This chapter helps 

the alcohol and drug counselor incorporate 

vocational components into a treatment plan for 

the client and actively involve the client in his 

rehabilitation by assessing strengths and 

interests, setting goals, and finding and 

maintaining employment. The chapter also 

discusses legal and social challenges to securing 

employment. Three case studies are presented 

to illustrate the concepts discussed in the 

chapter. 

Chapter 4 provides information about 

integrating onsite vocational services into 

substance abuse treatment programs. The main 

premise is that the substance abuse treatment 

program should not operate alone but should be 

part of a collaboration of agencies that provide 

various services to clients. Information is 

provided about models, staff development and 

training, integrating services, and, depending on 

the type of program (e.g., high-structure 

program, low-structure program), outcomes 

assessment, and uniform data collection. 

Chapter 5 discusses setting up a referral 

system among agencies. Counselors are 

introduced to the authentically connected 

referral network, which is an integrated system 

where agencies function as equal partners to 

best serve the various needs of their clients. In 

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Executive Summary and Recommendations 

an authentically connected network, a holistic 

view of the client is adopted. Barriers to 

collaboration, finding potential collaborators, the 

elements of effective referrals, and building an 

authentically connected network are discussed. 

Chapter 6 offers guidance to administrators 

who are navigating in the new, unfamiliar 

funding environment created by recent Federal 

and State reforms. Funding strategies and 

sources are provided, and the steps for adapting 

to the new funding and policy climate are 

reviewed. Future considerations regarding 

Single State Agencies, flexible funding 

mechanisms, accountability and resource 

redirection, and the role of the Federal 

government are also discussed. 

Chapter 7 provides an overview of legal and 

ethical issues for alcohol and drug counselors 

who are providing vocational services directly 

or through referral. Part I discusses 

discrimination, Part II discusses welfare reform, 

and Part III covers confidentiality issues. 

Chapter 8 presents information on the impact 

of increased law enforcement activity on clients 

with substance abuse disorders. The chapter 

provides some specific strategies to help clients 

who are making the transition from 

incarceration to the community find needed 

employment. 

The TIP also contains several appendices, 

including source information for various 

screening tools, Web sites, and other useful 

resources; a version of the Addiction Severity 

Index; a list of State employment agency 

addresses and Web sites; Federal and State 

funding sources; and a sample copy of an 

Individualized Written Rehabilitation Program. 

Throughout this TIP, the term “substance 

abuse” has been used in a general sense to cover 

both substance abuse disorders and substance 

dependence disorders (as defined by the 

Diagnostic and Statistical Manual of Mental 

Disorders, 4th ed. [DSM-IV] [American 

Psychiatric Association, 1994]). Because the 

term “substance abuse” is commonly used by 

substance abuse treatment professionals to 

describe any excessive use of addictive 

substances, it will be used to denote both 

substance dependence and substance abuse. 

The term does relate to the use of alcohol as well 

as other substances of abuse. Readers should 

attend to the context in which the term occurs in 

order to determine what possible range of 

meanings it covers; in most cases, however, the 

term will refer to all varieties of substance use 

disorders as described by the DSM-IV. 

The recommendations that follow are 

grouped by chapter. Recommendations that are 

supported by research literature or legislation 

are followed by (1); clinically based 

recommendations are marked (2). To avoid 

sexism and awkward sentence construction, the 

TIP alternates between “he” and “she” in 

generic examples. 

Recommendations 

The Need for Vocational Services 

¢ Vocational services should be an integral 

component of all substance abuse treatment 

programs. (2) 

¢ If work is to be sustained and enduring 

lifestyle changes made, the vocational 

services provided to clients must focus on 

pathways into careers, on job satisfaction, 

and on overcoming a variety of barriers to 

employment, as well as on the needed skills 

for maintaining employment. (2) 

¢ A number of changes that are affecting 

today’s workforce must be taken into account 

when delivering vocational services to 

substance abuse treatment clients. Because 

the world of work is dynamic and job 

obsolescence is a well-documented 

phenomenon, vocational services must reflect 

these changes. (1) 

¢ There are several laws in the area of welfare 

reform with which alcohol and drug 

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Executive Summary and Recommendations 

counselors should be familiar. These laws 

must be monitored closely because they 

signal time periods when financial support 

will be terminated for clients. These laws are 

as follows: (1) 

♦ The Personal Responsibility and Work 

Opportunity Reconciliation Act of 1996 

♦ The Contract With America 

Advancement Act 

♦ The Adoption and Safe Families Act of 

1997 

♦ The Workforce Investment Act of 1998 

♦ The Americans With Disabilities Act 

 In response to welfare reform efforts, 

substance abuse treatment programs should 

address the vocational needs of women and 

offer them a full range of vocational 

services. (1) 

Vocational Programming 

And Resources 

 Initial vocational screening can be done by an 

alcohol and drug counselor, and more indepth assessment should be conducted by a 

VR counselor or vocational evaluator. (1) 

 The vocational component of the treatment 

plan is a dynamic process and should be 

periodically evaluated to determine whether 

the stated goals are still viable and 

appropriate, further assessment is needed, or 

any adjustments in the plan are required. All 

professionals involved in the client’s 

treatment plan should maintain a close 

working relationship and a dialog about the 

client’s progress so that appropriate 

adjustments to the client’s treatment plan can 

be made. (1) 

 Screening allows the counselor to determine 

the kinds of vocational services the client 

may need and to develop an appropriate 

vocational component to the treatment plan. 

Screening should enable the alcohol and drug 

counselor to accomplish the following 

(although not to the degree of detail that 

would be provided through a followup 

assessment or counseling by a vocational 

specialist): (1) 

♦ Identify the client’s major employmentrelated experience, as well as her 

associated capacities and limitations 

♦ Determine what referrals will help the 

client attain successful employment (if 

needed) 

♦ Identify the necessary resources to make 

employment feasible for the client (e.g., 

transportation, day care) 

♦ Determine whether further assessment is 

needed to develop the vocational 

component of the treatment plan 

 The functional assessment should be 

performed by professionals well versed in 

how an individual’s skills and interests lead 

to successful vocational outcomes. Normally 

the VR counselor or vocational evaluator fits 

this description; however, the alcohol and 

drug counselor often has vital information 

about a client’s level of functioning. In 

complex cases, functional assessment can be 

accomplished with input from a 

multidisciplinary team. (1) 

 The next step after assessment is to counsel 

clients about setting vocational goals and 

creating short- and long-term plans for 

achieving those goals. To develop a plan 

with a client, factors to consider include the 

results of assessments, employment 

opportunities in the local area, existing 

training resources in the client’s area of 

interest, the feasibility of alternative goals 

when full-time employment is not an option, 

and client empowerment to make the 

necessary decisions. (2) 

 For referral purposes, it is important for the 

clinician to be familiar with the local 

vocational resources available to clients. (1) 

Before referring clients to State VR agencies, 

the alcohol and drug counselor should first 

xviii 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Executive Summary and Recommendations 

develop a relationship with the assigned VR 

office. (2) 

Clinical Issues Related to 

Integrating Vocational Services 

¢ To help clients attain work-related goals that 

will also support their recovery, the alcohol 

and drug counselor should consider the 

cultural, sociopolitical, physical, economic, 

psychological, and spiritual circumstances of 

each client. This is known as the 

“biopsychosocial−spiritual” model of 

treatment. (1) 

¢ To successfully incorporate vocational 

services into substance abuse treatment, the 

alcohol and drug counselor must first 

acknowledge that vocational training, 

rehabilitation, and employment are 

important areas of concern for clients. (2) 

¢ Clinicians can best address vocational issues 

by considering their relevance at every stage 

in the client’s treatment, including their 

incorporation into individualized treatment 

plans. Preliminary information on vocational 

needs should be collected and assessed at 

intake. (2) 

¢ The Consensus Panel believes, based on its 

collective experience, that three key elements 

are essential to effectively address the 

vocational needs of clients in the recovery 

process. They suggest that clinicians: (2) 

♦ Use screening and assessment tools, 

specifically for vocational needs, when 

appropriate. 

♦ Develop and integrate a vocational



component into the treatment plan. 

♦ Counsel clients to address their 

vocational goals and employment needs. 

¢ Clinicians often play a mediating role 

between clients and employers and should 

take advantage of opportunities to educate 

the employer on substance abuse issues and 

how to address them in appropriate 

policies. (2) 

¢ In defining the client’s educational needs and 

exploring resources available to meet them, it 

is important to recognize that the client’s past 

experience with the educational system may 

strongly influence work-related 

decisionmaking. (2) 

¢ Clinicians should receive basic information 

about clients’ medical and psychological 

condition at intake, since certain medical and 

psychological limitations may affect the type 

of employment for which they are best 

suited. (2) 

¢ Clinicians should be alert to clinical and legal 

issues surrounding clients’ past histories 

and recognize their implications for 

employment. (2) 

¢ The counselor should be alert for the 

presence of relapse triggers that have 

affected the client in the past and help the 

client recognize and cope with them. The 

treatment plan should provide for effective 

management of all relapse triggers that are 

relevant to the individual. (2) 

¢ To achieve therapeutic goals in the domain of 

employment, the clinician should develop a 

treatment plan that addresses the client’s 

vocational training, rehabilitation, and 

employment needs. (2) 

Integrating Onsite Vocational 

Services 

¢ Employment and vocational services should 

be a priority in substance abuse treatment 

programs, and employment should be 

addressed as a goal in treatment plans. The 

Consensus Panel recommends that if 

possible, a substance abuse treatment 

program should add at least one VR 

counselor to its staff. Should the size of the 

program or other fiscal shortcomings prevent 

this, arrangements should be made to have a 

VR counselor easily accessible to the 

program. (2) 

xix 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Executive Summary and Recommendations 

¢ Every treatment program should consider 

itself part of a collaborative interagency effort 

to help clients achieve productive work. (2) 

¢ The treatment program must determine the 

parameters of what it can offer clients in 

terms of vocational services. (2) 

¢ Programs must ensure that staff members 

have a thorough knowledge of the diverse 

populations represented in their treatment 

program and the particular challenges that 

different groups face in securing and 

maintaining work. It is also important to 

understand various cultural attitudes toward 

work. (2) 

¢ Counselors should evaluate their clients’ 

personal plans for change to determine 

whether the vocational goals they set are 

realistic (not too high or too low) and 

whether achieving the goals will allow them 

to make a sufficient living and support 

continued recovery. (2) 

¢ Each substance abuse treatment program 

must define successful outcomes appropriate 

to the population it serves and ensure that 

funders understand the importance of these 

outcomes and the services necessary to 

achieve them. (2) 

Effective Referrals and 

Collaborations 

¢ Collaboration is crucial for preventing clients 

from “falling through the cracks” among 

independent and autonomous agencies 

providing disparate and fragmented services. 

Effective collaboration is also the key to 

seeing the client in the broadest possible 

context, beyond the boundaries of the 

substance abuse treatment agency and 

provider. (2) 

¢ Programs must reflect the fact that it is not 

feasible or effective to provide everything 

that clients need “under one roof.” A more 

fruitful approach is to collaborate with other 

agencies on the basis of client needs and 

overlapping client caseloads. (2) 

¢ All collaborators, including those providing 

treatment for substance abuse, should be 

aware that their efforts are likely to be 

ineffective unless all the client’s life areas are 

addressed. To that end, each agency must 

recognize the existence, roles, and 

importance of the other agencies in achieving 

their goals. (2) 

¢ Building an integrated service model based 

on community partners must begin from the 

client’s base, taking into account his values 

and building on the strengths of his culture 

to create referrals that are appropriate and 

effective for his particular needs. (2) 

Funding and Policy Issues 

¢ To maintain financial solvency in this new 

era of policy and funding shifts, alcohol and 

drug treatment agencies must forgo their 

traditional independence and focus on 

building collaborative partnerships to meet 

their clients’ needs. (2) 

¢ A requirement for system competency 

(specifically, an understanding of funding 

sources and strategies) should be 

incorporated into Certified Addiction 

Counselor training and certification. (2) 

¢ Policymakers at the Federal and State levels 

should work together to create financial 

incentives for collaboration between 

substance abuse treatment providers and 

agencies that provide other services to an 

overlapping population. (2) 

Legal Issues 

¢ Alcohol and drug counselors providing VR 

services directly or through referral should 

be aware of legal and ethical issues in three 

areas: discrimination against recovering 

individuals, welfare reform, and 

confidentiality. (2) 

xx 
Executive Summary and Recommendations 

xxi 

¢ Counselors should be familiar with the 

Workforce Investment Act of 1998, which 

Congress passed to improve the workforce, 

reduce welfare dependency, and increase the 

employment and earnings of its participants. 

A major emphasis of this law is its “work 

first” approach, which strongly encourages 

the unemployed to find work before 

requesting training. (2) 

¢ Counselors should be familiar with the DrugFree Workplace Act and how it may affect 

their clients in recovery from substance abuse 

disorders. Counselors should help their 

clients prepare for interviews and help them 

deal with any employment discrimination 

issues that may arise. (2) 

¢ Counselors should be familiar with 

confidentiality and disclosure issues and how 

these issues affect working with other 

agencies that are providing services to the 

client. (2) 

Working With the Ex-Offender 

¢ Substance abuse treatment programs that 

engage ex-offenders should offer clients 

respect, hope, positive incentives, clear 

information, consistency, and compassion. 

Counselors need to provide these clients with 

an understanding of a career ladder that they 

will be able to climb and help them to see 

how skills and talents that have served them 

in the past can help them succeed in 

legitimate occupations as well. (2) 

¢ Programs can encourage and assist clients to 

acquire a General Equivalency Diploma 

(GED) by locating the GED classes in the 

treatment site. (2) 

¢ VR staff should be invited to spend some 

time at the substance abuse treatment 

program site. In this way, clients will regard 

VR staff as part of the “treatment family.” (2) 

¢ Treatment programs can incorporate job and 

skills training by providing clients with 

opportunities to perform jobs at the 

treatment site. (2) 

¢ Programs should provide clients with 

guidance on budgeting. Many ex-offenders 

have not learned how to budget money. (2) 

¢ Counselors should assist clients who are exoffenders in following through on referrals 

and assembling necessary documents, such 

as social security cards and school 

transcripts. (2) 

¢ Programs can match clients to mentors/peers 

who will assist clients with all components of 

the vocational training or job placement 

tracks. (2) 

¢ For female clients in particular, programs 

should include education in parenting skills 

and skills in finding child care. (2) 

¢ Once released from incarceration, women 

with substance abuse disorders should go 

immediately to substance abuse treatment 

centers. Ideally, the treatment program 

would form a linkage to the prison so that 

counselors have the opportunity to “reach 

in” to women while they are still 

incarcerated. (2) 

¢ Counselors should assess safety issues before 

women return to potentially violent 

environments, and a safety plan should be 

developed and implemented. (2) 

¢ To increase retention of female clients, it is 

important to find or develop a gendersensitive program that offers a continuum of 

care, including aftercare. (2) 

¢ Counselors should help clients who are exoffenders to focus their job search on 

occupations and employers who do not bar 

ex-offenders, develop realistic goals, clean up 

official criminal histories (“rap sheets”), 

know when to disclose information about a 

criminal record, and learn to see their 

employment situation from the perspective 

of potential employers. These clients need to 

prepare and practice a statement that 
 

 

 

 

 

Executive Summary and Recommendations 

acknowledges a substance abuse and 

criminal history and offers evidence of 

rehabilitation, a statement explaining their 

interest, a statement about positive aspects of 

their backgrounds, and a method of 

responding to illegal questions such as “Have 

you ever been arrested?” (2) 

¢ Treatment programs can assist clients who 

are ex-offenders by educating employers 

about the benefits of hiring such clients, 

educating clients about the work 

environments they can expect to encounter, 

and helping clients assess whether a potential 

job will provide a supportive environment 

for recovery from a substance abuse 

disorder. (2) 

xxii 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1 The Need for Vocational 

Services



Work as a productive activity seems to 

meet a basic human need to be a 

contributing part of a group. It is 

critical that the meaning of work be understood 

in the context of each individual’s personal 

values, beliefs, and abilities; cultural identity; 

psychological characteristics; and other 

sociopolitical realities and challenges. But what 

is work exactly? This appears to be an obvious 

question, but the nature of work is a 

multifaceted concept. The most basic definition 

of work is that it is a purposeful activity that 

produces something of economic or social value 

such as goods, services, or some other product. 

The nature of work is varied and may include 

physical activities (e.g., laying bricks), mental 

activities (e.g., designing a house), or a 

combination of physical and mental activities 

(e.g., building a house). High- or low-paid, hard 

or easy, work is effort toward a specific end or 

finished product. 

Many individuals in this country, however, 

are not in the workforce and do not hold regular 

jobs, including a large percentage of persons 

who have substance abuse disorders. 

Employment traditionally has not been a focus— 

or a stated goal—of treatment for substance 

abuse. The standard approach has been to take 

care of clients’ addiction problems, and in doing 

so issues such as employment would take care of 

themselves because of clients’ increased selfesteem and desire to succeed. Even in instances 

where employment has been a stated goal of 

substance abuse treatment, the vocational 

services to support such a goal have not been 

readily available for all clients. 

Recent reforms in the public welfare system 

and other benefit programs stress even more the 

importance of work and self-sufficiency. 

Because substance abuse disorders can be a 

barrier to employment, it is imperative that 

vocational services be incorporated into 

substance abuse treatment. This is particularly 

important because these treatment programs 

must be ready to serve the many welfare 

recipients with serious alcohol- and substancerelated problems who must find and maintain 

employment within a very short timeframe. 

This TIP was developed to assist alcohol and 

drug counselors with the daunting task of 

addressing the vocational and employment 

needs of their clients, especially in light of 

legislative and policy changes. While the 

alcohol and drug counselor may not be able to 

achieve complete mastery of multiple 

disciplines, she must acquire at least 

rudimentary skills in the area of vocational 

services provision, as well as be prepared to 

function as a case manager who advocates for 

the needs of the client and calls on other expert 

professionals as needed to provide the services 

that support the treatment process. 

This chapter discusses the rationale for 

integrating vocational services with substance 

1 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Chapter 1 

abuse treatment, given that work is necessary 

for the physical and emotional recovery of 

clients with substance abuse disorders. Chapter 

2 describes vocational programs and resources 

and the role of the vocational rehabilitation (VR) 

counselor. Chapter 3 discusses the clinical 

issues related to integrating vocational services 

with substance abuse treatment services, and 

Chapter 4 continues that theme by describing 

how to incorporate onsite vocational services in 

substance abuse treatment programs. Chapter 5 

discusses strategies for developing referral 

networks, and Chapter 6 provides information 

about seeking funding for these services. Legal 

issues and available resources are discussed in 

Chapter 7. Chapter 8 describes how to help 

clients in the criminal justice system address 

vocational issues. 

After reading this TIP, alcohol and drug 

counselors should have a better understanding 

of the importance that the world of work has for 

helping clients recover from abusing substances 

and how to tap into the wealth of resources 

available to help their clients gain entry into this 

critical aspect of human society. 

Employment as a Goal 

Unemployment and substance abuse disorders 

may be intertwined long before an individual 

seeks treatment. The 1997 National Household 

Survey on Drug Abuse revealed that 13.8 

percent of unemployed adults over age 18 were 

current substance users, compared with only 6.5 

percent of full-time employed adults (Substance 

Abuse and Mental Health Services 

Administration, 1998). The unemployment rates 

of people with substance abuse disorders are 

much greater than those of the general 

population, even though the mean educational 

levels of the two groups are comparable (Platt, 

1995). 

A related finding from numerous research 

studies is that employment before or during 

substance abuse treatment predicts both longer 

retention in treatment and the likelihood of a 

successful outcome (Platt, 1995). A study of 

employment outcomes for indigent clients in 

substance abuse treatment programs in the State 

of Washington concluded that of the factors 

measured in this research to determine who was 

likely to be successful following treatment, 

pretreatment employment accounted for 50 

percent of the reasons why they were successful. 

Client characteristics explained about 33 percent 

of the reasons, and treatment factors accounted 

for only 12 to 18 percent of differences in 

employment outcomes (Wickizer et al., 1997). 

Although employed clients who have a strong 

work history usually respond well to substance 

abuse treatment, other variables that measure 

functioning and stability can also influence 

treatment success, such as education and a 

positive marital relationship. 

Employment also helps moderate the 

occurrence and severity of relapse to addiction 

(Platt, 1995; Wolkstein and Spiller, 1998). In 

addition, employment can offer the opportunity 

for clients to develop new social skills and make 

new, sober friends who can help clients maintain 

sobriety. 

Another important impact of employment on 

clients is the development of positive parental 

role models for their children. Metzger found a 

correlation between parental employment 

during the childhoods of both African American 

and White methadone clients and these clients’ 

subsequent work histories (Metzger, 1987). 

Work breaks the intergenerational patterns of 

unemployment and dependency on social 

services. 

Clients have often indicated a desire for 

vocational services, although they seldom have 

received sufficient assistance to meet their needs 

or expectations (Center for Substance Abuse 

Treatment [CSAT], 1997; French et al., 1992; 

Harwood et al., 1981; Platt, 1995). However, 

clients who are interested in training and 

2 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

employment services may have unrealistic goals 

and expectations about the kind of work they 

are qualified to do. Therefore, clients should be 

referred to educational programs where they 

can acquire the education or training they need 

to meet their employment goals. In an ongoing 

effort to develop model training and 

employment programs (TEPs) for treatment 

facilities in Connecticut, a 4 site survey of 337 

clients found that 88 percent were actively 

interested in vocational services leading to fulltime jobs paying $8 to $10 per hour. When 

asked what they hoped to do, however, 34 

percent of these clients said they wanted a 

technical or professional occupation, and 

another 21 percent wanted a craft or skilled 

labor position. However, these were not realistic 

expectations for the skill levels possessed by 

these individuals (French et al., 1992). 

Challenges to Employing 

Clients in Treatment 

Unemployed clients in substance abuse 

treatment programs face many challenges and 

obstacles in obtaining and keeping jobs. 

Employed clients may need help finding more 

satisfying work or identifying and resolving 

stresses in the work environment that may 

exacerbate ongoing substance abuse or 

precipitate a relapse. The barriers clients face 

may exist within themselves, in interpersonal 

relations with others, or in coexisting medical 

and psychological conditions. Barriers also stem 

from society, scarcity of lower level jobs, and 

prejudice against employing people with 

substance abuse disorders. Comprehensive and 

individualized substance abuse treatment can 

help overcome existing barriers to employment 

but is often not sufficient by itself. Vocational 

services can help clients obtain marketable 

skills, find jobs, develop interviewing skills, and 

acquire attitudes and behaviors necessary for 

work, such as punctuality, regular attendance, 

The Need for Vocational Services 

appropriate dress, and responsiveness to 

supervision (Wolkstein and Spiller, 1998). 

Alcohol and drug counselors can help clients 

address work-related issues, even when VR 

counselors are not available. For example, a 

methadone or outpatient program where clients 

are required to report several times during the 

week presents a setting to help clients develop 

punctuality, regular attendance, and appropriate 

dress and behavior skills that could later be 

transferred to the work place. 

Figure 1-1 presents common challenges faced 

by substance abuse treatment clients who are 

seeking work. These have been cited by 

Consensus Panel members and a many 

investigators and specialists in the area of 

vocational services. Employability appears to be 

inversely proportional to the number of 

coexisting disabilities and social disadvantages 

faced by each client (Platt, 1995; Wolkstein and 

Spiller, 1998). 

Different investigators identified various 

hierarchies and combinations of obstacles that 

seem critical in predicting employability. The 

priority of barrier will vary by individual and 

the specific situation. In a review of the 

research, Platt notes that special disadvantages 

such as culturally distinct population status, 

physical disability, criminal record, mental 

instability, and a lack of a high school education 

or equivalency all decrease the likelihood of 

employment (Platt, 1995). The Urban Institute 

found a similar set of barriers to employment for 

welfare recipients, including substance abuse, 

physical disabilities, mental health problems, 

children’s health or behavioral problems, 

housing instability, learning disabilities, and, 

most important, low basic skills (e.g., literacy, 

job skills, life skills) (Olson and Pavetti, 1996). A 

risk index for welfare recipients reaching Statedefined and Federal time limits (60 months) 

without employment cites some female-specific, 

but similar, disadvantages. 

3 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Chapter 1 

Figure 1-1 

Challenges to Employment 

Client Obstacles 

Personal 

 Substance use (substances used, history and pattern of use, relapse, associated problems) 

 Mental or physical disabilities (psychiatric comorbidity, physical or medical condition, 

neuropsychiatric disability, cognitive disabilities, HIV/AIDS) 

 Deficits in education and skills (education level, learning disability, literacy, language, computer 

knowledge, obsolete or low-level job skills, little or no work experience) 

 At-risk history (developmental, familial employment, employment, criminal, loss of parental rights) 

 Unrealistic expectations and attitudes (toward job demands, work habits, authority, capability for 

self-sufficiency, personal competencies, change, failure, impulse control, delayed gratification) 

 Inadequate income (for clothing, food, transportation, housing, child care, job-related equipment) 

 Work disincentives (from welfare-based income, illicit activities, relatives) 

 Discontinuation of health benefits 

 Crisis lifestyle (illnesses, children’s illnesses, violent community, numerous family tragedies and 

deaths, children’s school problems) 

 Learned helplessness or dependence taught to clients over the years 

 “First things first” approach where the client is conflicted about seeking employment and instead 

encouraged to focus exclusively on sobriety (often this approach is used by 12-Step programs) 

Attitudes 

 Negative attitudes toward vocational rehabilitation 

 Negative attitudes toward disability 

Interpersonal 

 History of violence or abuse (e.g., domestic, physical, sexual, and psychological abuse; 

criminal activity) 

 Competing family responsibilities (e.g., child or elder care, disabled family members or relatives) 

 Inadequate social supports (e.g., spousal, familial, peer group, community, institutional) 

 Lack of positive modeling (e.g., peer group, familial/parental, societal) 

Substance Abuse Treatment Program-Level Obstacles 

Staffing 

 No onsite VR counselor 

 No staff knowledge about or use of available employment and vocational services 

 No staff training in delivery of vocational services 

 Lack of understanding about vocational issues 

Client–Counselor Interactions 

 Poor therapeutic relationship 

 Discrepant expectations with respect to vocational goals and needed services 

 Agency and counselor attitude about addressing substance abuse disorder before any other issues 

(e.g., vocational services) 

4 
 

 

 

 

 

 

 

 

 

 

 

The Need for Vocational Services 

Figure 1-1 (continued) 

Challenges to Employment 

Resources 

¢ Inadequate funding for vocational services for clients, staffing, or staff training 

¢ Inadequate networking with other service providers 

¢ Fiscal disincentives brought about by clients’ loss of Medicaid or other public assistance as a source 

of payment for treatment services 

Policies 

¢ Lack of commitment to vocational services 

¢ Vocational services not integrated into substance abuse treatment 

¢ Inflexible treatment schedules (e.g., not open on weekends or afte r 5 p.m. during the week) 

¢ Lack of commitment to individualized planning and treatment 

Structural Barriers 

Employers and Businesses 

¢ Biases against hiring persons in substance abuse treatment, with c riminal records, on welfare, of 

particular gender, with disabilities (coexisting), of a certain ethnicity, or with co-occurring mental 

disorders 

¢ Unfavorable work environment (see biases above) 

¢ Inadequate on-the-job-training 

¢ Inadequate pay scales, promotion policies, or benefit packages 

¢ Lack of supportive services and information 

¢ State-required caregiver background checks and inability to work in various jobs because of 

background regardless of employer’s willingness to hire 

Welfare to Work 

¢ Unrealistic expectation regarding client’s ability to work now with out adequate time to resolve basic 

problems 

Local Labor Market 

¢ Few entry-level jobs at sufficient pay that offer the prospect of adv ancement and benefits 

¢ Difficulties in matching clients to available jobs 

¢ Lack of, or exclusion from, union membership 

¢ Jobs located too far away for reasonable transportation time 

Local Services 

¢ Limited personal or public transportation 

¢ Insufficient safe, affordable housing 

¢ Inadequate regional or local resources (e.g., day care, schools, acce ssible medical care, libraries) 

Local Employment Programs and Vocational Services 

¢ Inadequate or out-of-date programs for current labor market need s

¢ Unsuitable programs and services (e.g., for clients in substance ab use treatment, women) 

¢ Insufficient funding for long-term training 

5 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Chapter 1 

Figure 1-1 (continued) 

Challenges to Employment 

¢ No focus on job retention problems 

¢ Premature job placement when client is not ready 

¢ Waiting lists or other delays in obtaining services 

¢ Insufficient attention to short-term training to accommodate welfare reform mandates 

¢ Insufficient coordination between service systems to identify mutual goals, needed collaborative 

approaches, and means to eliminate structural programmatic behaviors 

Funding 

¢ Work is not a goal for managed care or other insurance and therefore is not funded 

Sources: French et al., 1992; Platt, 1995; Wolkstein and Spiller, 1998; Woolis, 1998. 

These disadvantages include being under age 22 

when receiving first welfare check, never being 

married, not having a high school diploma, 

having little or no work experience, and having 

a child under the age of 3 (Duncan et al., 1997). 

An important distinction to make is that 

clients may face different obstacles in acquiring 

or improving marketable skills, securing jobs, 

and maintaining employment. For example, a 

client may have difficulty securing a job if he has 

poor interviewing and job-seeking skills, no 

clear vocational goals, and a distorted 

perception of his skills, the job requirements, 

and the compatibility between these. Once on 

the job, he may encounter difficulties with 

supervisors and coworkers if he cannot accept 

criticism or direction, has poor work habits, fails 

to report problems, or is frequently late or 

absent from work without an adequate reason 

(Schottenfeld et al., 1992). Counseling and 

vocational services must be tailored to each 

individual and to his stage of employment or 

job readiness. 

Further distinctions may be made between 

limitations to employment that are temporary 

and those that are chronic, and between those 

that can be resolved and those that cannot be 

changed. Some substance users, for example, 

have transitory memory or psychological 

problems (e.g., depression, anxiety, panic 

disorders) that improve spontaneously as 

recovery progresses or with specific medication. 

On the other hand, cognitive functioning may be 

permanently damaged as a consequence of longterm and excessive alcohol use or as a result of 

traumatic brain injury from a motor vehicle 

accident, or it may not ever have been within 

normal range as a result of birth trauma or other 

unknown causes. Some skill deficiencies may be 

resolved with additional training or education if 

the client is willing and capable of pursuing 

these remedies. All of these factors must be 

considered in deciding what remedies can be 

applied, by whom they can be applied, and with 

what likelihood of success they can be applied 

using the resources available (Wolkstein and 

Spiller, 1998). 

Vocational Issues 

Vocational Needs 

Persons with histories of substance abuse will 

have varying vocational histories, ranging from 

being chronically or permanently unemployed 

to being continuously employed. It is important 

to note that the severity of the client’s substance 

abuse does not necessarily correspond to 

substance-use–related problems, employment 

status, or the need for vocational services. For 

example, the chief executive officer of a large 

corporation may have serious alcohol use 

6 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The Need for Vocational Services 

problems that may not yet be directly affecting 

his job performance. 

Substance users may be classified into a 

range of categories according to their functional 

limitations and related needs for vocational and 

other types of rehabilitative services (Wolkstein 

and Bausch, 1998; Wolkstein and Spiller, 1998). 

Clients with a strong work history require 

different forms of vocational services than those 

who have never worked and have a lifetime 

history of substance abuse and dependency. 

Figure 1-2 provides strategies for promoting 

employment for individuals throughout the 

employment continuum (Nightingale and 

Holcomb, 1997). 

Availability of Vocational Services 

Even though vocational and employment 

services are needed and wanted by clients with 

substance abuse disorders, help of this type is 

generally not part of the substance abuse 

treatment package (Platt, 1995; Schottenfeld et 

al., 1992). Researchers from the Drug Abuse 

Treatment Outcome Study (DATOS) reported 

that there was a widening gap between clients’ 

need for support services beyond substance 

abuse treatment and the availability of those 

services (National Institute on Drug Abuse 

[NIDA], 1997). These services included 

vocational services. The focus of substance 

abuse treatment has become more 

comprehensive in recent years, with some 

assessment of employment history and 

vocational functioning typically a part of the 

intake process (e.g., Addiction Severity Index) 

and often demanded by managed care and 

welfare reform. However, the provision of 

vocational services by substance abuse treatment 

programs still should be expanded. 

Some of the major reasons for the lack of 

vocational services in treatment programs 

include the current emphasis on briefer forms of 

treatment (usually outpatient) that satisfy costefficiency concerns, the very short time many 

clients actually spend in treatment, and a 

treatment philosophy that is not vocationally 

driven. Although the effectiveness of treatment 

depends on meeting clients’ multiple medical 

and social needs related to substance use, many 

programs have cut back on the services they 

offer. In a survey of 481 outpatient substance 

abuse treatment units, researchers found 

significant decreases between 1988 and 1990 in 

all services examined—physical, medical, and 

mental health care; special treatment for 

multiple substance use; and employment, 

financial, and legal counseling (D’Aunno and 

Vaughn, 1995). Of 24 methadone maintenance 

treatment programs surveyed in 1990 by the 

General Accounting Office, only four had onsite 

vocational services, and the clients were not 

required to use them (French et al., 1992). A 

similar comparison of resources available to 

clients in community-based treatment in the 

Treatment Outcomes Prospective Study (TOPS) 

and in DATOS (Ethridge et al., 1995) found a 

marked decrease over a decade in both the 

number and variety of services provided. The 

study participants reported that substance abuse 

counseling alone did not address their wideranging service needs. 

Effectiveness of Vocational Services 

For Substance Abuse Clients 

While research has been conducted on the 

effectiveness of vocational services and on 

substance abuse treatment, few studies have 

addressed the effectiveness of vocational 

services in substance abuse treatment settings. 

A few large-scale collaborative efforts and more 

focused client-specific interventions have been 

mounted over the last 20 years to increase 

clients’ employment levels. These have included 

supported work demonstrations, job-seeking 

and placement services, personal competency 

and skill-building programs, and other 

vocational supports. Most have exhibited 

moderate success, but few have been widely 

7 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Chapter 1 

Figure 1-2 

Strategies for Promoting Employment 

Job Placement Strategies 

¢ Job search assistance, either in a group setting or through one-on-one counseling or coaching, 

sometimes through “job clubs” with workshops, access to phone banks, and peer support. 

¢ Self-directed job search, where individuals search and apply for jobs on their own. Sometimes 

individuals must submit a log of their job contacts. 

¢ Job development and placement, where program staff members identify or develop job openings for 

participants. Counselors refer individuals to openings, often using computerized job banks. In 

more intensive models, staff members develop relationships with specific firms, gaining knowledge 

of potential job openings or commitments to hire through the program. 

Job Training Strategies 

¢ Classroom occupational training, by training or educational institutions such as community colleges 

or vocational schools, community-based organizations, or nonprofit or for-profit training centers. 

Training may include formal postsecondary programs leading to certification or licensing in a 

particular occupation. 

¢ On-the-job training with public or private sector employers, who usually receive a subsidy to cover 

a portion of the wages paid during the training period. The employer subsidy may be drawn from 

welfare or food stamp payments that otherwise would have been paid to the individual recipient. 

¢ Use of a mentor, who provides support to the client within the work setting. A mentor could be 

someone who went through substance abuse treatment and is now working. 

Broad Education Strategies 

¢ Remedial education, such as preparation for the general equivalency diploma (GED), basic skills 

instruction in reading and mathematics, or English-language classes for persons whose primary 

language is not English, and computer-skills building. 

¢ Postsecondary degree programs (e.g., associate’s or bachelor’s degree), generally financed by grants, 

Federal loans, or scholarships. 

Mixed Strategies 

¢ Vocational training plus basic skills, either in the workplace or in instructional centers/classes. 

¢ Supported work experience, with pre-employment preparation, assignment to public jobs, and 

gradually increasing hours and work responsibility combined with ongoing counseling, education, 

and peer support. 

Source: Nightingale and Holcomb, 1997. 

replicated, primarily because of cost factors and 

ties to federally sponsored job-training activities. 

Many of these programs did not demonstrate 

much long-term effect and did not decrease 

substance use, although the supported work 

efforts did decrease dependence on public 

assistance and increase employment (Hall, 

1984). The mixed results from these studies are 

partly attributed to difficulties of research in this 

area and the lack of a standard methodology. 

As one researcher noted (Platt, 1995), 

8 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 There are different definitions of 

employment (i.e., point-in-time or period-oftime). 

 The followup periods are varied. 

 The case mix of the populations studied is 

not always defined. 

 The components of the vocational services 

offered are not adequately explained. 

 It is not clear how well client needs were 

matched to services offered. 

 Study participants were mainly from 

publicly funded clinics that serve lower 

socioeconomic groups and did not include 

the full continuum of individuals with 

substance abuse disorders. 

 In general, the research methodologies used 

in the large-scale studies were not rigorous. 

The treatment protocols were vague and 

changed over time and from site to site, and 

large dropout rates may have compromised 

random assignment (Hall, 1984). 

 In general, there is a scarcity of research on 

the vocational services and employment 

needs of substance-using women, the 

variables that differentially affect racial and 

ethnic groups, the effects of parental 

modeling, the predictors of employability, 

and the determinants of who cannot benefit 

from vocational services. 

Traditional vocational services emphasize 

esteem building, adjustment to social conditions, 

comprehensive assessment, skill building, and 

basic education. However, today’s focus on 

work first and quick employment, which try to 

prevent clients from being left without financial 

support when public assistance ends, overlooks 

these traditional emphases. This strategy helps 

unemployed, low-skilled clients find work 

rapidly but does not help these individuals 

advance into higher paying and more satisfying 

jobs. Investigators are discovering that a 

combination of quick-employment strategies 

(also known as “rapid attachment”) and basic 

education and training produces the best longThe Need for Vocational Services 

term impacts on continuing employment and 

advancement for low-skilled workers (Hanken, 

1998). However, it is the intent of funding 

sources, such as the Welfare to Work Block 

Grant, to make available not only job retention 

support services but also training and other 

services to help clients advance to higher level 

employment (see Chapter 6, Funding and Policy 

Issues, for more information). 

Treatment and 

Employment 

A review of the literature on the impact of 

substance abuse in the workplace concluded that 

employees who abuse substances are costly to 

employers. This is because people who abuse 

substances 

 Have twice as many lengthy absences as 

other employees 

 Use more sick days and benefits 

 Are tardy three times more frequently 

 Are five times more likely to file workers’ 

compensation claims 

 Are more likely to be involved in accidents 

 Are more inclined to steal property 

belonging to the employer or other 

employees 

 Work at approximately 75 percent of their 

productive capability 

Another literature review (Comerford, 1999) 

examined the similarities in the self-efficacy 

roots of substance abuse disorders and 

vocational dysfunction, along with the benefit of 

providing vocational services in conjunction 

with substance abuse treatment. Based on this 

review, Comerford recommended using client 

functionalities and level of care as a guide for 

vocational services, closely monitoring working 

clients, and providing long-term counseling to 

ensure that clients’ developmental gains are not 

lost. 

9 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Chapter 1 

The misuse of psychoactive substances often 

compromises a person’s work performance or in 

many cases becomes such a preoccupation itself 

that continued employment is impossible 

(Wolkstein and Spiller, 1998). A study from the 

Urban Institute found that welfare recipients 

who have substance-abuse–related problems are 

just as likely to work as other recipients (63 

percent worked at some point during the current 

or previous year compared with 58 percent of 

those without substance use problems), but 

those with substance-abuse–related problems 

work less steadily—only 15 percent work fulltime and year round compared with 22 percent 

of all recipients (Strawn, 1997). 

Many studies have found that substance 

abuse treatment does increase employment 

rates, although the magnitude of the gains varies 

widely, and the results are mixed. These gains 

in employment have been reported for heroin 

addicts in methadone maintenance programs 

and therapeutic communities, for polysubstance 

users in outpatient substance-free clinics, for 

male and female clients in residential programs, 

for alcohol users in private hospital-based 

programs, and for White and Hispano/Latino 

individuals with substance abuse disorders in 

California. However, no readily identifiable 

factors are consistently associated with or 

predictive of these increases in employment 

(Platt, 1995). 

Some of these studies (Pavetti et al., 1997; 

Young, 1994; Young and Gardner, 1997) have 

cited improvements in employment rates as 

great as 60 percent among certain groups as a 

result of treatment for California residents with 

substance abuse disorders, and 136 percent 

among Missouri clients. A study in Ohio found 

a 60 percent decline in absenteeism among 

working clients who were in treatment and a 15 

percent reduction in the number of clients 

receiving public assistance (Johnson et al., 1998). 

These investigators also noted that substance 

abuse treatment is not similarly successful for 

everyone with respect to employment gains. 

Evidence indicates that substance abuse disorder 

treatment increases both employment and 

earnings (Legal Action Center, 1997b; Young, 

1994). The National Treatment Improvement 

Evaluation Study (NTIES) (CSAT, 1997b) 

reported an 18.7 percent increase in employment 

of 5,700 study participants in the year after 

treatment. In Oregon, clients increased weekly 

earnings from $154 to $278 in the 3 years after 

treatment; in Minnesota, full-time employment 

of clients in the public treatment system 

increased by 18.1 percent in the 6 months after 

treatment compared with the 6 months before 

treatment. In these studies, the welfare rolls 

were reduced (resulting in substantial savings), 

cost offsets were produced for other health care 

(e.g., hospitalizations, drug overdoses, 

detoxification, mental health admissions to 

psychiatric hospitals, treatment of in utero 

substance-exposed infants), and substance use 

also decreased. 

Other data from Minnesota, Colorado, 

Florida, and Missouri reveal increases in 

employment rates for welfare recipients who 

completed a substance abuse treatment 

program. A study in Kansas showed that 

earnings for clients were 33 times higher after 

completing treatment, compared with before 

treatment (Young, 1996). A similar study in 

Oregon found that clients who completed 

treatment earned 65 percent more than 

counterparts who terminated prematurely 

(Young, 1996). 

Substance abuse treatment also improves jobtraining effectiveness, according to a report 

issued by the Miami Coalition for a Safe and 

Drug Free Community (Rector, 1997). Because 

many participants in Federal job-training and 

skill-development efforts in this city were found 

10 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

to be using crack, three Job Training Partnership 

Act (JPTA) programs added specially developed 

Training Assistance Programs (TAPs) to their 

activities from November 1994 to November 

1995. All three sites saw increases in 

effectiveness (i.e., the percentages of adult and 

youth trainees completing training and their job 

placement rates) after incorporating TAPs that 

focused on preventing and reducing crack use. 

If work is to be sustained and enduring 

lifestyle changes made, the vocational services 

provided must focus on pathways into careers, 

on job satisfaction, and on overcoming a variety 

of barriers to employment, as well as on the 

skills necessary for maintaining employment. 

National Trends 

Affecting Employment 

A number of changes affect today’s workforce 

and must be taken into account when delivering 

vocational services to substance abuse treatment 

clients. Because the world of work is dynamic 

and job obsolescence is a well-documented 

phenomenon, vocational services must reflect 

these changes. Particularly noteworthy are 

shifts from a manufacturing to a service 

economy and advances in communications and 

other technologies that make computer literacy a 

valued and necessary skill. 

Job growth has occurred in two areas at the 

opposite ends of the occupational spectrum: 

high-wage, high-skill technical and professional 

occupations, and low-wage, low-skill service 

jobs without many opportunities for 

advancement (Hanken, 1998). The greatest 

number of new jobs that have been generated 

pay $80,000 per year or more—or $15,000 a year 

or less. Few middle-income jobs have been 

created in recent years, and this overall wage 

inequality has been increasing in the United 

States for both men and women since the mid1970s. Real wages in terms of buying power 

have fallen substantially for workers with the 

The Need for Vocational Services 

fewest skills, education, and experience, 

whereas those of professionals at the top of the 

pay scale have skyrocketed. Wages for entrylevel jobs are low and declining; moreover, they 

are likely to decrease further as more unskilled 

work is conducted in foreign labor markets and 

as more welfare recipients are required to enter 

the labor force (Burtless, 1997). 

In the U.S. economy, poorly paid, entry-level 

service work is widely available, although this 

varies enormously by locale, by skill or specialty 

area, and by transportation access to jobs 

(Burtless, 1997). In many places, new 

immigrants, unskilled and undereducated 

workers, and ethnic minority groups face 

daunting challenges. In making vocational 

decisions, these clients, unless counseled 

otherwise, may have widely discrepant 

expectations about what is desired and what is 

possible. These discrepancies can lead to 

treatment and job failure, especially if the client 

underestimates or overestimates his abilities, is 

not realistic about costs of employment and the 

challenges of financial independence, and is not 

prepared for ongoing work and additional 

training beyond the immediate satisfaction of 

having a job. 

Moreover, in today’s work world, few 

employees can expect to remain with one 

company for a complete career. Low-wage 

workers are particularly vulnerable in this new 

world of work as other publicly funded safety 

nets weaken. Going back and forth between 

work and welfare or other subsidies is no longer 

a long-term option for the chronically 

underemployed (Hanken, 1998). Lack of 

financial security can produce anxiety and 

substance use relapse unless clients are trained 

to be flexible and assertive in regard to work. 

Because most workers will change jobs and 

occupations several times in the course of a 

career, retraining and adaptability are critical. 

Work must be seen from the perspective of 

developing and advancing personal goals. 

11 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Chapter 1 

Vocational counseling and guidance can play a 

vital role in defining one’s career path and 

making difficult work-related decisions. 

Federal and State Reforms 

Welfare reform and changes 

in child welfare laws 

The combined effect of the new welfare reform 

requirements and changes in the child welfare 

laws greatly pressure parents involved with 

child protection service agencies to quickly 

comply with multiple demands for compliance 

with public system requirements. To avoid 

losing parental rights to their children, parents 

may be required to enter substance abuse 

treatment and achieve sobriety as well as meet 

other expectations of the child welfare system, 

all within a limited time period. At the same 

time, under Temporary Assistance for Needy 

Families (TANF), welfare authorities may 

impose work requirements and sanction those 

who fail to comply. 

Those with substance abuse disorders, 

minimal work experience, and dubious 

parenting skills may feel overwhelmed by all 

these demands. Maintaining sobriety, by itself, 

is a difficult achievement for many. Complying 

with work requirements and parenting 

responsibilities at the same time may seem 

impossible. For some people, the response may 

be to deny that “the system” has changed. 

Others may be overcome by a feeling of 

hopelessness and the inclination to give up. Still 

other parents will relapse into substance abuse. 

As welfare reform and changes in child 

protection laws are implemented, alcohol and 

drug counselors will see increasingly stressed 

parents in need of supportive counseling and 

services. Providing support while conveying to 

clients the urgency of their attaining or 

maintaining sobriety will be the challenge in the 

years ahead. 

There are several laws in this area with 

which alcohol and drug counselors should be 

familiar: 

¢ The Personal Responsibility and Work 

Opportunity Reconciliation Act of 1996 

¢ The Contract With America 

Advancement Act 

¢ The Adoption and Safe Families Act of 1997 

¢ The Workforce Investment Act of 1998 

¢ The Americans With Disabilities Act 

These laws must be monitored closely 

because they signal time periods when financial 

support will be terminated for clients and 

delivery of vocational and employment services 

will be drastically modified. These changes will 

heighten the urgency for integration of 

treatment and vocational services as a means to 

provide clients with maximum opportunity for 

full rehabilitation. These laws are discussed in 

detail in Chapter 7; see also the TIP, Substance 

Abuse Treatment for Persons With Child Abuse and 

Neglect Issues (CSAT, 2000a) for discussion of 

these laws. 

Medicaid and managed care 

programs 

Although Medicaid has not been a major source 

of funding for substance abuse treatment, many 

States have negotiated coverage for screening 

services, inpatient detoxification, intensive 

outpatient day treatment, and some medical, 

methadone maintenance, counseling, and 

therapy services (Strawn, 1997). Most States 

now require that Medicaid recipients enroll in 

State-directed managed care programs. 

However, in many places, moving Medicaid 

reimbursements to managed care programs has 

created new obstacles to financing substance 

abuse treatment. 

A primary tenet of managed care is based on 

“continuum of care” principles in substance 

abuse treatment. This concept argues that 

treatment needs change over time, often in a 

predictable fashion. 

12 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Managed care plans typically require the use of 

a comprehensive program having several levels 

of care, such as detoxification (inpatient, 

outpatient, or residential), hospital 

rehabilitation, nonhospital residential 

rehabilitation, structured outpatient 

rehabilitation, and individual or group 

outpatient rehabilitation (Anderson and Berlant, 

1995). Matching the proper intervention with 

current patient needs should lead to more 

effective and cost-efficient service delivery. 

Although the emphasis on cost efficiency is 

commendable, there is concern that the 

emphasis on savings might curtail treatment 

effectiveness. A focus on improved fiscal 

outcomes that ignores more satisfactory and 

enduring client outcomes could be 

counterproductive (Young and Gardner, 1997). 

Treatment barriers imposed by managed care 

programs under Medicaid in some States 

include refusal to approve appropriate 

treatment placements, failure to accurately 

diagnose substance abuse, referral to 

geographically inaccessible facilities, and 

retroactive denial of benefits (Legal Action 

Center, 1996). Providers should remain abreast 

of changes in Medicaid rules and regulations in 

order to access such financial reimbursements 

for their clients. 

An existing Medicaid requirement has also 

complicated reimbursements for residential care 

for substance users. The Medicaid rules 

prohibiting reimbursement for residential 

services provided in a facility with more than 16 

beds to anyone between the ages of 22 and 64 

years have often discouraged special 

residential treatment for women and their 

dependent children. 

Populations Most Affected by 

Legislative Changes 

There are numerous concerns regarding the 

effects of the aforementioned legislative and 

policy changes on several populations. 

The Need for Vocational Services 

These populations include women on 

welfare, their children, noncustodial parents, 

former Supplemental Security Income (SSI) 

beneficiaries, and clients in the criminal 

justice system. 

Women on welfare 

Women on welfare have been the primary 

targets of reform efforts (particularly at the 

Federal level), which reflect changing societal 

attitudes about the expanded roles of women, 

their place in the workforce, and their 

capabilities for self-reliance. The sudden 

changes and multiple roles that women are 

expected to assume are a difficult balancing act. 

Without adequate support, women who are 

living in poverty with their children find it more 

difficult to assume full responsibilities as the 

head of the household and become productive 

outside the home. Unfortunately, the new 

emphasis on women does not necessarily 

consider the many disincentives and loopholes 

in the work requirements, such as lower wages 

from work than from welfare, lack of child care, 

and loss of Medicaid benefits after certain 

periods of work. 

In response to welfare reform efforts, 

substance abuse treatment programs must 

address the vocational needs of women and 

offer them a full range of vocational services. A 

recent study of an experimental TEP for 

methadone clients in three facilities in the 

United States found significant variations in the 

types of vocational services offered to male and 

female clients (Karuntzos et al., 1994a). The 

women in the TEP were less likely to be 

involved in vocational activities or employed at 

admission compared with males. These women 

were also less likely to have received job 

preparatory services than male counterparts, 

who received more job support, job 

development, and job placement services. 

Although the investigators argued that 

differences in the vocational services provided 

reflect gender differences in vocational pressure 

13 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Chapter 1 

and readiness, women who are expected to enter 

the job market in the near future will need a 

comprehensive range of vocational services that 

are delivered intensively, as well as child care. 

Women on the TANF rolls must be alerted to the 

law’s realities and the urgency to demonstrate 

work readiness and find employment rather 

than exhaust temporary benefits. 

Indications are that the Welfare Reform Act 

has apparently stimulated a dramatic 37 percent 

overall drop in welfare rolls—with decreases in 

all States (Archer, 1998; U.S. Department of 

Health and Human Services [HHS], 1994a). 

Some welfare offices are now functioning as job 

placement centers. However, a current survey 

indicates that the numbers on the welfare rolls 

are declining in part because applicants are 

being diverted from enrollment by one-time 

cash payments, requirements to exhaust all 

assistance from relatives and charitable 

organizations before getting TANF benefits, and 

additional stipulations to engage in immediate 

job search activities and to provide evidence of a 

predetermined number of job applications as a 

condition of TANF eligibility. States are also 

discovering that necessary and appropriate 

services for hard-to-place welfare recipients are 

not available and are investing more resources 

in providing ancillary services, such as 

transportation to existing jobs and in developing 

day care for children (National Governors’ 

Association [NGA], 1997). 

Children of women on welfare 

Children of women on welfare are affected by 

the requirement that their mothers rapidly enter 

the workforce, especially if their mothers take 

low-paying jobs. This is not a minor 

consideration because children are the largest 

group on the welfare rolls, representing 

approximately two-thirds of the recipients. 

Some mothers will not be able to provide basic 

necessities of food, shelter, clothing, and 

adequate day care if these items are costly in the 

local economy, if relatives are not nearby and 

cannot help, and if other government or 

charitable assistance is not forthcoming. These 

material hardships may increase the incidence of 

child abuse and neglect (HHS, 1999a). Access 

to health care also may be jeopardized if 

employers do not offer adequate insurance 

protections or if preexisting conditions are not 

covered. Although eligibility for Medicaid is 

still available for these children, most States rely 

on managed care efforts to keep Medicaid costs 

down, which may restrict available medical 

services. New funds, however, are now 

available from the Child Health Insurance 

Partnership (see Chapter 6) to provide insurance 

to children who are not eligible for Medicaid 

and not covered by private insurance. 

High-quality child care often is unavailable 

at a reasonable cost for mothers with low-paying 

jobs. Employed mothers also have less time to 

spend with young children, and jobs may 

require lengthy commuting times, resulting in 

children’s spending up to 12 hours a day or 

more in day care. As more mothers with infants 

begin to work, child care arrangements will 

affect these children’s learning environments 

and responses, for better or worse. While there 

has not been much research, there is some that 

indicates that maternal employment does not 

harm and can help the development, 

maturation, and cognitive functioning of schoolage children (Larner et al., 1997). A lack of 

adequate supervision, by contrast, could 

exacerbate behavioral problems in children and 

contribute to a punitive and dysfunctional 

family environment. Also, it is important to note 

that children with a parent or parents with 

substance abuse disorders are at higher risk of 

developing these problems themselves. 

Noncustodial parents 

Noncustodial parents, usually fathers, may need 

substance abuse treatment and vocational 

services as they try to become better providers. 

New policies in the TANF legislation also 

require that States try to collect child support 

14 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

from absentee parents who have abandoned 

their families; this has contributed to an increase 

in child support payments retrieved by State 

and Federal government (Office of Child 

Support Enforcement, 1999). The mechanisms 

in place to identify fathers and garnish their 

wages can be punitive but, more important, 

are ineffective unless these fathers are 

working and paid enough to meet child 

support requirements. 

Some investigators estimate that working 

noncustodial fathers could contribute as much 

as 40 percent of the amount previously received 

by mothers during the 18 years of Aid to 

Families With Dependent Children (AFDC) 

benefits while a child is dependent (Larner et al., 

1997). Minnesota, Missouri, and Nevada are 

already implementing strategies to improve the 

earnings of noncustodial parents, usually by 

court-ordered referral of unemployed fathers to 

vocational and training services and threatened 

sanctions such as revocation of their drivers’ 

licenses (NGA, 1997). These strategies could 

also include treatment for those identified as 

having a substance abuse disorder. 

Former SSI beneficiaries 

Former SSI beneficiaries who previously 

qualified for cash benefits because of substanceabuse–related disabilities are no longer eligible 

The Need for Vocational Services 

for this assistance or for food stamps unless they 

have another qualifying physical or mental 

health disability. Hence, comprehensive 

vocational services integrated into substance 

abuse treatment will be necessary now more 

than ever for this population. CSAT currently is 

funding studies on the impact of this benefit loss 

on this population. 

Criminal justice system clients 

Criminal justice system clients with drug-related 

felony convictions are no longer eligible for 

TANF benefits or food stamps unless States 

modify or opt out of this prohibition. This 

group is another target for vocational services 

and employment. In addition, clients in 

treatment as a condition of probation or parole 

may lose eligibility for TANF, food stamps, SSI, 

and public housing if they are found to be 

violating conditions of release during the period 

they received such funding, or have absconded. 

The definitions of violation and of duration of 

ineligibility must be defined, as must the 

procedures for reporting between welfare 

offices, treatment programs, and the criminal 

justice system. However, because a large 

percentage of substance abuse treatment clients 

have been criminally adjudicated, this legislation 

may be another avenue for termination of their 

financial support. 

15 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2 Vocational Programming 

And Resources 

Awareness is growing about the 

importance of, and in most cases, the 

necessity of work in the recovery 

process. Work is central to the existence of adult 

functioning; in addition to providing the funds 

needed to live, work supplies status and security 

for an individual. In most substance abuse 

treatment models, recovery involves a shift 

away from substance abuse or dependence 

behaviors, attitudes, and beliefs to a focus on the 

establishment of positive life activities and 

attitudes. Traditionally this involves abstinence, 

reshaping the personality and cognitions, and 

developing a strong support network, all aimed 

at maintaining a recovery process free of relapse. 

Loss of or failure to adopt a positive vocational 

identity is a risk-laden situation for most 

individuals and often leads to depression, 

poor self-image and self-esteem, and relapse 

for many. 

In addition to the obvious psychological 

implications of employment, legal and survival 

implications have emerged for many 

individuals. Welfare-to-work reforms at the 

State and national levels now mandate 

participation in gainful employment for nearly 

all adults; consequently, most individuals 

entering recovery must be prepared to seek and 

obtain employment. This can be a daunting 

task, both for individuals and substance abuse 

treatment agencies, many of whom may turn to 

vocational rehabilitation (VR) services for 

support and assistance. 

This chapter introduces the field of 

vocational rehabilitation to alcohol and drug 

counselors and describes the services VR 

counselors are trained to provide, such as 

screening and assessment, vocational 

counseling, referral for training and education, 

and placement assistance. The chapter lists State 

and community resources that are useful in 

placing clients in jobs. In the absence of a VR 

counselor, the alcohol and drug counselor may 

have some ideas about what types of resources 

to use in providing vocational assistance to 

clients. Chapter 3 discusses issues in vocational 

rehabilitation from the clinical side. 

Vocational Rehabilitation 

Counseling 

Vocational rehabilitation counseling focuses on 

the process of improving an individual’s 

functioning in primary life areas based on the 

person’s values, interests, and goals. The VR 

counselor is trained to provide a wide range of 

vocational, educational, supportive, and 

followup services (Wolkstein and Spiller, 1998). 

These services include five essential functions 

(Schottenfeld et al., 1992): 

1.	
 Providing information to clients about the

job market, the skills and experience

17 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Chapter 2 

necessary to obtain and work successfully at 

a particular job, and the types of stressors 

and rewards associated with different jobs 

2.	
 Assisting the client with developing a



realistic view of her skills, abilities, 

and limitations 

3.	
 Teaching the client basic problem solving 

and coping skills 

4.	
 Helping the client to develop or maintain 

motivation for vocational services 

and employment 

5.	
 Aiding the client in obtaining educational 

services, skills training, or the necessary 

entitlements to obtain education and 

training (case management) 

VR counselors are professionals who have 

earned a master’s degree in VR counseling in a 

rehabilitation counselor training program 

offered at nearly 100 universities and colleges 

across the country. They are trained as 

counselors with specialization in disability and 

vocational areas, and they work in a wide 

spectrum of school- or community-based VR 

programs. The VR field has long recognized the 

importance of its involvement in the treatment 

of substance abuse disorders. Consequently, in 

addition to their core studies, a significant 

percentage of rehabilitation counselor training 

programs include specialty studies in substance 

abuse disorders as an elective sequence in their 

programs (Benshoff et al., 1990). 

Graduates of VR counselor training 

programs are eligible to become Certified 

Rehabilitation Counselors (CRCs) through the 

national certifying body, the Commission on 

Rehabilitation Counselor Certification (CRCC). 

The CRCC is the oldest counselor certification 

program in the United States, and in 1996 the 

connection between VR counseling and 

substance abuse disabilities was given more 

emphasis. In that year, the CRCC created the 

Master Addiction Counselor (MAC) 

certification, which is available to those who are 

already CRCs. As a result, universities often 

work with substance abuse treatment programs 

to cross-train with their students. Accredited 

rehabilitation counseling programs require their 

students to complete a minimum of 640 hours of 

supervised fieldwork under the supervision of a 

CRC. Students seeking a specialization in 

substance abuse counseling often complete 

practice and internships in substance abuse 

treatment settings. 

Vocational evaluators are rehabilitation 

professionals specializing in assessment, 

vocational evaluation, and work adjustment, 

including prevocational readiness. Vocational 

evaluators may become certified as Certified 

Vocational Evaluators (CVEs), a national 

certification offered by the Commission on 

Certification of Work Adjustment and 

Vocational Evaluation Specialists (CCWAVES). 

To earn this certification, individuals must 

demonstrate proficiency in such areas as 

vocational interviewing, vocational assessment, 

and individualized vocational evaluation and 

planning. A bachelor of science degree in 

rehabilitation is the minimum qualification for a 

CVE, although many earn a master’s degree in 

vocational evaluation, thus gaining preparation 

to provide more specialized services. In 

addition to learning about assessment, these 

professionals have studied such topics as 

assistive technology; group and individual 

counseling; counseling theories; case 

management; job analysis; types of disabilities; 

career planning; job placement techniques, 

testing, and evaluation; and rehabilitation issues 

related to particular disabilities, including 

substance abuse disorders. 

Figure 2-1 illustrates how one agency 

combined vocational services with substance 

abuse treatment services in a residential 

treatment facility. 

Both the Rehabilitation Act of 1973 and its 

Amendments and the Americans with 

Disabilities Act (ADA) of 1992 offer protections 

and eligibility for benefits and services to 

18 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Vocational Programming and Resources 

Figure 2-1 

Vocational Services Provided to a Residential Treatment Facility 

The Virginia Department of Rehabilitative Services provides a full-time VR counselor (perceived by 

residents as a staff member) to support the integration of vocational strategies into residential 

therapeutic communities. The counselor works closely with the treatment provider, who collaborates 

in the development of a VR plan. Clients are referred to the counselor for planning and assessment, 

which include the administration of aptitude tests that often uncover learning disabilities. An array of 

services, listed below, is then provided based on the client’s individual needs. 

¢ Vocati onal evaluation, including aptitude, skill level, and interest testing 

¢ Resea rch on jobs of interest to clients and help in arranging informational interviews, along with 

career counseling 

¢ Referr al to training and education or apprenticeship programs 

¢ A wee k-long program in job-seeking skills, including role-playing and videotaped interviews 

¢ An inf ormal job club with ongoing group sessions to support people looking for work; participants 

keep a log of their accomplishments and discuss the problems related to reentering the workforce 

¢ Empl oyer outreach and marketing to raise awareness of the availability of this pool of prospective 

emplo yees 

¢ Job pl acement services that allow for funding of on-the-job training experiences and tax credits for 

emplo yers 

¢ Assist ance in purchasing work clothes or tools required for entry into a job 

¢ After employment, a “reentry support” group that meets at night during a work adjustment period 

individuals with substance abuse disorders. For 

example, the ADA considers individuals who 

are in recovery from dependence on alcohol or 

who are in recovery from illicit drug use to be 

individuals with disabilities who are entitled to 

the protections of the Act (Feldblum, 1991). 

Within certain limitations, these Federal laws 

entitle those with substance abuse disorders to 

receive VR services funded by Federal and State 

governments. (See Chapter 7 for a more 

detailed discussion.) 

Screening and 

Assessment 

Developing a vocational plan for a particular 

client begins with screening and continues, as 

necessary, with further assessment. Vocational 

screening is usually performed during the initial 

intake process and can be performed by an 

intake counselor, an alcohol and drug counselor, 

or a VR counselor. Screening is intended to 

provide a rough picture of the client’s vocational 

history and potential. It includes a brief 

vocational and educational history, touching on 

employment experiences of the individual, 

including legal and other-than-legal 

employment, military history, and special skills 

possessed by the individual. Many individuals 

with substance abuse histories lack a legal, easily 

verifiable employment history, but they may 

have worked in jobs that paid “under the table” 

and have developed certain job skills 

in consequence. 

In addition to background information, the 

screening should assess the client’s 

psychological willingness and readiness to enter 

the workforce. Many individuals who are thrust 

into employment by welfare reform fail, but not 

because of poor work skills. More often they fail 

because they have a poor understanding of 

workplace rules, regulations, or behaviors. 

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Chapter 2 

Their failures are traced to absences, tardiness, 

or an inability to get along with supervisors and 

coworkers. In some cases, screening will reveal 

individuals with a positive work history and an 

ability to enter the workforce; in most other 

situations a more in-depth vocational 

assessment may be required. In either situation, 

the alcohol and drug counselor may wish to 

consult with a VR counselor in the development 

of the vocational portion of the treatment plan. 

Vocational assessment is a longer, more 

intensive process aimed at identifying the most 

optimal vocational outcome for the individual 

(Power, 1991). It incorporates more in-depth 

evaluative procedures and examines the 

complex social, emotional, physiological, and 

vocational factors contributing to the 

individual’s vocational potential. Vocational 

assessment should be performed by a trained 

VR counselor or a vocational evaluator. 

When the findings from the screening and 

assessment process are analyzed, the services 

the client needs to gain “successful 

employment” can be identified. The meaning of 

successful employment is different for each 

client; it can mean anything from part-time to 

full-time employment or even volunteer work or 

vocational skills training. The clinician should 

not make assumptions and should work closely 

with the client to develop a treatment plan that 

includes a vocational component appropriate to 

the client’s needs and abilities. For the plan to 

be successful, the client must be an active 

partner in establishing and maintaining the 

recovery process and must be accountable for 

his actions and behaviors. 

As treatment progresses, the client’s abilities 

and life circumstances can change. These 

changes can affect the client’s capacity for 

employment, need, or eligibility for resources 

and her attitude toward employment. The 

vocational component of the treatment plan is a 

dynamic process and should be periodically 

evaluated to determine if (1) the stated goals are 

still viable and appropriate, (2) further 

assessment is needed, and (3) any consequent 

adjustments to the plan are needed. All 

professionals involved in the client’s treatment 

plan should maintain a close working 

relationship and a dialog about the client’s 

progress so that appropriate adjustments to the 

client’s treatment plan can be made when 

necessary. Key clinical issues related to the 

development of vocational treatment are 

discussed in Chapter 3. 

Screening 

Screening allows the alcohol and drug counselor 

to determine the kinds of vocational services the 

client needs and to develop an appropriate 

vocational component to the treatment plan. 

Screening should accomplish the following 

(although not to the degree of detail that would 

be provided through a followup assessment or 

counseling by a VR counselor): 

¢ Identify the client’s major vocationally 

related experience and education, as well as 

associated capacities and limitations. 

¢ Determine what referrals will help the 

individual attain appropriate vocational and 

educational outcomes. 

¢ Identify the necessary resources to make 

employment feasible for the individual (e.g., 

transportation, day care, psychological 

adjustment, healthy self-esteem). 

¢ Determine whether further assessment is 

needed to develop the vocational component 

of the treatment plan. 

In most intake or screening processes, an 

important task is to review the client’s medical 

records. If the client has not had a recent 

medical or psychiatric examination, these should 

be arranged as part of standard intake 

procedures since medical information has 

considerable relevance to a client’s 

employability. These examinations can identify 

a client’s limitations that are not otherwise 

20 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Vocational Programming and Resources 

apparent, such as visual and hearing 

impairments, mental health problems, and 

hidden coexisting disabilities. It is important to 

remember that information from a medical or 

psychiatric examination is confidential and may 

not be shared with other providers without the 

client’s written consent. See Chapter 7 for a 

discussion of confidentiality issues. 

Screening instruments 

An initial screening for vocational issues can be 

completed by the alcohol and drug counselor. 

Figure 2-2 contains a sample of the kinds of 

vocational information that the counselor can 

gather during this initial screen. Publicly 

funded alcohol and drug treatment providers 

are required to use the Federal Minimum Data 

Set (MDS), also called the Treatment Episode 

Data Set (TEDS), as part of their intake and 

discharge procedures. The MDS contains the 

minimum amount of data that States are 

required to submit to the Substance Abuse and 

Mental Health Services Administration 

(SAMHSA) each time a client enters or leaves 

publicly funded substance abuse treatment. 

Figure 2-2 

Vocational Information From Initial Screen 

Educational History 

Write a brief description of the client’s educational history in order to evaluate current academic 

functioning and potential to engage in training that could range from remedial to advanced. The 

history should include the following information: 

 Highest school grade completed, and when 

 Client attitude toward education and possible future training (verbal report may differ from 

behavior with some clients) 

 Favorite subjects, and why 

 Extracurricular activities 

 Potential for future education and/or training 

Standardized achievement tests of math, reading, and general learning ability are often used to 

augment interview questions. The client’s educational history can also be used to indicate vocationrelated interests and values. 

Vocational History 

Write a brief description of the client’s work history in order to estimate current and potential 

vocational functioning. Ask questions addressing the following: 

 Types of occupations in which the client has worked 

 Chronology of jobs within the last 15 years, including job title, name of employer, length of 

employment at each job, and primary job duties 

 Reasons for leaving each job 

 Client-identified work skills and any certifications or licenses held 

 Client’s perception of relationships with supervisors and coworkers 

 Favorite and least favorite jobs, and why 

 Work-related ambitions and goals 

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Chapter 2 

The TEDS asks about the client’s education and 

employment status. 

Assessment 

The processes and instruments used for 

assessment are tailored to the needs of the 

individual client and should be administered by 

a trained VR counselor or vocational evaluator. 

They are based on established career 

development theories, and the instruments 

should be able to provide evidence of validation. 

They also vary according to the following: 

 Method of administration. Some instruments 

use pen and paper or computer forms; others 

use more intensive forms of vocational 

assessment that require observation of the 

individual to assess skill level and areas 

of difficulty. 

 The time required for assessment. An 

assessment can require anywhere from 

several hours for a typical case to 2 to 6 

months for an extended work evaluation. 

For some clients, extended evaluation of 

work skills in a simulated work environment 

is necessary; for others, an evaluation can be 

accomplished using basic assessment 

instruments readily accessible to 

the counselor. 

 Timing of assessment. Generally, extensive job 

readiness and assessment should be 

completed within the first 90 days following 

entrance to treatment; however, some clients 

need time to allow their bodies to recover 

from the effects of severe substance abuse. 

 Resources. Assessment resources include both 

people and organizations with expertise in 

vocational assessment and are described later 

in this chapter. Various resources offer 

different types of assessment that may be 

helpful for particular individuals. 

Functional assessment 

Functional assessment is necessary to match 

clients with work they can perform successfully. 

Going beyond traditional models of diagnosis or 

client classification, functional assessment 

incorporates a broad range of assessment 

strategies. It aims to identify existing 

capabilities and limitations, along with the 

sociocultural or environmental conditions that 

impede or enhance success for the client. Sound 

treatment planning dictates that all of the assets 

and liabilities of the client be considered to 

develop a holistic plan. Functional assessment 

provides a more objective measure for 

evaluating client behaviors and for examining 

treatment planning outcomes. It is well 

documented that relapse and recovery failure 

are linked to vocational and educational failure. 

Functional assessment is a strategy designed to 

maximize success and minimize failure; it is not 

simply a tool to provide a diagnosis or 

a classification. 

The term functional capacities denotes the job 

readiness of the individual, including skills such 

as the ability to read, write, relate well to 

supervisors and coworkers, or use a computer. 

Functional limitations are those deficiencies that 

should be addressed by a recovering person and 

VR counselor when planning to meet short- or 

long-term vocational goals. Identifying these 

limitations is important because the extent to 

which an individual’s limitations are a barrier to 

employment depends in part on her work and 

living environment. For example, an individual 

with impaired mobility or who has a visual 

impairment may not drive and must travel to 

work by public transportation. But if the client’s 

area is not served by public transportation, then 

this limitation presents a more serious barrier. 

Public VR services may assist individuals with 

impaired mobility or impaired vision to procure 

transportation for employment, including 

providing funds to purchase vehicles or convert 

existing vehicles to make them accessible. 

The functional assessment should be 

performed by professionals well versed in how 

an individual’s skills and interests lead to 

22 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Vocational Programming and Resources 

successful vocational outcomes. Normally, the 

VR counselor or vocational evaluator fits this 

description; however, the alcohol and drug 

counselor often has vital information about a 

client’s level of functioning. In complex cases, 

functional assessment can be accomplished with 

input from a multidisciplinary team. 

Key functions 

A functional assessment evaluates the client’s 

performance of key functions in five areas: 

living, managing finances, learning, working, 

and interacting socially. Interventions can then 

be planned to help the client develop or apply 

the needed skills. 

1.	
 Living. An assessment in this area helps to 

determine whether the client has the 

individual and environmental resources to 

support the activities of daily living. What 

is the client’s present living condition? Is the 

individual dependent on someone else to 

provide basic services such as cooking and 

cleaning? 

2.	
 Managing finances. Can the individual 

manage financial activities, such as handling 

a paycheck, opening a bank account, or 

living within a budget? 

3.	
 Learning. The purpose of an assessment in 

this area is to determine the client’s 

educational level and, more important, the 

client’s ability to process new information. 

Can the client concentrate, remain on task, 

comprehend spoken and written 

information, recall information, apply what 

has been learned, and express what has been 

learned clearly to others? 

4.	
 Working. The goal of an assessment of this 

area is to determine whether the client has 

the skills to maintain a job. Job-keeping 

behaviors include attendance, punctuality, 

grooming, response to coworkers, and 

response to supervision. These kinds of 

behaviors, rather than the ability to do the 

job, are a primary cause of job separation 

(i.e., being fired, quitting) for people with 

substance abuse disorders (Krantz, 1971). 

5.	
 Interacting socially. The assessment goal is to 

determine the individual’s capacity to 

engage in functional interpersonal 

relationships. This includes an ability to 

accept authority, the willingness to conform 

to workplace rules and regulations as well 

as societal norms, and a sense of community 

responsibility. 

Categories of functional limitations 

People in recovery commonly have significant 

functional limitations, some as a result of 

substance abuse and some associated with 

coexisting disorders. These limitations can be 

physical, psychological, or social, and the 

categories may overlap. 

 Physical. Physical limitations result from 

impairments of the individual’s biological 

system, including deterioration of the body 

as a result of substance abuse. Some physical 

limitations, such as HIV/AIDS, hepatitis, and 

peripheral neuropathy, are often related to or 

the result of substance abuse, while others 

may predate substance abuse. Such 

conditions must be considered when 

determining the client’s vocational goals. 

Some limitations may be partially reversible 

with abstinence. 

 Psychological or emotional. Emotional 

problems, such as mood disorders, mental 

health problems, and anxiety, and 

neuropsychiatric conditions, such as learning 

disabilities, can affect a client’s life 

functioning. These disorders may require 

psychopharmacological or behavioral 

interventions prior to or concurrent with 

vocational services (Barlow, 1988, 1993; 

Linehan, 1993). 

 Social. Social limitations affect the 

individual’s capacity to interact productively 

with others. The heavy use of substances at 

an early age, a dysfunctional family or 

23 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Chapter 2 

neighborhood environment, or 

neurodevelopmental disorders such as 

attention deficit/hyperactivity disorder can 

arrest an individual’s social development 

and maturation. In general, the earlier the 

individual began using substances, the more 

likely limitations are to occur. Some 

recovering substance users also exhibit 

immature attitudes and behaviors not 

conducive to employment, such as a “short 

fuse” or a tendency to reject authority. 

A limitation in any of these areas can be 

considered a challenge to employment or a 

vocational challenge if it affects the individual’s 

capacity for successful employment. 

Six-realm classification system 

The areas of assessment have been further 

refined into a six-realm classification system for 

functional limitations and capabilities (Livneh 

and Male, 1993). Assessments using this 

sophisticated system should be performed by a 

trained VR counselor. The system can be used 

to identify and conceptualize limitations, 

consider remedial strategies, and help the client 

make an enlightened and appropriate career 

choice. The six realms are as follows: 

1. Cognitive–processing realm. This realm 

includes brain dysfunction or diminished 

cognitive processes (i.e., information 

processing, memory, intelligence). 

Individuals with this type of impairment 

often do better at less complex and more 

routine jobs that do not require much 

independent judgment. Also, they can 

benefit from job coaching and 

supported employment. 

2. Cognitive–affective realm. This realm includes 

impairments related to judgment, 

decisionmaking, motivation, concentration, 

and staying on task. Persons with serious 

impairments in this area may have difficulty 

functioning successfully on the job and are 

best suited for simple and routine jobs with 

a minimum of cognitive involvement. 

3. Social–affective realm. Impairments in this 

area include a limited ability to form or 

maintain meaningful relationships, as well 

as problems with social and interpersonal 

adjustment. Because most jobs require at 

least some interpersonal relationships, 

limitations in this area make it very difficult 

for an individual to sustain employment. 

Consequently, therapeutic intervention to 

improve relationship skills is essential prior 

to placement. 

4. Social–structural realm. Included in this 

realm are impairments that result from 

structural or environmental conditions (such 

as neurological disorders or speech 

impairments) that may interfere with the 

capacity to associate or communicate 

effectively with others. Most of these 

difficulties can be overcome if the focus is 

placed on the client’s capabilities and 

appropriate use is made of applicable 

procedures and technology. 

5. Physical–structural realm. This area is 

comprised of structural–physical 

abnormalities resulting from accidents, birth 

defects, diseases, and injuries. Limitations 

in this area require close collaboration with 

medical and physical rehabilitation 

providers to achieve a positive outcome. 

6. Physical–neurological realm. This realm 

includes neurological impairments that 

affect physical functioning, such as those 

that result from birth defects or traumatic 

injury. It is important to focus on and use 

the client’s remaining functional capabilities 

to secure appropriate employment. 

Substance abuse can be a direct cause or a 

result of functional limitations in each of these 

realms. Because substance abuse is often a 

coexisting disability, the clinician should be 

aware of the possibility of impairment in any or 

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Vocational Programming and Resources 

all six realms and ensure that adequate 

assessment has been done to identify such 

limitations. Because these areas require more 

comprehensive evaluation of a client’s strengths 

and limitations in several specific functional 

areas, a trained psychological or VR counselor is 

needed to make these assessments. 

Assessment instruments 

A number of assessment instruments are 

available to gather more in-depth information 

related to vocational skills, interests, and 

aptitudes (see Figure 2-3). However, special 

training in the use of some of the instruments is 

needed to correctly administer the tests and 

interpret findings. Descriptions of some of the 

most commonly used and helpful instruments 

follow. See Appendix B for information about 

obtaining these resources. 

Vocational interest tools for 

alcohol and drug counselors 

A number of instruments are available to assist 

in determining vocational preferences and 

interests. These instruments are based on 

different theoretical approaches to career 

counseling. The following are commonly used 

and can be administered by alcohol and drug 

counselors to engage the client in the 

vocational exploration process. See 

Appendix B for information about where to 

obtain these resources. 

 The Self-Directed Search. This tool addresses 

vocational interests in addition to client 

attributes (Holland, 1985a). It is easily 

administered and probes the client’s dreams, 

interests, and abilities, yielding a three-letter 

code that corresponds to suitable 

occupations. It is available in a variety of 

languages and in a form for people with low 

reading levels. Although some training in its 

use can be helpful for the counselor, the 

manual provides sufficient instruction to 

interpret and use results. For the employed 

client, the tool helps the clinician determine 

whether the client’s current job matches his 

skills and interests. For the unemployed 

client, it offers a sense of possible 

vocational directions. 

 Vocational Preference Inventory Interest 

Checklist. This inventory considers possible 

occupations for a client by matching 

personality types with occupational 

examples (Holland, 1985b). 

 My Vocational Situation. This tool addresses 

vocational identity and can be used to 

measure the effectiveness of career 

interventions. A simple paper-and-pencil 

test, it is easy to score and provides 

immediate feedback (Holland et al., 1980). 

Psychometric vocational interest 

assessment tests 

The following tests generally are administered 

by a trained VR counselor or vocational 

evaluator because of their complexity of 

administration or interpretation. 

 USES Interest Inventory (USES II). This selfreport instrument measures the respondent’s 

relative strength of interests in 12 categories 

of occupational activity: artistic, scientific, 

plants and animals, protective, mechanical, 

industrial, business detail, selling, 

accommodating, humanitarian, 

leading/influencing, and physical 

performing. It consists of 162 items of three 

types: job activity statements, occupational 

titles, and life experiences. The inventory can 

be used with the general adult population 16 

years of age and older (U.S. Department of 

Labor [DOL], 1981). 

 Work Temperament Inventory. This is a selfreport measure of 12 work temperaments 

and a person’s adaptability to these 

temperaments. The 12 temperaments are 

directing others, performing repetitive work, 

influencing people, handling a variety of 

duties, expressing feelings, making 

judgments, working alone, performing under 

25 
 

 

 

 

 

 

 

Chapter 2 

Figure 2-3 

Assessment Tools 

Screening Vocational Interests Measures/Approaches (not all-inclusive) 

Categories of interests  Geist Picture Interest Inventory 

 Kuder Occupational Interest Survey 

 Reading-Free Vocational Interest Inventory 

 The Self-Directed Search 

 Strong Interest Inventory 

 Vocational Preference Inventory Interest Checklist 

 Wide Range Interest Opinion Test 

Vocational functioning  Addiction Severity Index 

 Career Attitudes and Strategies InventoryTM 

 Career Thoughts InventoryTM 

 My Vocational Situation 

 Wonderlic Basic Skills Test 

 Work Potential Profile 

Functioning in particular areas related 

to employability 

 Addiction Severity Index 

 Employability evaluation 

 Employability plan 

 Interview information 

 Placement readiness checklist 

 Previous work experience 

 Readiness planning checklist 

Emotional functioning  Interview information 

 Tennessee Self-Concept Scale 

 The Psychological Screening Inventory 

 Verified work history 

Intellectual and aptitude functioning  Addiction Severity Index 

 Adult Basic Learning Examination (ABLE) 

 Educational experience and records 

 General Aptitude Test Battery (GATB) 

 Microcomputer Evaluation, Screening, and Assessment 

(MESA) 

 Minnesota Clerical Test 

 Peabody Picture Vocabulary Test 

 Revised Beta Examination 

 Slosson Intelligence Test 

 Wechsler Adult Intelligence Scale (WAIS-R) 

 Wide Range Achievement Test (WRAT) 

Source: Adapted from Power, 1991. 

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stress, attaining precise tolerances, working 

under specific instructions, dealing with people, 

and making decisions based on measurable data. 

It can be completed in about 20 minutes by hand 

or on a computer form. The computergenerated report will provide a percentile score 

profile on the 12 work temperament scales and 

list up to 12 worker trait groups for which the 

person is suited. 

 General Aptitude Test Battery. DOL developed 

the GATB as an occupational aptitude test 

(DOL, 1970). First published in 1947, it 

measures nine aptitude factors with eight 

paper-and-pencil tests and four apparatus 

tests. The aptitudes measured are general 

learning ability, verbal aptitude, numerical 

aptitude, spatial aptitude, form perception, 

clerical perception, motor coordination, 

finger dexterity, and manual dexterity. 

Trained VR counselors can administer the 

entire test battery, which is available to 

nonprofit organizations through licensing 

agreements with the U.S. Employment 

Service (USES), in about 21⁄2 hours. Either 

individuals or small groups can be tested. 

The GATB is part of a detailed career 

assessment and exploration system available 

to VR counselors. If it is used in conjunction 

with the USES-II (Droege, 1983) and the 

Guide for Occupational Exploration (GOE) 

(DOL, 1979), the VR counselor and client 

receive the most thoroughly researched 

occupation data file assembled for the U.S. 

labor market (Parker and Szymanski, 1998). 

Not only does it translate aptitude and 

interests into potential occupations, but it 

provides information on a series of critical 

job features, including physical demands, 

working conditions, specific preparation 

needed, and required mathematical and 

language skills. The results can be further 

organized via computer with the 

Occupational Report. 

Vocational Programming and Resources 

Work samples 

Assessment approaches abstracted from actual 

job tasks can be performed to complement 

psychometric testing. Psychometric tests “are 

close simulations of actual industrial operation, 

no different in their essentials from what a 

potential worker would be required to perform 

on an ordinary job. Through performance on a 

work sample, tentative predictions about future 

performance can be made” (Power, 1991, p. xiv). 

A number of such systems are available, and 

they all measure performance across a range of 

basic job tasks. 

An especially useful assessment approach is 

a computer-based system called the 

Microcomputer Evaluation Screening and 

Assessment System (MESA) (Brown et al., 1994; 

Valpar International Corporation, 1984). The 

MESA System is designed to “assist in 

identifying those individuals who are job or 

training ready, those who are in need of 

remediation, or those who may need a more 

comprehensive assessment” (Valpar 

International Corporation, 1984, p. 67). The 

MESA System was introduced in 1982, and the 

full and short forms of the system have been 

sold to thousands of rehabilitation facilities, 

schools, private practitioners, Federal programs, 

and other rehabilitation-related facilities in the 

United States. Thus, MESA System scores 

frequently are available to rehabilitation 

counselors whose clients have completed formal 

vocational evaluations. 

Vocational Counseling 

After assessment, individuals need counseling 

about setting vocational goals and creating 

short- and long-term plans for achieving those 

goals. To develop a plan with a client, the 

factors to consider include (1) the results of 

assessments, (2) existing training resources in 

the client’s field, (3) employment opportunities 

in the local area, (4) the feasibility of alternative 

27 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Chapter 2 

goals when full-time employment is not an 

option, and (5) client empowerment to make the 

necessary decisions. 

Client empowerment is a fundamental 

premise of rehabilitation; it implies an ability to 

shift away from dependence to independence, a 

notion consistent with recovery. The very 

notion of empowerment suggests both the 

availability of opportunity and the ability to 

move toward that opportunity through a 

sequential, developmental process aimed at 

creating further opportunity. Empowerment is 

not a foreign notion to drug and alcohol 

treatment and recovery. The peer self-help 

movement empowers individuals by focusing 

on control of what can be controlled and 

recognition and acceptance that some things 

(i.e., drugs, alcohol) cannot be controlled. In 

addition, it empowers clients by creating a 

mutual support system and by a philosophy of 

moving away from learned helplessness to 

taking responsibility for one’s own actions 

and behaviors. 

From a rehabilitation perspective, disabilities 

that disempower individuals are created by 

attitudes, beliefs, stereotypes, and actual 

physical barriers in the social, vocational, or 

personal environment of the individual and are 

not intrinsic to the person. Truly empowered 

individuals are as independent as possible 

across physical, psychological, intellectual, 

social, and economic dimensions. From a 

recovery perspective these individuals might be 

conceptualized as having learned strong 

recovery skills around impulse control and 

delayed gratification, self-advocacy, and 

assertiveness. Empowered individuals are 

capable of going beyond manipulation of 

systems and people to an open, honest style 

aimed at securing and enjoying basic 

entitled rights. 

A five-step approach to career counseling has 

been described this way (Salomone, 1988): 

1. Understand self. 

2. Understand the world of work and other 

relative environments. 

3.	
 Understand the decisionmaking process. 

4. Implement career and educational decisions. 

5.	
 Adapt to the world of work/school. 

VR counselors are trained to assist clients 

through these or similar steps to determine 

vocational goals and plans. 

Agreement With and Cooperation 

With the Plan Process 

VR counselors are required to develop an 

individual plan for employment with each 

client. Formerly called the individualized 

written rehabilitation program (IWRP), this plan 

specifies the goals and objectives agreed to by 

the client and the agency and spells out the 

services the State agency will provide (see 

Appendix G for a sample IWRP). It is a formal 

document within the VR system and essentially 

represents the contract between the agency and 

the client. The principle of free choice 

strengthens the development and 

implementation of the plan—the client is 

presumed to have the ability to choose 

appropriate, realistic objectives and goals in 

concert with the VR counselor and is expected to 

meet specific and reasonable criteria for plan 

continuation. Consequently, a client enrolled in 

an educational program may be required to 

attend a specific number of classes and maintain 

a passing grade point average; a client enrolled 

in a vocational training program may be 

required to attend training regularly and on 

time. However, clients with substance abuse 

disorder–related disabilities may encounter 

policies or regulations not encountered by 

individuals with other disabilities. These 

dictates may be formal or informal (i.e., not 

contained in the agency administrative 

regulations) and may be operationalized at the 

State, regional office, or individual counselor 

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Vocational Programming and Resources 

level. For example, some agencies may require 

an individual to demonstrate a period of 

abstinence prior to eligibility for service, a 

regional office may require an individual to 

participate in counseling at a particular 

counseling center, or a counselor may require 

participation in a specified number of Alcoholics 

Anonymous meetings during the rehabilitation 

process. While these policies and regulations 

are usually well intended, they often pose a 

bureaucratic barrier to rehabilitation services. 

Clients who feel they are being denied services 

or forced into unneeded service by unreasonable 

or unfair policies are guaranteed the right to 

appeal. Each State agency has established an 

impartial hearing process to resolve cases 

in dispute. 

Other legal or regulatory factors may affect 

participation in employment plans and 

treatment plans. Some clients may be required 

or mandated to perform certain activities by the 

courts or probation and parole. Welfare-to-work 

regulations may impose other conditions the 

client must fulfill. Depending on legal or 

regulatory factors, alcohol and drug counselors 

and VR counselors may need to adopt specific 

strategies to support, guide, and encourage 

clients as they seek to comply with and meet 

the demands of the employment plan and 

external forces. 

Prevocational and 

Ongoing Services 

Prevocational services are those that are 

typically provided before an individual begins 

the job-seeking process (see Figure 2-4 for 

examples of prevocational counseling activities). 

Although some clients already have workrelated skills that need to be recovered, updated, 

or refined through a training process (or 

rehabilitation), others have no job skills and need 

to develop them for the first time. Some clients 

need training in basic life skills, such as how to 

organize themselves to engage in learning, 

before they can benefit from vocational training. 

The term habilitation describes the process of 

helping these clients acquire the basic skills 

needed to perform effectively in the workforce. 

There are several types of services, including life 

skills training programs, job readiness, work 

adjustment, and mentoring. 

Life skills training prepares clients who have 

never lived independently to manage the 

requirements of daily life. Residential programs 

or halfway houses offer opportunities to gain 

social and life skills such as cooking, cleaning, 

time management, money management, grocery 

shopping, and general household planning. 

Occupational therapists are frequently the 

professionals who provide life skills training, 

when they are available. Otherwise, community 

support workers or other team members can 

supply the training. 

Job readiness programs help individuals gain 

the specific skills, attitudes, and motivation 

needed to obtain and maintain employment. 

For example, clients learn how to interview for a 

job and make a positive impression on an 

employer, how to apply for a job in writing, how 

to dress, and how to prepare a résumé or work 

history. These services are provided through job 

clubs, VR agencies (e.g., Goodwill Industries, 

State VR agencies), nonprofit or community 

agencies, federally funded job training 

programs, or consultants. 

Work adjustment is a prevocational support 

program for people who have never had a job 

and who need help learning how to work 

effectively. Clients perform tasks in a simulated 

work environment with regular evaluations. A 

work adjustment program should be of limited 

duration, with a goal of eventual competitive 

employment. Such programs teach clients new 

skills and help them learn to tolerate criticism 

and work well with peers and supervisors. Most 

work adjustment programs are designed for 

clients who are mentally retarded, and they have 

29 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Chapter 2 

Figure 2-4 

Prevocational Counseling Activities 

Psychosocial–spiritual development 







Keep a diary of daily activities. 

Participate in role-playing exercises (e.g., for developing interpersonal communication skills, 

expressing needs and wants without appearing demanding). 

Complete values clarification, skills assessment, and personal traits exercises. 

Career exploration 









Generate an autobiography on vocational and educational experiences. 

Visit community resources, including libraries, stores, businesses. 

Read newspapers for a specific purpose (e.g., employment trends, want ads). 

Watch educational and interactive programs to stimulate discussion and practice new behavior. 

Structured activity 









Take a battery of vocational tests. 

Pursue and perform volunteer assignments. 

Take continuing education courses to determine and validate interests. 

Write a résumé. 

Source: Adapted from Rehabilitation Research and Training Center on Drugs and Disability, 1996. 

been criticized for frequent failure to lead to 

competitive employment. Some VR programs 

also provide specially trained job coaches to 

assist clients with work adjustment. Work 

adjustment needs of individuals with substance 

abuse disorders may be similar to the needs 

presented by individuals with other types of 

disabilities, but many substance abuse disorder 

clients may be offended by or resistant to 

participating in work adjustment programs. 

This is especially so if they perceive themselves 

as having been placed in a setting or with a 

disability group that is below their operational 

level. Both VR counselors and alcohol and drug 

counselors must be sensitive to these feelings in 

recommending a particular work 

adjustment site. 

Training and Education 

Many clients can only meet their employment 

goals through appropriate education or training. 

Some perhaps lack literacy. They may have 

dropped out of high school. Some have a 

history of chronic underemployment, and others 

have long-term plans that require advanced 

knowledge and skills. 

The terms education and training are 

sometimes used interchangeably; however, 

providers of these services commonly make a 

distinction between the two. These services, or 

the referrals for them, are available through 

State employment services commissions, onestop centers, schools, employers, VR centers, and 

colleges and universities. 

In general, an educational program provides 

information and sometimes skills that the 

participant can use in a variety of settings; there 

is no clear and specific vocational application. 

At the end, the participant has learned a subject 

and may also have developed or honed skills— 

such as the ability to make a well-reasoned 

argument—that can be applied in many 

contexts. For example, a college program 

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Vocational Programming and Resources 

leading to a bachelor of arts degree in history is 

an educational program. 

In contrast, a training program, such as the Job 

Corps, shows the participant how to perform a 

task and in the process provides information to 

give the instruction a context. For example, a 

course where the individual learns to 

repair computers or to build a database 

using a particular kind of software is 

considered training. 

It is possible to envision a continuum from 

“pure” education that has little to do with a 

particular job (e.g., history) to training that 

builds skills that can be applied in a variety of 

jobs (database development) or that is specific to 

the needs of a particular job (how to use customdesigned software to build a database for a 

specific job application). Which type of program 

is most applicable to meeting the client’s needs 

will, of course, depend on the client’s goals, 

timelines, and aptitude for engaging in 

learning under given conditions. 

Most secondary school and adult education 

programs provide a combination of educational 

and training activities. 

This section describes several of the most 

common kinds of training and education 

programs that are available to clients. These 

resources include school-to-work transition 

programs, on-the-job training, apprenticeship 

programs, technical schools and colleges, 

community-sponsored adult education, and 

colleges and universities. 

School-to-Work Transition 

Programs 

School-to-work transition programs provide 

opportunities for students to broaden their 

educational, career, and economic opportunities. 

These programs build on and expand other 

existing programs of several types, such as 

technical preparatory, cooperative education, 

youth apprenticeship, career academics, and 

schools within schools. These programs have 

several components: 

 Work-based learning. This includes work 

experience, job training, workplace 

mentoring, and instruction in workplace 

competencies that occur on the worksite. 

 School-based learning. This type of learning 

includes career counseling, career selection, 

major program of study, and integrating 

academics with vocational education. 

 Connecting activities. These include matching 

students with employers, job placement, 

continuing education or further training 

assistance, and linkages with youth 

development activities and industry. 

Most local school systems are directed to 

provide career exploration and support for all 

students, beginning in elementary school. 

On-the-Job Training 

Some employers offer their employees 

opportunities to gain the necessary skills for a 

specific job task in a supervised setting. On-thejob training, when available, clearly benefits the 

employee by providing useful training at no 

cost; it also benefits the employer by ensuring 

that the employee is familiar with the company’s 

particular way of doing things. 

Through networking with employers and 

tapping into the knowledge of employment 

professionals, the clinician can learn which 

employers in the area train their new employees 

and under what terms, and then make helpful 

suggestions to clients. Programs are sometimes 

available to assist in organizing these 

experiences, subsidizing the salary through the 

training period, or providing a tax credit. 

Alcohol and drug counselors should consult the 

Job Training Partnership Act (JTPA) and 

welfare-to-work agencies in their area to see if 

on-the-job training relationships have already 

been developed with local employers. 

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Chapter 2 

Apprenticeship Programs 

Apprenticeship programs offer a structured 

process for mastering a particular profession, 

such as carpentry or plumbing. Individuals 

work side by side with a skilled person. All 

apprenticeship programs require some 

classroom work as well. 

These programs are organized through 

unions and employment commissions. State 

agriculture departments often have 

apprenticeship programs suitable for farm and 

greenhouse management positions. An 

individual must meet certain criteria and often is 

required to take aptitude and interest tests upon 

application. It is important for the applicant to 

have references and experience in entry-level 

jobs in the field. Of course, a critical component 

is the employer’s willingness to make a 

commitment to train the individual. 

Technical Colleges and Schools 

Some schools and colleges offer vocational 

training in which participants develop and 

practice the skills needed to meet the 

requirements of a particular job. Some examples 

of jobs include computer operator or 

repairperson, business manager, automotive 

service technician, nurse’s aide, emergency 

medical technician, beautician, chef, welder, 

plumber, and veterinary assistant. Usually, 

technical colleges and vocational schools serve 

specific groups of occupations, such as 

technological or human services. 

Some schools offer 2-year degree programs 

that lead to an associate’s degree, 1-year 

diploma programs, or certifications that require 

less than 1 year. The degree programs often 

combine technical classes with general education 

requirements that focus on oral and written 

communications skills, math skills, research and 

computer skills, and social/interpersonal skills. 

All technical colleges and schools operate 

under an admissions policy that outlines the 

requirements for attendance. Some require a 

high school diploma or general equivalency 

diploma (GED), whereas others offer remedial 

education that allows a person to obtain a GED. 

All such programs require tuition, paid by either 

the student or another funding source. Some 

offer financial aid and provide staff members to 

assist students in the pursuit of such funding. 

Referring a client prematurely to a technical 

school can be harmful if the client embarks on 

the program without the financial support to 

complete it successfully and defaults on 

the loan. 

Community-Sponsored 

Adult Education 

Some city or county school systems use public 

schools on evenings and weekends to deliver a 

range of programs for adults, recent graduates, 

and young persons who dropped out of school. 

Many regions have accessible, well-staffed 

community colleges. These programs often are 

attractive to young people who do not have 

enough money to enter extensive training 

programs. Public schools sometimes offer 

preparation for GEDs, remedial education 

programs, and basic courses for adults. Some 

community programs offer courses in word 

processing, graphic design, and other skills. 

Programs available through community 

schools and community colleges are often 

reasonably priced and likely to be accessible by 

mass transit services. Alcohol and drug 

counselors should become familiar with the 

public educational opportunities provided by 

local schools to assist clients in using 

these resources. 

Colleges and Universities 

Colleges and universities offer programs that 

provide general knowledge and skills that are 

applicable to many different professions. Statesupported schools are likely to have lower 

tuition fees and generally give priority to 

State residents. 

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Vocational Programming and Resources 

Some clients who want to attend a college or 

university have poor academic records because 

of previous substance abuse or learning 

problems. Students who are unsure of their 

academic skills may want to take some courses 

on a pass/fail basis or register as special 

students rather than as degree candidates taking 

a full-time course load. For those who want to 

demonstrate their qualifications as students to a 

college or university before applying, taking 

courses at a less competitive school and doing 

well in them, then transferring, is a good 

strategy. Note, too, that clients may wish to 

pursue a 2-year associate’s degree if it is difficult 

to commit to a 4-year program. 

Colleges and universities are required by law 

to provide support services to students with 

disabilities, including learning disabilities. This 

might mean providing accommodations such as 

assistance in taking class notes or special 

arrangements for taking tests. However, to 

receive such services, the student must present 

documented evidence of a disability requiring 

the need for the accommodations requested. 

Employment Services 

The following sections review some of the most 

commonly used employment and vocational 

services that could benefit clients recovering 

from a substance abuse disorder who are 

seeking employment. 

Job-Seeking Skills and Training 

Some clients will need help learning how to 

secure employment because they have never 

looked for a job, are seeking a different kind of 

job, or have special problems to address in the 

job search (e.g., how to handle the existence of a 

criminal record). Many of the providers 

identified in this chapter offer assistance in 

numerous areas, such as the following: 

 How to read and assess want ads. This 

includes how to determine whether a 

position is appropriate for the client’s 

interests, skills, and background. 

 How to obtain job leads. This includes using 

job development programs like those 

maintained by unions and unemployment 

offices, the Urban League, and the National 

Association for the Advancement of Colored 

People (NAACP), and finding alternative 

sources for job information, such as 

networking with friends, and checking job 

boards in public housing administrative 

offices, city halls, and the like. 

 How to prepare a résumé that presents the 

client in the best possible light. Clients who 

have never written a résumé will need help 

in distinguishing among types of résumés, 

knowing which type is appropriate for their 

skill level, and determining 

employers’ preferences. 

 How to find job information provided on the 

Internet. The moderately sophisticated client 

will be able to use information from the 

Internet in locating suitable opportunities. 

 How to contact employers and make 

appointments for job interviews. This could 

include developing a short introductory 

speech, role-playing its delivery, and 

learning what types of responses to expect 

from potential employers. 

 How to fill out job application forms that are 

legible, highlight the client’s skills, and 

provide the information requested. This also 

includes discussion of when and how to 

inform an employer about a substance 

abuse history. 

 How to interview for a job, including how to 

dress and how to answer questions related to 

the client’s substance use history, coexisting 

disability, gaps in employment, or criminal 

record (see Chapter 7 for more information). 

Different jobs require different degrees of 

formality of dress, but cleanliness, grooming, 

and manners are always important. 

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Chapter 2 

 How to organize and manage time during

the job search process so that the client’s time

is structured and conducive to maintaining

abstinence. Being systematic and organized in

the job search pays off. This includes

expectations for the number of contacts made

each week, the best times to contact

employers, and working out transportation.

Job clubs, which use a behaviorally based,

group-oriented approach, are another source to 

help jobseekers (see Chapter 4 for more 

information about job clubs). Meeting daily or 

weekly, jobseekers help themselves and each 

other develop and pursue job leads, practice 

interviewing skills, and receive encouragement. 

These approaches have proven effective in 

helping many people achieve their job goals. 

Another valuable source for jobseekers is the 

Internet. Figure 2-5 describes America’s Job 

Bank (AJB), a Web site maintained by DOL in 

conjunction with State employment offices. 

Job Development and 

Placement Approaches 

Effective job development generally requires the 

VR counselor to provide multiple services, such 

as networking with employers, establishing 

relationships with them, and assembling 

information about employment opportunities 

for clients. The counselor locates jobs and also 

provides information to the employer about the 

client (within the confines of confidentiality). 

This addresses potential barriers to employment 

that result from biases and discrimination. VR 

counselors also conduct outreach to area 

Figure 2-5 

Job Search Resources: America’s Job Bank on the Internet 

America’s Job Bank (http://www.ajb.dni.us) is a partnership between the DOL and State-operated 

employment services. This computerized network links State employment service offices to provide 

jobseekers with the largest pool of active job opportunities available anywhere, plus nationwide 

exposure for their résumés. For employers it provides rapid, national exposure for job openings and an 

easily accessed pool of candidates. The AJB Web site is available on computer systems in public 

libraries, colleges and universities, high schools, shopping malls, and other public places. 

Every day, AJB receives new job listings from the States, and the Internet database is updated each 

night. On average, more than 5,000 new jobs are received daily from the States. Also, thousands of 

employers enter their jobs directly into the system in real time. Typically, more than 3,000 new jobs are 

received directly from employers daily. 

In addition to the AJB, there are three other sections to explore on this Web site: 

 America’s Talent Bank (http://www.ajb.dni.us). This is a nationwide electronic résumé system.

Jobseekers enter résumés into this national network, which is then searched by employers for

workers who meet their needs.

 America’s Career InfoNet (http://www.acinet.org). This is a comprehensive source of occupational

and economic information. It contains information about general outlook, wages, trends, State

profiles, and a resource library.

 America’s Learning eXchange (http://www.alx.org). This is an online source for training and

education resources. Jobseekers can find a myriad of training opportunities, including traditional

classroom- based training, leading-edge distance learning, Web-based instruction, and multimedia

instructional materials (e.g., CD-ROM, video).

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Vocational Programming and Resources 

employers to publicize the availability of 

individuals with the requisite skills for the job. 

Participating employers can receive certificates, 

publicity, or other recognition. 

Job development also requires the counselor to 

become familiar with the local labor market to 

better guide clients about the types of 

employment that are available locally. For many 

States this information is available online. DOL 

regularly identifies the professions that it 

projects will expand in the future on its Web site and 

in its annual publication, Occupational Outlook 

Handbook. AJB has links to State employ- ment 

databases, and the Career InfoNet Web site also 

provides occupational growth projections. This 

information allows the client to make decisions about 

a career that will be viable both in the present and in 

the future. 

In the act of job placement, the VR counselor 

can intervene with the employer on behalf of the 

jobseeker. The intensity of the placement services 

varies from case to case, depending on such 

factors as the client’s level of motivation, 

openness on the part of the employer, and the 

status of the economy. It requires a skilled 

professional with the knowledge and abilities to 

counsel both the client and the employer 

effectively, as well as to understand the intricacies 

of recruitment, human resources issues, and job 

satisfaction (Parker and Szymanski, 1998). 

Research also indicates that when a job placement 

plan is developed separately (i.e., in addition to 

the primary substance abuse treatment plan), 

counselors are more likely to successfully place 

their client in a job (Zadny and James, 1977). This 

may be because separately developing a 

vocational plan places more emphasis on 

employment. 

Job placement can be completed by an 

individual consultant or through a program or 

agency. Also, a number of national 

computerized services exist to help individuals 

identify prospective employment suitable to 

their skills (see Figure 2-5). Most States have 

online systems that work in a similar way: 

Employers post job openings, and respondents 

place résumés and cover letters on file for 

employers to review. 

Supported Work Programs 

Supported employment enables people with 

disabilities who have not been successfully 

employed to work and contribute to society. 

The locus of vocational rehabilitation in 

supported employment shifts from that of a 

sheltered setting to a real-world job setting. This 

approach is appropriate for clients with coexisting 

disorders (e.g., mental retardation, chronic mental 

illness, traumatic brain injury) that are so severe 

that they cannot maintain employment without 

intervention. Common forms of supported 

employment service delivery include the 

following: 

 Job coaching. A life skills coach works with

the client in a blended staff situation. The

coach may go to the client’s home or

“shadow” the client to get him to work on

time. Job coaching is usually used during

early phases of employment (i.e., the first 90

days), then discontinued or reintroduced

as needed.

 Enclave or mobile crews. Although this

approach has been criticized for isolating

rather than integrating workers with

disabilities, it is still common. An enclave is a

group of individuals who accomplish a set of

work tasks at a specific place of employment,

sometimes by sharing a single job as a group.

Typically, the business pays the service

provider, which in turn pays the enclave

employees. A mobile crew forms contractual

relationships with businesses to perform a

service, such as grounds maintenance or

housecleaning. A supervisor or counselor

oversees a group of clients who perform a job

together to ensure work quality.

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Chapter 2 

¢ Mentoring. A mentor is an individual who 

provides support to the client within the 

work setting. For example, a mentor can be 

someone who has gone through treatment 

and now holds a job similar to the client’s job. 

This arrangement is relatively easy for a 

residential treatment facility to arrange if the 

same employers hire clients from the facility. 

Mentoring can be extremely effective when 

linked to self-help support groups. 

¢ Wage subsidy programs. These Federal and 

State programs provide a subsidy for 

sheltered employees to encourage employers 

in the competitive job market to hire them. 

Typically, they pay up to one-half the 

employees’ salary for the first 90 days 

of a job. 

Figure 2-6 provides an example of a 

rehabilitation facility that offers supported work. 

Job Retention and Advancement 

Once a client has a job, a different set of issues 

arises. The client needs assistance in identifying 

relapse triggers that exist on the new job and in 

resisting the impulse to celebrate by drinking or 

using drugs for having secured employment. If 

the client has a disability in addition to a 

substance abuse disorder, VR counselors may 

need to help him identify any reasonable 

accommodations and assistive devices needed to 

perform required job functions. Individuals 

sometimes find they need additional education 

to help them manage their paycheck and 

household budget or to address other life 

changes and responsibilities that occur as a 

result of employment. Counselors should 

encourage clients to take advantage of their 

employer’s employee assistance program as 

needed. Treatment programs need to 

accommodate their newly employed clients by 

having evening counseling hours and providing 

onsite child care while clients attend 

treatment programs. 

Some kind of support for the long term must 

be built into VR programs so that the client 

avoids boredom, takes advantage of 

opportunities to advance, and manages crises at 

work. In addition, today’s job market demands 

that clients be prepared for the possibility of job 

loss. VR counselors can inoculate clients against 

the attendant dangers of despair and relapse by 

working with the clients to develop a career 

network that identifies alternative strategies and 

pathways clients can use in the event of job loss 

or new openings. (See Chapter 3 for additional 

discussion of clinical aspects of job retention 

and advancement.) 

Overview of Vocational 

Resources 

For referral purposes, it is important for the 

clinician to be familiar with the local resources 

available to clients. Some clients will need only 

education and training to help them prepare for 

a career or enhance existing qualifications. 

Others will require a variety of rehabilitation 

services in addition to training or education. 

Some will need counseling to help them choose 

an employment situation that will make the best 

possible use of their skills and satisfy their own 

criteria for “successful employment.” 

The following sections discuss the variety of 

resources and services that may be available to 

clients. There will be considerable differences 

from one region to another in what resources are 

available, how they are structured, and whom 

they serve. 

However, this discussion is intended to 

suggest avenues that could be explored to find 

new sources of vocational assistance. 

36 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Vocational Programming and Resources 

Figure 2-6 

Vocational Opportunities of Cherokee, Inc.: 

Rehabilitation Facility Providing Primarily Onsite Services 

Vocational Opportunities of Cherokee, Inc., offers both supported and sheltered employment for 

Native Americans with severe disabilities. Clients are referred to the program by social welfare 

programs; alcohol and drug treatment providers; medical treatment providers; the Women, Infants, 

and Children Program; and other sources. 

Following an assessment, the individual reviews job descriptions and chooses a field of work. 

Detailed evaluations of the individual’s capabilities, if needed, can take up to 18 months. All clients 

receive a basic training program that includes commonly needed skills, such as conflict resolution and 

grooming. The client then receives appropriate training in the chosen field and to enhance his 

functional capabilities. He begins with jobs requiring lower dexterity and skill and moves up to more 

complex jobs as capabilities increase. 

The program includes the following services: 































Evaluation 

Counseling and guidance 

Physical and mental restoration 

Culturally appropriate social activities for the client and her family 

Vocational and other training services 

Transportation 

Services to the family members of the client 

Interpreter and note-taking services for the deaf 

Readers, rehabilitation teachers, and note-taking for the blind 

Telecommunication, sensory, and other technological devices 

Recruitment and training services for public service employment 

Placement and suitable employment 

Postemployment services to enable the client to maintain, regain, or advance in employment 

Occupational licenses, tools, equipment, initial stocks, and supplies 

Rehabilitation engineering services; other goods and services 

The program employs three counselors, a job coach, and three trainer/managers. It is funded by the 

State VR agency and by tribal funds. The industrial training floor is operated through contracts with 

private employers. Some clients also perform contract work, such as grounds care for Federal 

buildings. 

Employment Resources 

Workforce Investment Act 

On August 7, 1998, President Clinton signed P.L. 

105-220, the Workforce Investment Act of 1998, 

into law. This legislation consolidates more than 

60 Federal programs into three block grants to 

States for employment, training, and literacy. 

This reform measure replaces programs 

currently under the Job Training Partnership 

Act, the Stewart McKinney Act, the Carl Perkins 

Act, and the Adult Education and Family 

Literacy Act. Statewide and local Workforce 

Investment Boards (WIBs), which will replace 

Private Industry Councils (PICs), are required to 

provide employment and training activities to 

help youths and adults facing serious barriers, 

such as disabilities (including substance abuse 

37 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Chapter 2 

disorders). The activities of the WIBs include 

disseminating lists of service providers and 

establishing one-stop delivery systems for the 

following services: 

 Outreach, intake, and orientation to 

available services 

 Assessment 

 Job search and placement assistance 

 Career counseling 

 Provision of employment information 

and forecasts 

 Assistance in finding funding and other 

support for training and education 

 Followup services 

These programs provide job training and 

other services that are intended to increase 

employment and earnings, increase educational 

and occupational skills, and decrease reliance on 

welfare. Alcohol and drug counselors should be 

aware of the eligibility requirements and 

locations of these programs in their areas and 

refer clients to these services as appropriate. 

(See Chapter 7 for further discussion of the 

Workforce Investment Act.) 

State employment services 

commissions 

A network of State employment agencies is 

funded by DOL to offer a variety of services to 

persons who are eligible to work in the United 

States. The agency names vary (see Appendix E 

for a list of the agencies in all States). A central 

office is usually established in the State capital, 

and field offices are dispersed in communities to 

serve people in specific geographic areas. 

Typically, they offer the following types of 

services to those looking for jobs and 

to employers: 

 Jobseeker services. Such services may include 

job referral and placement, referral to 

training, and activities to build skills in the 

job search process. 

 Job search support. Many State programs have 

computer-assisted job search capability, 

which allows jobseekers to reach beyond 

their immediate community. These 

databases also can provide assistance with 

career information. Multimedia systems 

include computer programs, career 

information hotlines, microfiche, 

newspapers, and Internet listings. 

 Employer services. Staff can assist employers 

by screening and referring applicants for 

job vacancies. 

 Labor market information. The agency collects, 

analyzes, and publishes data relating to all 

aspects of the State’s labor market. This 

information includes current employment 

statistics, wage information, unemployment 

rates, and data regarding occupation trends. 

 Unemployment insurance services. The agency 

collects unemployment taxes from employers 

and pays unemployment benefits to eligible 

individuals who have lost a job through no 

fault of their own. 

These State agencies work closely with local 

government and private employers. Some have 

WIBs and Employer Advisory Committees. 

Employer Advisory Committees are local 

conglomerates that have a function similar to 

WIBs and are charged, usually by “one-stop” 

legislation such as the Workforce Investment Act 

of 1998, with planning, coordinating, and 

implementing all public economic development 

and employment services. As a consequence, 

these organizations also often provide direct 

links to available Federal, State, and local 

government jobs. Two government-run case 

management programs are described in Figures 

2-7 and 2-8. Figure 2-9 describes an 

employment program for ex-offenders in Texas. 

38 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Vocational Programming and Resources 

Figure 2-7 

The Michigan Drug Addiction and Alcoholism Referral and Monitoring Agency: 

A Case Management Model 

The Michigan Drug Addiction and Alcoholism Referral and Monitoring Agency (DAARMA) operated 

under Michigan Rehabilitation Services of the Michigan Jobs Commission until it was eliminated by 

changes in Social Security and Medicaid. The program served clients receiving Supplemental Security 

Income who had substance use disorders in addition to other disabilities. Its purpose was to help these 

clients return to the workforce by ensuring that they had the tools necessary to achieve full 

rehabilitation and self-sufficiency. This program description is retained because it has many 

transferable elements. 

The program was a three-way partnership between the alcohol and drug counselor, DAARMA, and 

the vocational rehabilitation services agency. The partners were cross-trained: the State treatment 

provider agency gave a 6-week intensive training program on substance use disorders for all staff and 

in turn received training on Medicare rules and on the counseling rehabilitation model. Written 

agreements documented the partnership. Collaborating agencies made joint decisions on the 

appropriate timing for the introduction of vocational rehabilitation services. Services generally were 

introduced as soon as the clients were “clean” and their condition stabilized. The time required for the 

referral and monitoring process in the Michigan program ranged from 2 to 5 years. The program 

operated on several principles: 

 Careful, comprehensive recovery plans focusing on full rehabilitation and a return to the workforce 

are essential if the program is to be successful and cost-effective. 

 The effectiveness of a recovery plan is only as good as the quality of partnership between the 

beneficiary’s therapist and the referral and monitoring agency counselor. 

 For the treatment plan to be successful, the beneficiary must be an active partner in the 

accomplishment of his own recovery and must be held accountable for his actions. 

The case management program included the following elements: 

 A preliminary intake to determine clients’ needs. Based on the intake results, some clients were 

referred to a residential program for detoxification. 

 Counseling to ensure that clients understood the program’s benefits and the sanctions that could be 

imposed for noncompliance. 

 Periodic progress reports involving the clinician and, for corrections clients, the corrections officer. 

 Individualized referral to, and coordination of, all services needed to sustain the client’s full 

recovery and rehabilitation (i.e., substance use, physical and/or mental health treatment, 

habilitation and rehabilitation services, other supportive social services). 

 Tools to monitor compliance, including drug testing. 

Compliance issues included the following: 

 A distinction between noncompliance and relapse. A client who relapsed might continue to receive 

benefits while attempting to return to treatment, whereas a client who missed appointments 

regularly might have her cash benefits temporarily suspended. The ability to suspend benefits gave 

the program a high success rate. 

39 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Chapter 2 

Figure 2-7 (continued) 

The Michigan Drug Addiction and Alcoholism Referral and Monitoring Agency: 

A Case Management Model 

 Loss of 1 month’s benefits the first time a client was noncompliant, 2 months of checks for the 

second noncompliance, and 3 months of checks for the third noncompliance (which seldom 

occurred). 

 During the first year of the program, 53 percent of the participants were noncompliant; however, 72 

percent of them returned within 30 days after losing their first checks. 

Social Security funded the case management and monitoring function, Michigan Jobs Commission 

Rehabilitation Services funded the cost of rehabilitation services, and Medicaid funded treatment 

services. The DAARMA’s case management cost per case was $350 per year. One month’s benefit 

check for one individual without dependents was $457. Thus, successful rehabilitation saved the 

General Fund a minimum of $5,500 per year, per case, in cash benefits. In cases of noncompliance, 1 

month’s benefit suspension ($457) saved the cost of case management of a case for an entire year. The 

average cost of rehabilitation services for substance use disorder clients averaged about $1,200 per case. 

State vocational rehabilitation 

agencies 

The Rehabilitation Act of 1973, as amended, 

authorizes the allocation of Federal funds to 

establish State VR programs to assist individuals 

with disabilities in preparing for and 

securing employment. 

Priority is given to people with the most 

severe disabilities. To be eligible for VR services 

from a State agency, a person must 

 Have a physical or mental impairment 

(includes substance abuse disorder) that is a 

substantial impediment to employment 

 Be able to benefit from VR services in terms 

of employment 

 Require VR services to prepare for, enter, 

engage in, or retain employment 

This type of agency exists in all States and 

Territories. Each agency has a central office, 

which is usually located in the State or Territory 

capital, and field offices throughout the State or 

Territory. Counselors may be assigned to 

specific geographic locations, particularly to 

ensure coverage in rural areas. Some specialize 

in providing certain services, such as job 

placement, or work with a specific population 

(e.g., those with substance abuse disorders or 

brain injuries). 

State VR offices provide a wide range of 

services, including vocational counseling, 

planning, training, and job development and 

placement. The alcohol and drug counselor can 

refer a client to a State VR office after the initial 

assessment phase is completed and the client is 

ready to benefit from these services. Before 

accepting the client, the coordinating counselor 

arranges for further assessments to determine 

the client’s readiness for rehabilitation. 

The primary case management and 

counseling services for the State agency are 

provided by a rehabilitation counselor. The 

rehabilitation counselor’s responsibilities include 

(1) assessing the client’s needs, (2) developing 

programs and/or plans to meet identified needs, 

and (3) providing or arranging for the services 

needed by the client, which may include job 

placement and followup services (Parker and 

Szymanski, 1998). 

40 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Vocational Programming and Resources 

Figure 2-8 

Combating Alcohol and Drugs Through Rehabilitation and Education (CADRE) 

Limited Case Management/Rehabilitation Support for a Public Housing Community 

Fourteen CADRE centers provide prevention and intervention services, operating in 12 Chicago 

Housing Authority (CHA) developments. Each conducts intake assessment and makes referrals for 

substance abuse treatment for the community and helps residents to move toward self-sufficiency. As 

part of these services, residents may receive vocational services on a voluntary basis. Participants are 

self-referred as a result of flyers distributed door to door or are referred by various social service 

agencies that work with CHA residents. Each center has a director, one case manager (who is a Statecertified alcohol and drug counselor), two prevention specialists, and a general clerk. Programs are 

funded by the U.S. Department of Housing and Urban Development’s Public Housing Drug 

Elimination Program through a grant to CHA’s in-house employment and training program. 

The CADRE centers make available the following vocational services: 

 Job readiness programs that teach participants how to write a résumé, how to look for a job, how to 

dress for a job, and similar skills 

 Job fairs where local businesses take applications and résumés 

 Recovery support groups (not geared specifically to employment) 

 Access to job-hunting resources such as a telephone, fax machine, computers, and the Internet 

 Job training provided through outside consultants 

Once a client is accepted by the agency, 

rehabilitation legislation mandates the 

development of an individual plan for 

employment (IPE)—also known in some States 

as the IWRP—to identify goals and objectives for 

employment, as well as a timetable for 

achievement. It is important for the alcohol and 

drug counselor to review the plan with the VR 

counselor to support the client in achieving these 

goals and identifying potential difficulties. The 

vocational plan should reinforce the substance 

abuse treatment plan and make the interagency 

linkage work as well as possible for the client. 

Before referring clients to this type of service, 

the clinician should first develop a relationship 

with the assigned VR office, which is likely listed 

in the phone book in the State government 

section. Because many VR staff members will 

need cross-training in substance abuse 

treatment, each office should have a supervisor 

who can help determine which counselor should 

receive the referral. 

Clients referred to a State VR agency must 

call to make an intake appointment. It helps to 

have psychological and medical evaluations 

ready, as obtaining documentation of disability 

is the second step of the process and often the 

most cumbersome. These evaluations must be 

signed by appropriate professionals and indicate 

the type of disability and limitations. Also, any 

information about a client that is divulged to 

another agency must be accompanied by a 

release form signed by the client (see Chapter 7 

for a detailed discussion on confidentiality 

issues). State VR agencies can place clients in 

precontracted job training programs or provide 

funding for eligible clients to attend technical or 

college programs. This funding can enable 

indigent clients to receive the higher education 

services that would have eluded them without 

this support. 

41 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Chapter 2 

Figure 2-9 

The Texas Workforce Commission: Project RIO (Re-Integration of Offenders) 

Project RIO is administered by the Texas Workforce Commission in collaboration with the Texas 

Department of Criminal Justice (TDCJ), the Windham School District, and the Texas Youth Commission 

(TYC). One goal of the project is to link education, training, and employment during incarceration with 

employment, training, and education after release from prison. Another goal is to reduce the rearrest 

rate through employment. 

Program participants receive services both pre- and postrelease from prison. An individualized 

treatment plan is developed for each offender to identify a career path and to guide placement 

decisions. Before release, a comprehensive evaluation is conducted to assess the needs of the offender 

and to assist in the selection and placement in Windham, college, TDCJ, and TYC programs. The 

evaluation process is a multistep process that includes information gathering, goal setting, program 

placement, and offender assessment. 

Project RIO staff members encourage participants to take advantage of the education and vocational 

services and assist offenders in obtaining the documents necessary for employment. Staff also provides 

placement services to give offenders practical work experience in their areas of training. 

After release, program participants receive individualized services, including job preparation and 

job search assistance. Participants attend job search workshops that focus on basic skills, such as 

completing a job application, preparing a résumé, and building interview skills through mock job 

interviews. The most important goal of the Project RIO program is for ex-offenders to secure 

employment as soon as possible after their release. 

Project RIO also involves employers in the community. Program staff ensures that potential 

employers are aware of the incentives for hiring ex-offenders. The staff certifies prospective employees 

for the Work Opportunity Tax Credit program, which provides a tax incentive to employers for hiring 

economically disadvantaged ex-offenders. 

Seeking and Securing Funds for 

Vocational Services 

Two recent pieces of legislation will strongly 

influence the ways that treatment programs seek 

and secure funds to meet their clients’ vocational 

needs. The Personal Responsibility and Work 

Opportunity Reconciliation Act of 1996 

dramatically transformed the means by which 

public assistance is provided (see Chapter 7 for 

details on this legislation). The Balanced Budget 

Act of 1997 provided additional resources to 

support the goals of the 1996 welfare reform 

legislation by authorizing DOL to provide 

welfare-to-work grants to States and local 

communities. These grants are to be used for 

transitional employment assistance to move 

hard-to-employ recipients of Temporary 

Assistance for Needy Families (TANF) into 

unsubsidized jobs offering long-term 

employment opportunities; clients with 

substance abuse disorders are specifically 

targeted. The program is mobilizing the 

business community (largely through local 

WIBs) to hire welfare recipients and is working 

with civic, religious, and nonprofit groups to 

mentor families leaving welfare for work. 

Funds can be used by States, PICs, WIBs, and 

other entities to move eligible individuals into 

long-term jobs by a number of means, including 

job retention and supportive services such as 

substance abuse treatment. Although TANF 

(and therefore welfare-to-work) funds cannot be 

used for “medical services” such as 

detoxification under the care of a physician, a 

range of substance abuse treatment services can 

be provided under this funding. In some States, 

42 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Vocational Programming and Resources 

TANF block grant funds have been allocated for 

substance abuse treatment services, including 

assessment, residential treatment, and less 

intensive outpatient programs. 

The welfare-to-work legislation is 

implemented differently in each State, and there 

is a complex web of political and financial forces 

that must be understood to access this funding 

effectively. Scanning the environment to 

determine the relationships among the welfare 

agencies, PICs, WIBs, State substance abuse 

agencies, and other community-based 

organizations is critical. It is in this context—a 

complex landscape of shifting ideas about 

treating substance abuse disorders, changing 

funding streams, and the blurring of roles and 

responsibilities between public and private 

sectors and between Federal and State 

governments—that substance abuse treatment 

programs must seek to secure the funds that 

have been set aside to help chronically 

unemployed welfare recipients obtain and 

maintain work. 

Program planners should look to the future 

and budget for one-time expenditure items that 

will improve vocational outcomes for clients. 

Such items might include a computer with a 

package of vocational assessment software. A 

VR library can be budgeted as a one-time 

expense although some updating is periodically 

needed (see Figure 2-10). Additional 

information on securing funding for expanding 

current programs and hiring is provided in 

Chapter 6. 

Resources for Veterans 

When eligible dependents and survivors are 

included, nearly one-third of the U.S. 

population is entitled to veterans’ benefits (U.S. 

Department of Veterans Affairs, 1997). The 

huge job of administering these benefits belongs 

to the Veterans Benefits Administration (VBA). 

The VBA’s mission, in partnership with the 

Veterans Health Administration, is to provide 

benefits and services to veterans and their 

families in a responsive, timely, and 

compassionate manner in recognition of their 

service to the nation. The benefits include 

compensation and pensions, housing loans, 

insurance, and vocational or educational 

counseling and training. The VBA’s educational 

services have two objectives: 

1. To enable veterans to pursue training or

attain higher education for the purpose of

adjusting to civilian life, restoring lost

educational opportunity, and expanding

economic capacity.

2.	
 To provide educational opportunities to

children whose education would be

impeded by reason of death or disability of a

parent incurred in the Armed Forces; these

opportunities are extended to surviving

spouses in preparing them to support

themselves and their families at a level the

veteran could have expected to provide.

Vocational Rehabilitation and Counseling 

Service programs (VR&C services) primarily 

serve veterans entitled to benefits under 38 

U.S.C., §3100 et seq. VR&C services administer 

vocational training to certain nonserviceconnected veterans awarded disability pensions 

and educational and vocational counseling to 

specified classes of beneficiaries (veterans, 

service members, spouses, widows, and children 

of disabled veterans). Alcohol and drug 

counselors should be aware of those clients who 

are entitled to these benefits and how to access 

these services. Persons eligible for veterans 

benefits must apply through the local or regional 

Veterans Administration office, which can be 

located through the Federal government pages 

of the telephone book. 

Community-Level Providers 

Almost every community has a host of agencies 

that provide VR services. They offer a variety of 

43 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Chapter 2 

Figure 2-10 

Basic Materials for a Vocational Reference Library 

VR counselors use a variety of resources to help clients find jobs. The following is a list of basic 

materials that a counselor should have available. Although not all programs can afford an Internet 

hookup to access online employment-related information, they should identify locations where clients 

can obtain Internet access, such as schools and public libraries. 

DOL Documents 

¢ Guide for Occupational Exploration 

¢ Dictionary of Occupational Titles 

¢ Occupational Outlook Handbook 

Local Resources 

¢ Local newspaper classified ads 

¢ Local telephone directories 

¢ Catalog of employer profiles 

¢ Contact information (address, phone number of personnel department) of 

♦ The largest employers in the area

♦ The employers who hire the largest number of local workers

♦ The fastest growing local employers

♦ Employee Assistance Programs

¢ Mentor lists by employer 

¢ Public transportation routes and schedules 

¢ Course catalogs describing majors and programs in local technical schools, community colleges, and 

universities 

Employment-Related Publications 

¢ College Placement Annual 

¢ National Business Employment Weekly 

¢ The Professional and Trade Association Job Finder 

¢ The National Job Market 

¢ The National and Regional Job Bank 

¢ Career Guide to Professional Associations 

¢ What Color is Your Parachute: A Practical Guide for Job-Hunters & Career-Changers 

Other Resources 

¢ Materials from the local Chamber of Commerce 

¢ Materials from the local Job Service 

¢ Access to Web sites such as America’s Job Bank (http://www.ajb.dni.us) 

¢ State economic development Web sites for access to State and national job bank databases 

services, from job-seeking assistance to State-certified and funded. In other States they 

employment in a sheltered or supported are funded and operated by counties or cities. 

environment. In some States these agencies are In many instances, the agencies are private, 

44 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Vocational Programming and Resources 

nonprofit groups funded from a variety of 

sources to serve a specific group of clients. 

Eligibility for the services varies according to the 

policies established by the specific organization 

and its funding sources. Some serve persons 

with disabilities who are unable to work in a 

competitive environment, whereas others focus 

on youths who are at risk for dropping out of 

school or need a second opportunity because 

they already dropped out. Particular 

populations, such as those in a public housing 

community, could also benefit from 

rehabilitation programs targeting their needs. 

The key is that these services are designed to 

meet the unique needs of the community. 

These organizations receive funding from a 

number of funding streams—Federal, State, and 

private (including foundations). The 

Neighborhood Funders Group is a national 

association of grantmaking institutions. It has 

more than 150 member foundations that seek to 

improve the economic and social fabric of lowincome urban neighborhoods and rural 

communities. Many of their programs fund 

employment projects that vary from community 

to community. The local social services agency 

is a starting point to learn more about 

these programs. 

Community-based 

rehabilitation centers 

Community-based rehabilitation centers offer a 

range of medical, social, psychological, and 

technological services to persons with 

disabilities. They serve a locality, allowing 

people to undergo rehabilitation and build 

supports in their own community. They receive 

funding from State agencies, insurance 

companies, and nonprofit agencies (e.g., 

Goodwill Industries). A community-based 

rehabilitation center’s target population varies 

according to the center’s mission but might 

include persons with a traumatic brain injury, 

spinal cord injury, and learning disabilities, 

among others. Referrals to this type of center 

require coordination with the funding source. 

Mental health agencies 

Some local mental health agencies have 

designed vocational services as part of their 

continuum of care for eligible clients. These 

services vary and require coordination through 

the mental health care center or office. Persons 

who have a mental illness and require 

supportive services to obtain and maintain 

employment may be eligible. Some examples of 

typical programs include job club programs as 

part of day treatment programs, job coaching for 

obtaining and maintaining appropriate work 

behaviors, and supportive employment onsite in 

a work setting. Alcohol and drug counselors 

have numerous avenues for finding out about 

local VR services: 

¢ State VR department or a local office of the 

department in a city 

¢ The Web site for the State VR department 

¢ Single State Agency for substance abuse 

prevention and treatment 

¢ State Department of Labor 

¢ State or local Workforce Investment Board 

¢ Local employment development department 

¢ Private agencies, such as Goodwill Industries 

45 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3 Clinical Issues Related to 

Integrating Vocational Services 

There are many compelling reasons for 

vocational components to be part of the 

substance abuse treatment plan for 

clients in recovery. For example, 

 Achievements such as completing education 

or training, finding a job, and maintaining 

employment counter a sense of personal 

incapacity and provide a basis for increasing 

self-esteem. Many substance-using clients 

used drugs initially to avoid feelings of 

worthlessness and powerlessness. 

 The work environment offers an opportunity 

for the client to apply recovery skills, such as 

building supportive relationships, learning to 

work within an authority structure, accepting 

responsibility, managing anger, and 

recognizing boundaries. 

 As clients consider the possibility of entering 

or reentering the workforce, highly charged 

clinical issues may emerge. For example, 

some clients have painful memories of school 

and consider themselves failures, especially if 

they have specific learning difficulties. Other 

clients may have had limited social 

interactions during their periods of substance 

abuse and may find the complex relationship 

patterns of a new work environment 

mystifying or frightening. Clients’ family 

histories will also affect their view of 

workplace authority figures. 

 Meaningful progress toward employment 

can reduce the potential for relapse. 

To help clients attain work-related goals that 

will also support their recovery, the alcohol and 

drug counselor should consider the cultural, 

sociopolitical, physical, economic, psychological, 

and spiritual circumstances of each client. This 

is known as the “biopsychosocial−spiritual” 

model of treatment. For example, clients who 

enter a workplace culture that contradicts their 

cultural values will face a particularly difficult 

challenge, and clinicians will need to help these 

clients mediate between the two opposing 

cultural realms. 

This chapter discusses clinical issues related 

to the incorporation of vocational components 

into the substance abuse treatment plan and 

how to counsel clients to address their 

vocational goals and employment needs. 

Exploring options for appropriate training or 

education, finding and maintaining 

employment, and coping with environmental 

and legal challenges also are discussed. The 

chapter then addresses how to develop a 

treatment plan and at the end presents case 

studies using the principles discussed 

throughout the chapter. 

Incorporating Vocational 

Services 

To successfully incorporate vocational services 

into substance abuse treatment, the alcohol and 

drug counselor must first acknowledge that 

47 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Chapter 3 

vocational training, rehabilitation, and 

employment compose an important area of 

concern for clients. How clients handle work 

often is closely related to how they handle other 

aspects of their lives; therapeutic concerns such 

as poor self-esteem, feelings of inadequacy, 

hypersensitivity to criticism, and issues with 

authority tend to manifest themselves in 

relationships at work. Therefore, gainful 

employment can be a measure of a client’s 

successful adjustment, social functioning, and 

community reintegration (Schottenfeld et al., 

1992). Research also suggests that the 

occurrence and severity of relapse tend to be 

lessened in individuals who can develop 

positive self-images and raise self-esteem 

through employment (Arella et al., 1990; Deren 

and Randell, 1990). Employment also can help 

decrease criminal behavior and substance abuse 

(Schottenfeld et al., 1992). Realistically 

speaking, clients must be able to support 

themselves financially. These findings confirm 

the therapeutic importance of including 

employment as part of the substance abuse 

treatment process. 

Clinicians can best address vocational issues 

by considering their relevance at every stage in 

the client’s treatment, including their 

incorporation into individualized treatment 

goals. Preliminary information on vocational 

needs should be collected and assessed at intake. 

When the client’s situation is stable, the 

vocational element of the treatment plan should 

be more fully developed. Additional 

assessments should be conducted if necessary, 

with referrals to vocational services 

as appropriate. 

The Consensus Panel believes, based on its 

collective experience, that three key elements are 

essential to effectively address the vocational 

needs of clients in the recovery process. They 

suggest that clinicians 

1.	
 Use screening and assessment tools,

specifically for vocational needs,

when appropriate.

2. Develop and integrate a vocational

component into the treatment plan.

3.	
 Counsel clients to address their vocational

goals and employment needs.

These recommendations are discussed in 

more detail below, except for screening and 

assessment, which are discussed in Chapter 2. 

Developing and Integrating a 

Vocational Component Into the 

Treatment Plan 

Regardless of the client’s employment 

situation—employed, looking for better work, or 

unemployed—it is appropriate for the treatment 

plan to have a vocational component that 

specifies objectives developed jointly with the 

client. Goals should be set that can be achieved 

through counseling (such as improving 

relationships with coworkers, handling anger or 

stress appropriately in the workplace, improving 

attendance), or the client may require referral to 

vocational rehabilitation (VR) counselors. The 

following are situations in which a clinician 

should refer the client for vocational services: 

 The client is asking questions about 

employment or vocational goals that the 

clinician has difficulty answering. 

 The counselor and client cannot develop a 

clear and concise set of goals concerning 

vocational issues because of a lack of 

information or guidance. 

 The client needs special vocational testing 

or training beyond the expertise of the 

counselor or has a disability that 

requires special accommodations to 

obtain employment. 

 The client’s vocational history is either 

nonexistent or has been so seriously affected 

48 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Clinical Issues 

that another person with expertise in this 

area should be introduced to assist the client 

with vocational issues. 

 The client clearly wants to accomplish 

something meaningful through work but 

needs help, for whatever reason, to make 

such a major life change. 

Counseling Clients To Address 

Vocational Goals and 

Employment Needs 

Research suggests that counselors can help 

clients progress by focusing on what clients feel 

is most important (Jongsma and Peterson, 1995; 

Linehan, 1993; Meyers and Smith, 1995). For 

many clients, employment is the primary 

concern. For women with children, their care is 

of primary concern, and employment is the 

means to obtain that goal. For clients coming 

from incarceration, employment may be a 

condition of their parole. For others, work may 

seem unrelated to their current needs and 

desires as they perceive them. Still, exploring 

vocational goals can help these clients attain 

other goals, such as increased financial 

independence or a more satisfactory living 

arrangement. By helping the client appreciate 

the benefits of work, expressing optimism about 

the client’s ability to obtain work, and preparing 

the client for the work environment, the clinician 

can foster positive change in the client’s sense of 

worth, increase hope for the future, and 

positively affect many other areas. Figure 3-1 

presents a list of early-stage vocational issues to 

explore with clients. 

Many persons in recovery share common 

internal and external challenges in regard to 

employment. These include out-of-control 

feelings, coexisting disorders or disabilities, low 

self-esteem and self-efficacy, poor work 

histories, fear of failure, fears and anxieties 

severe enough to block needed actions, 

deficiencies in life skills such as financial 

planning, and poor problemsolving or coping 

skills. As these challenges become clinical 

issues, the clinician should address them in an 

empathic but motivational style, building 

rapport and trust and practicing reflective 

listening skills. A solution-focused approach 

can be used to help clients recognize that 

although it feels as if there are no alternatives, 

they can choose from among a range of options. 

The timing of the introduction of elements of 

vocational services depends on a number of 

factors, which are presented below in the section 

on developing the treatment plan. 

A treatment plan for substance abuse ideally 

includes professionals from a number of 

disciplines. This multidisciplinary approach is 

discussed in greater detail below. The roles 

assumed by two of the players—the alcohol and 

drug counselor and the VR counselor—differ 

from one program to another and sometimes 

even within programs from one client to 

another. If the alcohol and drug counselor is the 

only person addressing employment issues, this 

clinician’s tasks will be different from the case 

where the client is engaged in a formal 

vocational program. 

The clinician—either the alcohol and drug 

counselor or VR counselor—has important 

responsibilities in (1) activating and supporting 

the client’s desire for change, (2) motivating the 

client to take the risk of seeking new or better 

employment when appropriate, (3) helping the 

client learn to anticipate and solve problems, 

and (4) referring the client to community 

resources that can provide support at various 

points on the employment continuum. 

Appropriate therapeutic goals in the realm of 

employment include the following: 

 Help the client establish a positive life vision. 

What were the client’s childhood dreams? 

What kind of person does she want 

to be now? 

 Establish life goals with the client that are 

consistent with this life vision and realistic in 

49 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Chapter 3 

Figure 3-1 

Early-Stage Vocational Issues and Approaches 

Psychosocial–Spiritual Values 





















Explore alternatives to a substance-using lifestyle and personal value system. 

Explore goals, interests, abilities, strengths, weaknesses, and personal values. 

Learn to consider personal and spiritual needs. 

Identify and acknowledge specific talents. 

Develop the concepts of lifestyle change and psychosocial development. 

Have a stable home and intact family; receive regular paychecks. 

Examine the relationship of substance abuse to other life issues. 

Consider ways to achieve positive parenting, good health, and economic independence from 

welfare and other support systems. 

Revise one’s self-concept in relation to independent functioning at home, school, and work. 

Develop a positive outlook. 

Activities of Daily Living 











































Learn effective socialization skills. 

Interact without the use of drugs, with people who have not used drugs. 

Engage in activities of daily living. 

Begin to incorporate more healthful habits into daily living. 

Learn appropriate dress, hygiene, walk, talk, and eye contact. 

Learn to manage money. 

Open and maintain bank accounts, budget, and save money. 

Change living situation, if necessary. 

Acquire stable housing away from people currently using drugs; reunite with spouse, parents, or 

children. 

Check for any outstanding arrests on the client’s record and follow up on results. 

Clean up legal records. 

Increase independence and responsibility. 

Assume responsibility for managing money and solving problems. 

Improve communication. 

Talk to new people in new ways. 

Learn to structure and be responsible for time. 

Manage time, calendar, appointments. 

Organize documents, e.g., social security card, birth certificate, military discharge papers, driver’s 

license, diploma, training certificates. 

Get credentials in order and ready to present. 

Consider spirituality as a part of daily living. 

Determine sources for spiritual expression. 

Education 







Evaluate educational level, skills, and potential. 

Take tests, assess deficits, plan for remediation if required. 

Examine attitude toward school. 

50 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Clinical Issues 

Figure 3-1 (continued) 

Early-Stage Vocational Issues and Approaches 

 Highlight positive points. 

 Consider longer term educational and vocational goals. 

 Consider benefits of further education. 

Vocational Skills 

 Evaluate vocational level. 

 Take tests; engage in a situational assessment. 

 Evaluate courses that have been taken; differentiate from courses that have been completed. 

 Reexamine prior training and what is still current. 

 Consider current vocational skills and their potential for employment. 

 Perform skills assessment. 

 Examine desires for training. 

 Consider why further training is necessary; consider in the context of specific goals. 

Employment 

 Develop an understanding of the world of work. 

 Read career literature; visit work sites. 

 Adopt an identity as a worker. 

 Explore opportunities to be productive. 

 Examine work experiences for past successes and failures. 

 Develop a realistic picture of accomplishments and problems. 

 Consider potential for transferability of skills. 

 Compare skills to job demands. 

Source: Adapted from Rehabilitation Research and Training Center on Drugs and Disability, 1996. 

terms of the client’s knowledge, skills, 

and abilities 

 Identify the objectives, resources, and specific 

steps needed to enable the client to meet 

those goals within an appropriate timeframe. 

It is also important to have an understanding 

of the client’s cultural and family values and 

beliefs about work. For example, many Asian 

Americans are likely to focus heavily on 

returning to work because of the strong work 

ethic within their culture and the shame 

associated with being out of work. Family 

members are likely to be pressuring the client 

(possibly not with great sensitivity) to return to 

work. However, the client may be reluctant to 

explore the reasons for job loss or to identify the 

specific steps needed to make a change. 

In such cases, the clinician should validate 

and support the cultural value placed on the 

importance of work and acknowledge the 

client’s sense of being pressured to return to 

work. In addition, it is sometimes helpful to 

frame the treatment as a rebuilding process 

similar to the body’s healing and reconstruction 

after an injury. 

It is important to recognize that all clients, 

not simply those who belong to cultural and 

ethnic minorities, approach work from a 

particular cultural framework. However, the 

clinician should beware of making assumptions 

about how clients’ cultural backgrounds affect 

their perceptions and experience because 

individuals can differ significantly from the 

norms of their culture. 

51 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Chapter 3 

In addition, the clinician should maintain an 

awareness of his own values, attitudes, and 

biases that affect the view of work-related 

decisions and challenges and how these can 

negatively affect the client’s ability to progress. 

The clinician who does not see in work the 

possibility for growth and a way to enhance 

recovery will inevitably communicate to the 

client a poor attitude regarding work. 

Clinicians often play a mediating role 

between clients and employers, helping each 

understand the other’s point of view. The 

clinician’s grasp of the employer’s view is 

essential to ensuring the client’s smooth 

transition to the workplace. Clinicians should 

also take advantage of opportunities to educate 

the employer on substance abuse disorder issues 

and how to address them in appropriate 

policies. A service partnership or close 

collaboration with a VR counselor is especially 

valuable in mediating and facilitating client– 

employer relations. VR counselors work 

regularly with employers in their communities 

and are trained to negotiate win-win situations 

with clients and employers. 

Competency Areas for 

Employment 

As clients move toward planning for future 

work or addressing challenges in their current 

workplaces, many opportunities for personal 

growth and accomplishment arise. Competency 

areas applicable to clients in recovery who are 

concerned with vocational issues include 

 Identifying vocational goals 

 Seeking appropriate education or training 

 Coping with medical and psychological 

challenges 

 Coping with environmental challenges 

 Coping with legal challenges 

 Developing social and life skills 

 Finding and maintaining employment 

 Planning for a career and resilience 

 Preventing relapse 

The clinician should explore the client’s 

developmental history and other pertinent facts 

in each competency area, including relevant life 

experiences and their positive or negative 

consequences. This section discusses these 

competency areas and addresses the clinical 

challenges that commonly arise in each area. 

Identifying Vocational and 

Employment Goals 

As clients envision the possibility of a 

vocation—purposeful work that is meaningful to 

them—they also have an opportunity to address 

important therapeutic goals such as increased 

self-sufficiency, self-trust, and a sense of efficacy 

in the world. Although employment accepted 

for the purpose of gaining money also addresses 

these goals, the sense of choice that is implied by 

the term “vocation” is especially powerful. 

Because of this, the clinician will want to help 

the client distinguish between short-term 

employment strategies and long-term strategies 

for developing a vocation. In guiding the client 

to address this important topic, the clinician 

should use appropriate pacing and timing and 

avoid a confrontational approach. A realistic 

vocational goal should be part of a positive and 

compelling life vision that truly belongs to 

the client. 

If the client has a negative work history, the 

clinician can activate a positive self-image by 

asking the client about areas in her life in which 

she has been successful (e.g., helping parents or 

other family members, participating in a 

religious group or other community 

organization). The idea that skills acquired in 

one setting are often transferable to another is 

sometimes new and reassuring to many clients. 

To assist the client with vocational planning, 

the alcohol and drug counselor or VR counselor 

will need reliable information about the client’s 

52 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Clinical Issues 

life experiences, especially past work and 

educational experiences, as well as his 

knowledge, skills, and abilities. If available, the 

clinician should review prior employment and 

vocational skills assessments and the results of 

prior aptitude testing. (Information relayed by 

the client about educational or VR agencies that 

have previously worked with the client should 

be verified and records obtained to ensure the 

accuracy of details.) With a work history, the 

counselor can perform a “transferable work 

skills analysis.” Typically, this process involves 

the following steps: 

1.	
 Use the relevant job history, training, 

experience, skills learned, and 

responsibilities handled and identify the 

client’s relevant characteristics (e.g., physical 

capabilities, working conditions, education). 

2. Translate these characteristics into 

measurable traits and skills and assign a 

value or level to skill development. 

3.	
 Conserve the value of specific residual skills 

unaffected by disability (i.e., what the client 

has not lost because of disability). 

4.	
 Apply the residual traits and skill levels to 

the universe of potential jobs. 

Salomone states that transferring skills from 

one job to another requires the assessment of (1) 

the worker-specific vocational preparation that 

classifies work as unskilled, semiskilled, or 

skilled; (2) the physical demands of previously 

performed jobs; (3) a medical determination of 

the client’s current physical and mental status 

and ability; and (4) the identification of specific 

jobs that the client could perform given the three 

factors noted above (Salomone, 1996). There are 

computer-based programs such as the EZ-DOT, 

CAPCO, and RAVE (Brown et al., 1994) that can 

be used to assist the counselor in this process. 

The client’s work history will reveal the skills 

the client already has. However, some clients 

may have forgotten parts of their employment 

history, and many will not be able to articulate 

the knowledge, skills, and abilities they possess. 

To elicit this information, the clinician can ask 

about specific activities the client has done, such 

as using a jackhammer or cooking, as well as 

about the client’s use of spare time. Hobbies 

and interests sometimes suggest possible career 

directions, as well as natural talents. To assess 

clients’ vocational interests, the clinician can use 

the easy-to-administer Self-Directed Search, 

mentioned in Chapter 2. The results of this scale 

can then be discussed with the clients to 

determine realistic vocational choices to explore. 

As previously noted, vocational issues are 

ideally introduced when the client is relatively 

stable, although there are situations where the 

need for employment is so compelling that it 

must be addressed immediately. Whenever this 

issue is raised, the counselor should tailor the 

strategy to the client’s stage of “readiness to 

change.” A well-known model of change, 

developed by psychologists James Prochaska 

and Carlo DiClemente, is relevant (Prochaska 

and DiClemente, 1982). This model envisions 

the process of change as a wheel in which the 

individual moves from a stage of not thinking 

seriously about change (precontemplation) to 

seriously contemplating the possibility of 

change, determining to undertake change, acting 

to make the desired change happen, maintaining 

the new behavior, dealing with possible relapse, 

and then around the circle from contemplation 

once more. Different skills are required on the 

part of the clinician when the client is at 

different stages (Miller and Rollnick, 1991; see 

also TIP 35, Enhancing Motivation for Change in 

Substance Abuse Treatment [CSAT, 1999c]). 

As the client progresses through the cycle of 

change, it becomes possible to address new 

and more challenging dimensions of longterm planning. 

Clients who are at a precontemplation stage 

in regard to work may need motivation to help 

them develop a positive attitude toward the 

prospect of work. Applicable clinical strategies 

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Chapter 3 

include encouraging positive “self-talk” and 

exploring both the benefits and the 

disadvantages associated with work in a 

motivational style that elicits “self-motivational 

statements” (Miller and Rollnick, 1991). The 

clinician can build on the client’s desire to stay 

“clean” and show how work can support that 

objective by providing a legal means of income 

as well as the potential for developing 

relationships that support a substancefree lifestyle. 

Some clients who have clear and pressing 

reasons to find work are nevertheless in denial 

about the necessity to make a transition. This 

condition may present itself as avoidance: “I’m 

doing 12-Step and that’s it—I’m in recovery, and 

I just can’t handle anything else.” Some clients 

enjoy the sharing and social contact that a group 

offers so much that they want to make it fill their 

lives; finding or staying in jobs may seem a 

distraction from what feels most important. The 

challenge for the clinician is to help them 

appreciate the realities of the situation and 

envision the consequences of their decisions, 

while maintaining the primacy of recovery. 

Clinicians should be careful not to foster a belief 

in their clients’ fragility that could lead to their 

being denied useful services. If clients are 

genuinely unsure of where they stand (e.g., in 

regard to welfare-to-work requirements), then 

accurate information should be provided to 

them, or the clinician should make relevant 

referrals as appropriate. 

For many clients, the transition to work 

seems a daunting leap from their present 

situation. Some are used to thinking in terms of 

getting through 24 hours at a time, and the 

thought of how to plan for a year or more can be 

overwhelming. Such clients can benefit from 

encouragement and from a focus on short-term, 

specific, manageable goals within the context of 

a longer term strategy. Clinicians can help 

clients envision each step and prepare them to 

overcome the obstacles that each step presents. 

For clients who lack work experience, a positive 

framework for considering work issues needs to 

be built. It should be explained to them that 

work is sometimes difficult and may require 

sacrifice but that it offers the satisfaction of 

achievement. For some clients, a period of 

temporary work in a supervised and controlled 

setting is necessary to prepare them for more 

permanent full-time work. Certain residential 

programs, for example, have clients engage in 

mechanical work under the auspices of the 

program in order to ease the transition and build 

a positive work history (see Chapter 2). 

Clients who must for the first time accept 

menial employment will have understandable 

difficulty with the transition to work. 

Reorienting their values and framing the new 

work world positively is usually a long-term 

and difficult task. The clinician will need to help 

clients develop reasonable job expectations 

given their skills and environment. It will also 

be important to emphasize the nonmonetary 

rewards of work such as no more fear of arrest 

for selling or using illegal drugs and the esteem 

from family for having “gone straight.” 

Clients must also learn to envision a ladder 

to more prestigious employment and accept a 

reasonable pace of progress. Use of metaphors 

that are meaningful to the client helps to 

illustrate stages of growth leading to the goal. 

For example, sports superstars start out by 

practicing, learning, developing, and 

demonstrating their talents before they can build 

a reputation. Or, the clinician might compare 

the injury caused by the substance abuse, and 

the recovery afterwards, to the time and effort 

needed to rebuild the strength in an arm or leg 

after a serious wound or fracture. These 

analogies can be effective with clients who relate 

more readily to physical symptoms than to 

psychological concepts. 

Even for clients who are currently employed, 

a reconsideration of vocational goals is often 

advisable as part of the recovery process. 

54 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Some employed clients in recovery should 

consider a transition because their job exposes 

them to alcohol or drug use on the job. For 

example, a construction worker whose crew 

drinks or smokes pot at lunchtime or after work 

may not be able to maintain a substance-free life. 

Assessing the Need for 

Education or Training 

In defining the client’s educational needs and 

exploring available resources to meet them, it is 

important to recognize that the client’s past 

experience with the educational system may 

strongly influence work-related decisionmaking. 

For example, the client may have had an 

undiagnosed learning disability and may have 

experienced repeated failure within the 

educational system, or the client may have had 

poor experiences with teachers. Some clients are 

illiterate, although they may have concealed this 

fact even from some of their closest associates. 

Clients who are not native English speakers 

may have experienced difficulties from the 

language difference that have affected their 

education. It is important for the clinician to 

be aware of the client’s history in these areas 

and to help the client recognize and reframe the 

impact of a negative learning history on the 

present situation. 

To support the client in obtaining successful 

employment, the clinician should be able to 

answer the following questions: 

 What are the client’s functional limitations 

that influence the type of work that would 

be appropriate? 

 What strengths and attributes does the client 

bring to the world of work? 

 Is the client literate in any language? 

 Does the client use more than one language? 

 What is the client’s language preference? 

 Is improving language skills important to 

the client? 

 What is the client’s level of education? 

Clinical Issues 

 What level of education does the client want 

to have? 

 What is the client’s past experience with 

schooling or learning? 

 What is the client’s present attitude toward 

schooling or learning? 

 What level of literacy or educational 

attainment is necessary to meet the client’s 

current vocational goals? 

The clinician can learn the answers to some 

questions indirectly by noticing cues from the 

client, assessing writing skills on the basis of the 

intake forms, and observing the client’s patterns 

of communication. Other questions are best 

addressed by asking the client directly at an 

appropriate time in the treatment process. 

Typically, the clinician makes a preliminary 

estimate of the client’s educational abilities at 

the outset, then refers the client to other 

resources as necessary for a more thorough 

assessment. Counselors working with clients 

who are ex-offenders also should be familiar 

with the educational resources available to those 

clients through the prison system so that 

appropriate referrals can be made if necessary. 

When the clinician has the information about 

the client’s educational history, needs, and 

interests, the clinician can then assist the client 

with identifying career goals and determining 

the education required to meet those goals. The 

clinician should help the client recognize when 

his goals may be either too high or too low. 

However, it is important to be sure the process is 

client-driven, emphasizing the client’s 

responsibility for decisionmaking. 

As the client demonstrates a capacity to 

engage in education and becomes more 

employable, the clinician can support the client 

by raising the bar of expectation and 

encouraging the client to take on more 

challenging educational and vocational 

objectives. It is important, however, that the 

pace of progress not exceed the client’s ability to 

55 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Chapter 3 

experience success and handle whatever 

disappointments occur. 

Finding and Maintaining 

Employment 

The process of finding a job provides an 

opportunity for clients to grow in many areas 

important to recovery. It provides an 

opportunity to practice goal-setting and 

recognize achievement. Through a successful 

job search, the client can acknowledge the 

potential for positive change and movement in a 

direction of her own choosing. 

To be successful, clients may need to grow in 

a number of different ways. Common growth 

areas include the following: 

 Overcoming the fear of change or the unknown. 

Counseling can be a valuable resource in 

overcoming this fear, which can lead to 

relapse in a newly recovering substance user. 

This fear is also addressed by pointing the 

client toward a job club formed by others in a 

similar position or by helping the client find a 

peer or mentor who has traveled a similar 

path. Judicious self-disclosure by the 

clinician may also be appropriate. Moving 

toward desired goals may still be anxiety 

producing, and small steps will 

maximize success. 

 Developing job-seeking skills. These skills 

include allocating an appropriate amount of 

time to job hunting, finding ways to 

compensate for the lack of a network of wellplaced contacts, using the job search methods 

most likely to be successful, being 

available for employer contact, and 

mastering the “walk, talk, and dress” of an 

employable person. 

 Being patient. Overcoming the desire for 

immediate gratification, learning to accept 

incremental progress, handling 

disappointments appropriately, and keeping 

things in perspective are all parts of a healthy 

approach to work. 

 Communicating effectively with the employer. 

Clients must learn how to present facts about 

the past and any disabilities to employers in 

a positive framework as well as how to gauge 

a prospective employer’s willingness to work 

with a person in recovery. Addressing gaps 

in employment that have resulted from being 

fired from previous jobs or from being 

incarcerated is also important. This provides 

an opportunity to frame the treatment 

experience as a transition, focusing on the 

client’s views for the future—but without 

dishonesty or denial. It can be beneficial for 

clients to talk with their employer about 

treatment and the choices they are currently 

making, placing their past choices firmly in 

the past. For some, being employed will 

provide incontrovertible evidence of the 

changes they have made. Counselors should 

caution clients to be selective in selfdisclosure. Some employers can be very 

judgmental. Figure 3-2 depicts a model for 

an appropriate dialog that the client could 

practice through role-playing exercises with 

the clinician or therapy group members 

(recognizing that interviews in the real world 

are not likely to be so straightforward). 

Once the client has found employment, the 

work setting itself will present challenges and 

provide opportunities for growth. It provides an 

opportunity to learn appropriate boundaries and 

appropriate self-protection. The client may need 

help discerning when self-disclosure is 

appropriate and when it is not. Recovering 

clients who are newly employed—particularly 

those with criminal records—should be careful 

of being in vulnerable positions in which they 

could be accused of stealing or other illegal 

behaviors (e.g., avoid closing up a store alone). 

Work will also provide an opportunity for some 

to recognize and accept responsibility. 

Workplace conflict is to be expected, and 

persons in recovery may find such conflicts 

powerful triggers for relapse. 

56 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Figure 3-2 

Answering Questions Related to Substance Use History—A Sample Scenario 

 

 

 

 

 

 

 

 

Clinical Issues 

Interviewer: I noticed that none of these jobs lasted more than 18 months, and most were only a few



months.



Client: Yes, a couple of years ago I had problems at a couple of jobs. I think it was partly a question of



immaturity. I just wasn’t ready to take things seriously. 

Interviewer: I also noticed that you haven’t been working for the past year. What have you been



doing? 

Client: I decided I had to get my life together. I’d started using drugs and ended up getting arrested. 

The court gave me a choice and I took the opportunity to go into drug treatment. I learned a lot about 

myself and also about working. At the treatment program I volunteered to work in the office. 

Interviewer: Do you have any convictions? 

Client: Yes, one conviction for drug sale and possession while I was using drugs. I did have problems 

earlier, but at the drug treatment center I found that I really enjoyed working in the office doing data



entry, filing, and answering the phones. 

Source: Adapted from Englehart, 1993. 

The workplace may evoke associations with 

the family of origin, intensifying and potentially 

distorting the client’s sense of what is at stake in 

conflict situations. The clinician, alone or 

through a therapeutic group, can help the client 

get the distance needed to perceive the situation 

accurately. The therapeutic process will help the 

client become conscious of associations and 

better able to separate past and present issues. 

Impulse control, problemsolving skills, stress 

management, and conflict resolution skills may 

all require development. In addition, the client 

may need help recognizing the legitimate 

options open to her in the situation—for 

example, getting help from the human resource 

department or requesting a transfer. 

Many persons in recovery experience 

problems with authority that can become clinical 

issues as they enter the work environment. 

Some mistrust authority and experience a great 

deal of stress when dealing with their 

supervisors. They may have an excessive fear of 

being fired or a too-quick response to perceived 

mistreatment. Some fail to manage anger and 

can explode when the boss is critical or 

inflexible. The clinician can help the client 

distinguish between appropriate and 

inappropriate behavior on the part of the 

supervisor, and, if this is a problem, help the 

client separate emotional reactions to the 

supervisor from feelings about a parent or other 

authority figure. Clients can work on seeing 

“the boss” as a person. In addition, clients 

should learn to recognize their personal power 

in dealing with the supervisor and notice 

opportunities to negotiate. These issues can be 

dealt with successfully in individual or group 

therapy, or the client may be referred to 

community resources for training in 

pertinent job and behavioral skills such as 

anger management. 

Coping With Medical and 

Psychological Challenges 

Some clients have medical and psychological 

needs and limitations that can affect the type of 

employment for which they are best suited. The 

clinician can help them consider how to present 

these needs and limitations to an employer and 

acquaint clients with their legal rights 

concerning accommodations. 

57 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Chapter 3 

Clinicians should receive basic information 

on the client’s medical and psychological 

condition at intake. The Addiction Severity 

Index (ASI) can provide a brief history and 

description of the client’s medical needs (See 

Appendix D). If a more in-depth vocational 

assessment is needed it should be done by a VR 

counselor or a vocational evaluator (see Chapter 

2). Also, a physical examination is usually part 

of the intake procedure; the clinician should 

identify acute and chronic medical needs and 

identify a process to address them. In particular, 

clients should be screened for substance abuserelated disorders such as sexually transmitted 

diseases, HIV/AIDS, and hepatitis, at the 

initiation of the treatment process so that these 

disorders may be treated and stabilized prior to 

the client’s vocational training or employment 

endeavor. The screening should include 

determining what accommodations might be 

necessary for a client with medical dysfunction 

in training or employment settings. 

Similarly, at intake or as soon as possible 

thereafter, clinicians should determine whether 

the client has coexisting psychiatric disorders. 

ASI has a psychiatric domain that may be 

helpful. The client may have problems such as 

depression, anxiety, anger control, memory 

deficits, concentration deficits, or more severe 

symptoms such as hallucinations. In that case, 

the client should be referred to a psychiatrist for 

further evaluation and to determine whether 

medication is necessary (or if current medication 

is effective). Such disorders have implications 

for vocational planning and for the kinds of 

support the client needs from the clinician when 

actively seeking or trying to maintain 

employment. Keep in mind that diagnosis of a 

psychological disorder is impossible if the client 

is still using. The psychoactive effects of drugs 

or the manifestations of withdrawal may mimic 

the symptoms of mental conditions. Generally 

the client must have abstained from drugs for an 

extended period of time (6 to 12 months) before 

a differential diagnosis can be made. 

Special issues arise for clients who are either 

reliant on opioid maintenance therapy (i.e., 

methadone) or dependent on prescribed 

medications. If a client is taking methadone, 

then she may fail drug tests mandated in some 

places of employment unless she has disclosed 

the fact to the employer’s medical review officer. 

It can be beneficial for a methadone patient to 

transfer to treatment with LAAM (levo-alphaacetyl-methadol) as LAAM cannot be detected 

in urine drug screens except for thin layer gas 

chromatography and gas chromatography/mass 

spectrometry. See TIP 22, LAAM in the Treatment 

of Opiate Addiction (CSAT, 1995d). Similar 

problems can arise with certain prescription 

drugs (see Chapter 7 for a discussion of 

associated legal issues). The clinician or another 

knowledgeable specialist should help the client 

manage appropriate self-disclosure in advance 

of the drug test so that his right to 

confidentiality is protected. 

Medications can generate a variety of other 

work issues that, whenever possible, should be 

anticipated before the client seeks or accepts 

employment. Some psychotropic medications, 

for example, can cause side effects such as 

lethargy, dizziness, and nausea. It is essential 

that these side effects be considered when 

determining appropriate work situations for 

clients so that they are not placed in a dangerous 

situation or one that will ultimately lead to 

failure. The timing and conditions under which 

the medication must be consumed should also 

be taken into account. Some medications leave 

the body through sweat, reducing their 

effectiveness; clients in jobs involving physical 

exertion, such as construction, should make 

appropriate adjustments for this. In other cases, 

a job coach or other monitoring may be needed 

to help the client cope with coordination 

problems resulting from medication. 

58 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Clinical Issues 

The clinician should also ensure that clients 

(particularly those with comorbid medical or 

psychiatric disorders) recognize the importance 

of finding a job with health insurance. A good 

number of clients will obtain jobs without 

benefits or with benefits that phase in after a 

probationary period. Those involved in 

treatment should coordinate their efforts to 

ensure the most positive blend of resources and 

services possible to assist clients. In addition, 

counselors should educate clients about their 

right to confidentiality and accommodation for 

disabilities (see Chapter 7; see also TIP 29, 

Substance Use Disorder Treatment for People with 

Physical and Cognitive Disabilities [CSAT, 1998c]). 

Coping With Environmental 

Challenges 

Many clients must overcome logistical 

challenges to securing and maintaining work. 

The clinician can play an important role in 

helping clients identify the most effective 

approaches to addressing these difficulties. The 

Consensus Panel suggests using solutionfocused strategies, building on coping skills the 

client has already demonstrated, and applying 

them to new contexts. Clinicians should 

encourage the client to identify resources used to 

accomplish other objectives and determine how 

these strategies might be useful in negotiating 

work-related issues. The clinician also should 

know about community resources, particularly 

in the frequently troublesome areas of housing, 

transportation, and child care. Progress and 

difficulties in meeting employment goals should 

be discussed regularly. 

Housing and other basic needs 

The clinician should be aware of the client’s 

basic living situation and be able to refer the 

client to community resources if needed. Is the 

client coming from a residential treatment 

setting? Is he homeless, just out of the hospital, 

or in a group home with substance users? The 

client’s living arrangements will have 

implications not only for the availability of 

support during recovery, but also for the 

availability of job-related resources such as 

access to an answering machine or a reliable 

message taker. Clients can also be referred to 

one-stop career centers or employability centers 

for assistance. Clinicians should be familiar 

with what housing options are available, such as 

through local housing authorities and the U.S. 

Department of Housing and Urban 

Development (HUD). 

Transportation 

Many clients have transportation issues such as 

suspended or revoked driver’s licenses, lack of 

public transportation, or geographic isolation. 

For people with children, long hours on public 

transportation and the ability to get to a sick 

child greatly influence the ability to stay 

employed. If transportation is known from the 

beginning to be a problem, the client should 

only explore job opportunities accessible by 

public transportation. Clinicians can help them 

review how they have arranged transportation 

in the past (e.g., to get to a methadone clinic), 

and brainstorm about alternatives, including 

carpooling. VR services, medical assistance 

programs, and public transportation systems 

often provide free or low-cost transportation for 

eligible clients. 

Child care 

Locating suitable, convenient, and affordable 

child care is a common problem. For clients 

involved with child protective services or 

welfare agencies, child care vouchers are 

available both for child care centers such as the 

YMCA and local Boys and Girls Clubs and for 

family day care arrangements. These programs 

are usually licensed and provide safe and 

developmentally appropriate services for 

children while parents are at work. Head Start 

and early intervention programs are also 

available for low-income families through local 

schools, religious organizations, and social 

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Chapter 3 

service agencies. Some child care voucher 

programs are initiated when employment 

begins. The resources clients used to care for 

their children when they were using substances 

are probably not the safest or best alternatives. 

However, the clinician can expand the client’s 

repertoire of possibilities by making 

suggestions—for example, sharing caretaker 

responsibilities with friends or relatives who 

work different hours. Again, being familiar with 

local child care agencies and resources will 

allow the clinician to provide appropriate 

referrals in this area. 

Coping With Legal Challenges 

For some clients, eligibility for work can be 

affected by criminal records or by issues related 

to their immigrant or residency status. Clients 

are sometimes barred from specific jobs (such as 

child care worker) on the basis of prior 

convictions. In addition, many have records so 

complicated they are actually unaware of 

outstanding warrants; it is not unknown for a 

client to have rebuilt her life and be gainfully 

employed, only to be arrested for a crime 

committed some years ago. See Chapter 

8 for more information about working with 

ex-offenders. 

Recent immigrants often need assistance in 

collecting the documents needed to work and in 

accessing reliable information about legal 

requirements. The clinician should direct such 

clients to community resources for help in 

applying for legal residency, getting a work 

permit, or learning the process for becoming a 

U.S. citizen. Clients not familiar with the U.S. 

Immigration and Naturalization Service and 

State requirements will need help distinguishing 

between realistic concerns and those that should 

not be a deterrent in seeking and maintaining 

work (see Chapter 7). 

Developing Social and Life Skills 

The first task in helping a client move toward 

employment is motivating the client to want to 

join society rather than be on its fringes. Work is 

an opportunity to advance the client’s progress 

toward this important goal. The newly 

employed client can practice effective 

communication skills in a new environment, 

including learning how to talk to persons in 

authority, manage anger, and raise issues 

effectively. Developing confidence in 

appropriate self-expression, especially when it 

leads to the desired result, can enhance the 

client’s sense of self-efficacy. Researchers have 

demonstrated that when people believe that 

they are capable of performing a new behavior 

(i.e., have efficacy expectations) and know that 

the new behavior will get them what they want 

(i.e., have outcome expectations), they are likely 

to persist and be successful in their attempts for 

change (Bandura and Adams, 1977). 

Clients returning to work, or those 

attempting to maintain employment for the first 

time after a period of withdrawal from society, 

may be deficient in the basic skills needed to 

function within an organizational culture, 

manage resources, and gain social acceptance. 

Specific skills that may be needed include 

 Communication skills, including appropriate 

and inappropriate responses to supervisors 

and coworkers 

 Cleanliness, personal hygiene, and 

appropriate dress 

 Management of personal finances 

 Healthy eating habits 

 Management of time, including getting 

enough sleep and being at work on time, 

managing competing obligations to family, 

work, and treatment (especially regular 

attendance at AA or NA meetings) 

 Coping with crises that can trigger relapse 

 Responding to invitations to “happy hour” or 

office parties 

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Clinical Issues 

 Recognizing and respecting unwritten 

“rules” of the work culture, such as not 

bringing friends or children to work 

Although some transition skills may be 

effectively gained through referrals to other 

community resources, it is the clinician’s 

responsibility to assure the client of the necessity 

for change and to engage the client in mastering 

the social skills that will support recovery. The 

clinician can use the group therapy format to 

give clients an opportunity to role-play 

responses in difficult social situations and 

receive feedback from the group. If the client is 

employed at a work site that pressures him to 

drink, the client may need help avoiding or 

managing ostracism—or finding a healthier 

work environment. 

For clients moving into the work 

environment for the first time or after an 

extended period of withdrawal, family 

members’ behaviors toward the client around 

work issues can either help or hinder the 

client’s progress. It will be useful for the 

clinician to have some information on how 

family members are responding to the client’s 

employment situation. 

An understanding and encouraging family 

can provide much needed emotional support to 

the client. Unfortunately, however, many 

families may have covert reasons for not 

wanting to see the client recover fully in the area 

of work. For example, clients may fear losing 

disability benefits if they recover sufficiently to 

work or a wife may be ambivalent about her 

husband’s return to work because she has grown 

accustomed to being the sole decisionmaker in 

family matters while her husband was disabled 

by his substance abuse. If these issues are not 

addressed, then family members might not 

support the client’s attempts to return to the job 

market. In fact, the family members might 

actually sabotage the client’s efforts to return to 

work, viewing work as competition. For 

example, a client’s child may begin acting out at 

school to get his attention. Recognizing and 

dealing with family resistance to work is a 

complex and continuing task with some clients. 

Planning for a Career and 

Resilience 

Losing a job, which can trigger a profound sense 

of failure and self-doubt, has been highly 

correlated with relapse (Platt, 1995). Yet, few 

persons in this era can expect to retire from the 

job at which they first started work—either 

through their own choice or their employers’. 

As a result, the client is likely to have more than 

one opportunity to exercise job-seeking skills. 

Today, the “contract” between employer and 

employee is “short-term and performance 

based,” and “the company’s commitment to the 

employee extends only to the current need for 

that person’s skills and performance” (Hall and 

Mirvis, 1996, p. 17). Because of this philosophy, 

the clinician should help prepare clients for the 

need to change and grow throughout their work 

life. Either directly or through referral, the 

clinician should help clients envision the next 

steps they might take after leaving their present 

job. This kind of preparation can make each job, 

regardless of its duration, a learning experience 

rather than a failure. Some job counselors 

envision an employment “web” in which the 

client can move laterally, up, or down to 

accomplish strategic objectives. Clients should 

be prepared to show resilience and exercise 

choice in their work lives. 

Preventing Relapse 

As discussed previously, job-seeking and 

employment present an opportunity for growth 

and stabilization that can support recovery. 

However, the process can also be stressful and 

present many potential triggers for relapse. For 

example, if a client witnesses substance abuse on 

the job, should he report it or try to be “one of 

the guys?” General assistance in managing 

stress effectively should be provided. 

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Chapter 3 

Even if the client can find employment that 

provides good support for a substance-free 

lifestyle, the workplace will almost inevitably 

present challenges that could trigger renewed 

use. The clinician should be alert for the 

presence of triggers that have affected the client 

in the past and help the client recognize and 

cope with them. For example, 

 Losing a job may trigger relapse. 

 Jobs that do not provide sufficient structure 

can lead to boredom—a common trigger for 

use. Time away from work, formerly 

structured by alcohol or drug-related 

activities, will also need to be structured. 

 Some workplaces offer frequent invitations to 

socialize where alcohol or even, in some 

environments, drugs are consumed. The 

client may need help maintaining a 

substance-free lifestyle without becoming 

an outcast. 

 Job finding will have a systemic impact on 

the family, especially when the “screw up” 

suddenly becomes the breadwinner and 

wants a major or leading role in family 

decisions. To help other family members 

cope with such changes, family therapy 

should be considered at an early stage of 

vocational counseling (if it is not already a 

component of substance abuse treatment). 

Family members are more likely to support 

the client’s vocational goals if they 

understand the issues and feel included in 

the process. 

Developing the 


Treatment Plan 


To achieve therapeutic goals in the domain of 

employment, the clinician should develop a 

treatment plan that addresses the client’s 

vocational training, rehabilitation, and 

employment needs. Typically, such plans cover 

a period of 90 days (although some treatment 

episodes do not allow for this length of time). 

The case studies at the end of this chapter 

illustrate how vocational rehabilitation is 

integrated into treatment plans. Consensus 

Panel members suggest envisioning the clinical 

treatment process as intertwined with the 

client’s cultural background and the client’s 

“work identity.” Work identity denotes the 

specific meaning of the concept of work to the 

individual client. This includes 

 Why work is done (“Why do I work?”) 

 The degree of importance placed on work 

(“How much does work really matter 

to me?”) 

 The client’s life goals (“Where will it 

get me?”) 

The client’s goals can include the attainment 

of good pay, interesting work, job security, 

opportunity to learn, interpersonal relationships, 

variety in tasks, autonomy, opportunity for 

advancement, and other considerations 

(England, 1991). These motivational 

considerations will obviously influence the 

career path chosen. They are also integral to the 

treatment process, a way for the individual with 

a background of substance abuse to begin to 

create an identity as a person in recovery. 

The following considerations, discussed in 

this section, are key to the formulation of a 

treatment plan: 

 Multidisciplinary participation 

 Timing of vocational training, rehabilitation, 

and employment services delivery in relation 

to substance abuse treatment service delivery 

 Tailoring treatment plans for the different 

stages of the substance abuse disorder and 

recovery, as well as plans related to recovery 

from use of, or dependence on, different 

substances 

 Consideration of external factors in 

treatment planning 

 Maintenance of employment gains and 

relapse prevention 

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Clinical Issues 

Multidisciplinary Participation 

To provide adequate support to the client in 

gaining successful employment, 

multidisciplinary participation is often needed. 

The case manager, whether the clinician or 

another person, should identify people from a 

range of professional disciplines who are able to 

supplement the clinician’s skills and meet the 

client’s needs. Most should be involved at the 

time of intake, then consulted afterward as 

needed. The group will most likely not come 

together as a team, but members should 

recognize that they each have significant 

responsibilities toward the client. Because of 

their ability to help clients meet therapeutic 

goals in their domain of employment, the group 

frequently includes the following members: 

 VR counselor 

 State or local employment service 

representative 

 Education specialist or special education 

person for school or transition programming 

 Nurse, physician, mental health clinician, or 

psychiatrist (for coexisting disorders) 

 Adult education consultant 

 Vocational trainer or work adjustment trainer 

 Social worker 

 Disability specialist 

 Job placement specialist 

Some clinicians would include the client’s 

new employer or a representative of the client’s 

school as a member of the treatment recovery 

team. Advantages to this approach include the 

potential for educating this person, as a 

representative of an institution that will play a 

key role in supporting recovery, to understand 

potential triggers for relapse in the workplace 

and increase the likelihood that the client will 

receive appropriate support. However, even 

assuming the client’s informed consent, issues 

related to confidentiality, boundaries, and 

stigma should be carefully considered. Conflicts 

of interest could arise. The employer or 

educator may treat the client differently and 

project a bias, consciously or unconsciously, that 

affects the individual’s employment experience. 

Timing of Vocational Training, 

Rehabilitation, and Employment 

Services 

Unless a client needs time for detoxification or 

adjustment to sobriety, some aspects of 

prevocational counseling can begin in the early 

stages of treatment. If the client has an 

immediate need for employment and is capable 

of managing it successfully, the timetable can be 

accelerated to encourage the client to accept an 

available entry-level job. 

Although treatment initially focuses on use 

issues, a brief discussion of long-term treatment 

goals, such as work, will lay groundwork for 

later therapy. The client should have, in the 

back of his mind, the notion that work will be an 

important component of recovery, and although 

not addressed directly at first, vocational issues 

will play an important role in his treatment. The 

time for introducing vocational services must be 

paced according to the client’s specific 

situations. Among the factors that must be 

considered are 

 The client’s stage of recovery 

 The client’s stability 

 Any external legal mandates 

 Impending termination of public 

assistance benefits (for either the client or 

dependent children) 

 Limits on duration of treatment 

 The client’s goals 

 The identification of therapeutic goals that 

may be addressed through the vocational 

domain (such as the need to learn to 

structure time or respond appropriately 

to authority) 

 Client recovery needs that can only be met 

through gainful employment (such as 

earning funds necessary to move from a 

house where people are using substances) 

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Chapter 3 

It is important to coordinate treatment 

services to avoid conflict with the client’s current 

job or educational pursuits because both of these 

may be helpful in stabilizing the client and 

supporting a substance-free lifestyle. 

Tailoring Treatment Plans 

Stages of substance abuse 

and recovery 

Vocational plans will differ according to the 

client’s stage of substance abuse and recovery. 

The client’s commitment to work and the 

appropriate type of work can only be projected 

on the basis of thoughtful analysis of his specific 

situation. This includes considerations related to 

the specific substance or substances the client 

has used, his pattern of use, the amount of time 

in recovery, relapse triggers, and the social and 

other support systems available to assist in his 

recovery. If ongoing effects from substance 

abuse are evident, the clinician should assess the 

level and nature of dysfunction the substance 

abuse is causing (or has caused). Clearly, the 

client’s level of functioning will affect the type of 

work he can undertake successfully (see 

Chapter 2 for further information on 

functional assessment). 

Substance abuse 

If the client does not have medical complications 

or withdrawal, or if the client has used a 

substance that does not have long-term effects 

that continue into the period of initial 

withdrawal, vocational planning issues can be 

addressed earlier in the treatment process. 

Vocational issues should be discussed whenever 

the opportunity arises. Even if a client’s 

prospects for obtaining employment in a 

competitive market are slim, volunteer or 

supported work activities can be an important 

adjunct to traditional treatment and can give 

structure and meaning to the individual’s life. 

Substance dependency 

Short-term dependency 

Individuals with short-term substance 

dependency are likely to have less severe 

functional limitations and therefore a potentially 

wider range of job options (if they are 

unemployed). They may have a positive work 

history and may even have maintained a job. If 

they do need employment, they usually will 

have fewer difficulties in gaining it. If other 

factors are equal, these individuals are generally 

capable of achieving higher goals. 

Chronic dependency 

Some individuals with chronic substance 

dependency (dependence for 2 years or more) 

can be employed, but the longer the dependency 

has continued, the more likely it is that the 

individual has lost her job and has experienced 

functional loss and other difficulties that will 

make her more difficult to employ. These 

individuals generally have more medical 

problems or issues. Also, as masked symptoms 

emerge, the clinician may encounter coexisting 

disorders such as depression and anxiety that 

will have ramifications in the workplace. These 

clients usually have fewer resources and may 

have burned more bridges during their period 

of dependency. 

A special class of chronic users includes 

functional alcoholics, whose relatively ingrained 

dependency is usually time limited. These 

individuals have learned to abstain for short 

periods—long enough to maintain 

employment—then binge. In setting goals for 

individuals with chronic dependency, enough 

time must be allowed for the individual to adjust 

to abstinence. As use decreases, vocational 

challenges can be increased. 

Clients in early recovery 

Clients who have been abstinent for 90 days or 

less are at the greatest risk for relapse. Because 

64 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Clinical Issues 

of this, modest vocational goals are more 

appropriate. However, some individuals have 

significant cognitive dysfunction and have 

difficulty making plans and structuring time. It 

is generally best to limit stress and make only 

gradual changes in life activities, keeping the 

client focused on the recovery process and the 

“here and now.” If it is essential to address 

vocational goals prior to 90 days of abstinence, 

then strong supports will be needed to maximize 

the individual’s chance of success. 

Mid-range abstinence (3 months 

to 2 years) 

Individuals who have maintained their 

abstinence for more than 3 months have a 

diminished risk of relapse and, in general, a 

greater success rate for engaging in new 

activities and tolerating stress. Their family lives 

and sense of self have moved toward stability, 

and they have an increased capacity for longrange planning and problemsolving. They are 

often ready to engage in active job seeking or to 

begin work toward long-term vocational goals 

by acquiring new skills and knowledge. The 

treatment provider should ensure that the 

vocational plan provides that resources will be 

in place should a crisis occur, with adequate 

aftercare and followup treatment. 

Recovery from different substances 

The type of substance or substances the client 

has used also has implications for employment 

planning or work toward long-range vocational 

goals. Although each client’s situation will have 

unique elements, the following generalizations 

suggest common concerns that should be taken 

into account. 

Alcohol 

Because alcohol is a legal substance, clients who 

use alcohol have generally experienced more 

social acceptance and are less likely to have 

criminal records than persons who use illegal 

drugs. These clients may, in general, have 

greater functional ranges, fewer personality 

disorders, and less of an “up and down” cycle 

than those dependent on illegal substances. As a 

consequence, there tend to be fewer obstacles to 

employment, and the client may have succeeded 

in maintaining a job through the period 

of dependency. 

Even when a client in treatment is employed, 

there can be obstacles in the vocational area. 

These clients are more likely to have coworker 

encouragement to use alcohol. For example, 

going out for lunch with others may be a trigger 

for use, or employees may get together at a bar 

after work on Fridays. As part of the “methods” 

section of the treatment plan, the clinician and 

client will want to consider how to change workrelated habits that have encouraged alcohol use 

in the past; for example, the client may find a 

lunchtime 12-Step program meeting or take a 

book to lunch, following the standard process of 

changing “people, places, and things” associated 

with use. 

It is usually possible to detoxify the client’s 

system in a relatively short time, even for clients 

who have used alcohol intensively. It is 

important to consider the implications of 

detoxification for employment and manage the 

issue of work leave in the manner most likely to 

protect the client’s job. The client’s workplace 

may have an employee assistance program that 

can help with this task. Ideally, the client will 

have sick leave or annual leave that may be 

used to provide the time needed without 

endangering employment. 

For clients whose alcohol use has affected 

their attendance at work and who have a 

negative reputation for reliability, the plan may 

appropriately include a quantitative objective, 

such as attending work for 28 out of the next 30 

days. Pharmaceutical help may be available to 

the alcohol-dependent employee. Naltrexone 

(ReVia) is approved by the Food and Drug 

Administration as a treatment for alcoholism. 

Although its cost is prohibitive for some, 

naltrexone appears to reduce craving in many 

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Chapter 3 

abstinent patients and block the reinforcing 

effects of alcohol in many patients who continue 

to drink. The latter effect often enables patients 

who drink a small amount of alcohol to avoid 

full-blown relapse and lessens the likelihood of 

their return to heavy drinking. The mechanism 

of naltrexone’s effect in alcoholism has yet to be 

conclusively demonstrated, but there is hope 

that combining this drug with “talk therapy” 

(i.e., cognitive–behavioral treatment) will reduce 

relapse and improve outcomes of traditional 

alcohol dependency treatment. For more 

information about naltrexone, see TIP 28, 

Naltrexone and Alcoholism Treatment 

(CSAT, 1998b). 

Amphetamines 

Depending on the length of time the client has 

used amphetamines, a longer period of 

abstinence may be required before vocational 

rehabilitation can begin in earnest. Long-term 

use may result in psychosis, making short-term 

employment impossible. Other common 

coexisting disorders include depression, anxiety, 

and panic attacks—all of which raise the 

possibility of relapse. Problems maintaining 

attention and concentration are also common. 

These difficulties, which should generally be 

dealt with through appropriate referrals, usually 

suggest the need for a relatively long period of 

abstinence before symptoms are controlled and 

vocational issues can be addressed. 

Amphetamine users typically are excitement 

seekers who are used to performing when “up” 

and then crashing. During the “down” part of 

the cycle, they may have experienced a high rate 

of absenteeism from work. Therapeutic 

objectives can address the client’s need to keep a 

steady pace throughout the day. Healthy 

nutrition, energy management, and sleep are all 

likely to be important areas in which 

behavioral changes are needed in order to 

sustain productivity. 

In setting vocational objectives, a sensible 

balance is needed between jobs that require high 

levels of risk-taking behavior and those that 

offer too much sameness and predictability. 

High-excitement jobs feed the “up-and-down” 

cycle associated with amphetamine use and also 

may offer daily association with others who may 

use amphetamines, resulting in a high potential 

for relapse. Monotonous, clerical work is likely 

to result in relapse because of boredom; jobs that 

require creativity, flexibility, and movement are 

usually more successful. For example, an 

intelligent former amphetamine-using 

individual with computer skills might do well at 

designing computer games. 

Cocaine 

There is no pharmacological substitute for 

cocaine, as there is for heroin, and an intense 

subculture helps to maintain the cocaine-using 

lifestyle. During the period of active use, the 

user will typically have a spotty record of work 

attendance, sometimes leading to job loss. It is 

not uncommon for cocaine abusers to have 

borrowed against their next paycheck. This 

behavior should be addressed with 

arrangements to repay the company. Long-time 

users may have brain damage (neurochemical 

changes) and functional loss (Gawin and 

Ellinwood, 1988). Whether the client has used 

crack or powder cocaine, it is important to 

consider work that will help the client maintain 

the sober lifestyle because it is easy to become 

readdicted. Coexisting depression and anxiety 

disorders must be addressed with cocainedependent clients (as with other recovering 

substance users) because these negative 

emotional states readily lead to relapse. 

It is important to have a plan for rapid 

intervention and excellent aftercare. Potential 

relapse may also be reduced by asking the 

employer to directly deposit paychecks into the 

employee’s bank account. As with any 

recovering substance user, jobs that are 

especially likely to trigger relapse should be 

avoided—all night shifts at factories, routine 

jobs, unsupervised jobs such as late-night guard, 

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Clinical Issues 

or jobs in industries that contain a high 

percentage of users (Budney and Higgins, 1998; 

Carroll, 1998). For more information on the 

treatment of cocaine, see TIP 33, Treatment of 

Stimulant Use Disorders (CSAT, 1999b). 

Heroin 

For recovering heroin users, an adequate period 

for detoxification before resuming work is 

critical. Clients experiencing withdrawal 

symptoms will be too ill to concentrate in a 

structured environment for any length of time. 

Intravenous injection of this drug can cause 

related medical problems that must be 

addressed before these clients can work. Such 

problems may include hepatitis, endocarditis, 

fatigue, and ulcers. Many clients will not be able 

to do a great deal of walking or handle 

physically demanding jobs during the 

recovery period. 

As previously noted, clients who are in 

opioid maintenance therapy (i.e., methadone, 

LAAM) should have a plan to address the 

possibility of failing a urine test. It is also 

important to take the job requirements into 

account when the dispensing schedule is 

organized. Because work will mean relearning 

the rituals of maintaining relationships and 

acting appropriately within the work culture, 

the treatment plan may also include objectives 

related to reacquisition of social skills and their 

application in the workplace. 

Prescription drugs and narcotics 

Some clients use prescription drugs, including 

narcotics, to self-medicate to mask anxiety, 

depression, or pain. The treatment plan should 

include a process for addressing these 

underlying conditions. For example, national 

pain management organizations can perhaps 

suggest alternative ways to manage pain. In 

vocational planning, the clinician should bear in 

mind that pain saps energy, and individuals 

who suffer from chronic pain are unlikely to be 

able to manage high-energy jobs. 

Polysubstance abuse 

Individuals who have been polysubstance users 

may have cognitive impairments such as 

hyperactivity and concentration deficits that will 

limit their potential for employment. They may 

also have more complex triggers for use. The 

clinician should assess these triggers and, based 

on findings, identify comfortable, incremental 

steps that can be successfully achieved. 

Although difficult, it will be helpful to identify 

work environments that provide as few of the 

individual’s primary triggers as possible. 

Consideration of External Factors in 

Treatment Planning 

Welfare-to-work issues 

Clients who are required to have a job in order 

to maintain eligibility for welfare, or who are 

losing welfare support, may have to start work 

earlier in the recovery process than would 

ordinarily be advisable. Under these 

circumstances, the client should be assured that 

the job he has accepted, for which he may be 

overqualified, is a temporary choice that is 

appropriate to meeting the immediate need. In 

addition, the client’s initial job may provide a 

forum for acquisition of job skills, social 

competencies, and recommendations requisite 

for higher education or employment. 

Child custody issues 

With individuals for whom child custody is an 

issue, whatever is required to regain or maintain 

custody is likely to be the client’s top priority. 

The timelines and requirements related to this 

external constraint should be reflected in the 

vocational plan. 

Lack of finances 

In treating clients who lack funds for basic 

expenses—food, shelter, clothing, 

transportation, child care, and health care—the 

clinician’s role is to help the client find 

community resources and social services to help 

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Chapter 3 

meet these basic needs. An entry-level job may 

be appropriate for meeting the immediate crisis. 

Therapeutically, the client’s need for financial 

support may be a powerful motivator for 

positive change. 

Discrimination in the labor market 

Participation in the work world is, 

unfortunately, influenced by many factors other 

than an individual’s interests and abilities. 

Segments of the labor market may be less 

accessible for some because of gender, race, 

ethnicity, culture, and disability. These 

differences are due to societal factors such as 

discrimination and unequal educational 

resources allocated to schools in lower income 

communities (Szymanski et al., 1996). 

The clinician should maintain a realistic 

attitude when addressing clients’ specific 

situations, ensuring that their goals are 

achievable and that they understand legal 

antidiscrimination protections. A number of 

legal protections exist to protect people from 

workplace-related discrimination (see Chapter 7 

for more information on these protections). It is 

important to acknowledge the reality of 

discrimination that some clients face, while 

concurrently nourishing a drive to succeed and 

channeling it in promising directions. 

Maintenance of Vocational/ 

Employment Gains and Relapse 

Prevention 

When clients return to work, they are exposed to 

a number of potential relapse triggers 

(Rehabilitation Research and Training Center on 

Drugs and Disability, 1996). These include 

 Active drinking or substance use by other 

employees 

 Pay day (i.e., money management) 

 Working a rotating, “graveyard,” or 

night shift 

 Seasonal work 

 Lack of supervision 

 Working excessive overtime 

 Dealers near the job 

 Access to marketable goods or petty cash 

 Receiving cash tips 

 Transportation issues 

 Too much free time on the job 

 Working two jobs 

 Too much pressure on the job 

 Job dissatisfaction or boredom 

 Required business meetings, dinners, and 

parties where drinking alcohol is expected 

 The other issues and crises that cannot be 

addressed because of time limits now that the 

person is employed 

The treatment plan should provide for 

effective management of all relapse triggers that 

are relevant to the individual. The plan should 

establish a proactive strategy to avoid the loss of 

newly won ground. It is useful to consider in 

advance the possibility of job loss or demotion 

and to consider the moves that would then be 

open to the client. This will help to reduce the 

likelihood that either event will lead to despair 

and relapse. 

Case Studies 

The following case studies represent either 

particular or composite cases familiar to 

Consensus Panel members. They are intended 

to illustrate several ways in which clinicians 

have helped clients in recovery from substance 

abuse disorders achieve appropriate vocational 

goals consistent with the recovery process. 

Case Study 1: “Kay” 

Background 

Kay was referred to outpatient substance abuse 

treatment 4 months ago by the criminal justice 

system when she and her boyfriend were 

convicted of possession with intent to sell illegal 

drugs. Her drugs of choice were cocaine and 

amphetamines. She has past convictions related 

to drugs and prostitution. 

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Kay is 22 years old and the mother of two 

young children who are living with her mother, 

an employed waitress. Kay’s therapeutic goals 

include becoming economically self-sufficient 

and regaining custody of her children. 

Vocational concerns have become a large part of 

her focus in both individual and group 

counseling sessions. Kay consistently insists that 

“any job will do.” What is important to her is to 

be employed so that the criminal justice system 

does not put her in jail and thereby prevent her 

from regaining custody of her children. 

However, in planning for her to become 

economically self-sufficient, the clinician 

recognizes that she must have a job that 

provides enough income to support two 

children. In addition, the job should have 

health benefits. 

The clinician learns at intake that Kay 

attended school only through ninth grade. She 

dropped out when she gave birth to her first 

child. Her educational records show that she 

repeated first grade; she says this was because 

the teacher felt she wasn’t mature enough and 

because she could not focus on her work. Her 

attitude about returning to school is that it is not 

an option “because I am dumb.” However, her 

records include the results of recent aptitude 

testing that suggest that she is capable of 

pursuing her education beyond high school. 

Kay has a very spotty work history. Her 

primary places of employment were fast food 

restaurants and nightclubs. The counselor 

learns that requirements of the probation and 

parole system pushed her into employment in at 

least two instances. None of her jobs lasted 

more than 4 months, and Kay does not believe 

she is capable of holding down a job. She 

reports being fired for not showing up to work 

when she overslept or had been out partying the 

night before. She also has been reprimanded for 

not grasping the work tasks quickly enough and 

for having poor customer relations skills. She 

was fired from one job when a customer told the 

Clinical Issues 

nightclub manager that she had a criminal 

record. She feels inadequate in many ways; for 

example, she is concerned about her ability to 

read and to manage numbers, count change, and 

so on. 

Therapeutically, it is important that Kay find 

employment that supports her recovery lifestyle; 

however, the pressure she is under to locate a 

job must also be acknowledged. In the group 

sessions, the clinician finds that Kay identifies 

with another woman who admits to being 

terrified to go to work. Exploring this, Kay 

reveals that her fear is associated with having to 

tell an employer about her criminal record and 

what she has done to get drugs, as well as her 

past employment experiences. 

In summary, Kay presents a self-image of 

failure supported by her past experience in 

academics and work. Her options are limited by 

her lack of a high school diploma or general 

equivalency diploma (GED), yet she needs to 

obtain a job that provides an adequate income 

and includes benefits in order to provide a 

foundation for her children. She has no 

knowledge of what types of jobs are available 

beyond restaurants and other service-oriented 

industries, nor does she currently have the skills 

for many occupations. 

Counseling strategy 

The first step in responding to Kay’s vocational 

needs was to identify who should serve on her 

team. In addition to the treatment staff, the 

team included a State VR counselor, her 

probation officer, a social worker, and a 

representative from the State employment 

service. She was referred for a 

vocational evaluation to assist her in making 

employment decisions. 

Kay’s vocational evaluation included a series 

of interest inventories, aptitude tests, and other 

assessments. At the exit interview with the 

evaluator, Kay reported not being able to 

remember anything except that she could 

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Chapter 3 

complete the requirements for a GED, if she 

wanted to do so. A followup meeting was 

scheduled with her VR counselor, social worker, 

and drug and alcohol counselor. By this time, a 

written report was available, and they reviewed 

it with Kay in detail. Her reading and math 

skills were both at the fifth-grade level. She 

showed the aptitude to complete her GED and 

pursue vocational training. The 

recommendations for an immediate 

employment objective included positions in the 

restaurant and hospitality industries or in a 

clerical position such as receptionist, file clerk or 

other entry-level position. Certain positions for 

which she had an aptitude were ruled out 

because of her criminal record. 

During the discussion of vocational 

alternatives, Kay leaned toward choosing a job 

in a restaurant because that was the type of 

work she had done previously. In the joint 

counseling session, however, it was pointed out 

that the hours associated with this type of work 

and the environment would be likely to trigger a 

relapse. Kay’s lack of interpersonal skills was 

another concern. Kay also received guidance 

about the problems frequently associated with 

some entry-level jobs: Coworkers are often 

younger and are inclined to “party,” the hours 

are irregular, and alcohol is readily available. 

There was also a discussion about what her 

course of action would be if confronted with 

situations that might cause her to relapse. 

Kay’s final decision was to pursue 

employment in an office clerical position. She 

was nervous that she would be rejected if 

employers discovered her criminal past and that 

she would not fit in with the other workers. 

Because Kay lacked effective job-seeking and 

maintenance skills, it was decided that she 

would participate in a program that taught these 

skills and would address the concerns about 

interpersonal relations at the office, as well as 

how to handle issues related to her criminal 

past. The VR counselor also arranged for her to 

start in the Job Club program. The program 

provided assistance in completing applications, 

looking for job openings, developing 

interviewing skills, and writing a followup 

letter. She was told she could use the 

rehabilitation center’s facilities to look for work 

because they had access to the State 

Employment Commission’s job-opening 

database, maintained posted job 

announcements, subscribed to the newspaper, 

and provided job placement counselors to assist 

in the process. 

Kay obtained a job in a company that had 

hired a number of persons with disabilities. 

Because the VR counselor had experience with 

the employer, he told Kay about the work 

setting and the benefits and support programs 

that were available. One of those was an 

employee assistance program. He explained 

that they could help if she felt that she was 

having problems that would interfere with her 

job (e.g., stress or transportation difficulties) or 

that were related to her recovery. The company 

also had medical benefits and paid vacations. 

The company’s human resources director 

was concerned about Kay’s lack of skills and 

educational history. She thought Kay would be 

a good employee but would need extra training. 

To assist with this, the State VR Agency 

arranged an on-the-job training program. In 

exchange for the employer providing the extra 

training, the agency paid a portion of her salary 

for a preset period. 

The alcohol and drug counselor and the VR 

counselor worked out a daily plan with Kay. 

They discussed transportation to and from 

work, lunch, breaks, and how to fit in her 

Narcotics Anonymous meetings, counseling 

sessions, and meetings with her probation 

officer. They also helped her plan a budget that 

would allow her to save money for an 

apartment. In the meantime, she would 

continue living in the supervised housing run by 

the substance abuse treatment program. 

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Clinical Issues 

Kay also expressed concern about fitting in 

with her coworkers. She owned mostly T-shirts 

and jeans and did not have suitable office 

clothing. A local program that helped women 

going back to work provided her with enough 

outfits for one week of work. With her clinician, 

she role-played possible conversations with 

coworkers and what she would do if 

approached to go for drinks after work. 

She started working and was successful. Her 

performance evaluations were good, but her 

supervisor indicated she needed to work on 

being assertive and asking questions. In her 

regular counseling sessions, the clinician talked 

to her about daily work-related issues that arose. 

The supervised housing provided a setting that 

allowed her to talk with other people in 

recovery. The support group helped her 

identify solutions and options to problems, 

which included her continuing difficulty in 

adhering to a budget. 

Kay developed a long-term plan with her 

social worker and alcohol and drug counselor. 

She would continue to adhere to a daily 

recovery plan, and visits with her children 

would be allowed. If she continued to progress 

in recovery, she would be able to petition for 

custody. At the end of the on-the-job training 

period, Kay continued to work with the 

company. Her case with the VR agency was 

then closed, with the understanding that 

followup support could be provided if 

necessary. She continued in aftercare and met 

with her probation officer on a regular basis. 

Once her housing and work stabilized, Kay 

planned to pursue a GED. 

Case Study 2: “Young-Hwa” 

Background 

Young-Hwa, a 40-year-old Korean male, had 

immigrated to the United States 15 years ago 

without proper documentation. He had a hard 

life because, despite his training as a chef in 

Korea, he had difficulty finding a well-paying 

job without proper documentation. After many 

years as a kitchen assistant and then as an 

assistant cook, he finally was hired as a chef in a 

Korean restaurant. 

During his long quest for suitable 

employment, Young-Hwa used alcohol to 

handle the stress and feelings of frustration and 

disillusionment. The many years of hardship 

put a strain on his marriage and he had many 

arguments with his wife. He progressively 

increased the amount of alcohol he used. 

During these heavy drinking episodes he 

became verbally abusive to his wife and two 

young children. After 3 years of continued 

alcohol use and verbal abuse, his wife and 

children left him. One year later, he was fired 

from his job for being drunk at work. 

Over the next 3 years, he became depressed 

and continued to drink heavily. Finally, he was 

arrested for driving under the influence of 

alcohol and was ordered by the court to an 

alcohol residential treatment program. 

Counseling strategy 

In treatment, the clinician helped Young-Hwa by 

activating his desire to have contact with his 

children as motivation for recovery. The 

clinician supported the idea that his children 

needed a caring, loving, and competent father. 

In addition, the counselor focused on YoungHwa’s strengths as a competent chef for many 

years and engaged him in a discussion of how 

he could regain that level of functioning. 

The clinician referred Young-Hwa to an 

Asian American legal services organization, 

which helped him apply for the immigration 

residency amnesty program in effect at the 

time. This step would grant him legal 

residency status. 

In the meantime, Young-Hwa needed to find 

employment as quickly as possibly, both to 

satisfy requirements for probation and to 

support himself. There was no separate VR 

counselor on site; also, the client was suspicious 

of non−Asian counselors and resisted the idea of 

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Chapter 3 

a referral to State or county rehabilitation 

agencies. Because of this, the Korean clinician 

performed some of these tasks. The clinician 

guided him in exploring job opportunities in the 

Korean community and recommended that he 

begin at a lower level than full chef. The client 

resisted this idea initially, but later agreed that 

he needed to rebuild his level of competence in a 

step-by-step fashion. 

He found a job as an assistant cook. Because 

he was very interested in boxing and was a 

boxer when he was in high school in Korea, the 

clinician used that sport as an analogy. He 

reminded Young-Hwa that for a boxer to come 

back from an injury, he needed to rebuild 

slowly. This rebuilding involves a step-by-step 

process until he finally can become a “major 

contender” again. 

Case Study 3: “Julia” 

Background 

Julia is a 27-year-old Italian American female. 

She was referred to a specialty residential 

program by the child protective services agency 

because her daughter was born with a 

toxicology screen that tested positive for heroin, 

cocaine, and marijuana. In order to keep her 

baby, she was required to participate in this 

program with her infant daughter. Julia was 

administered a battery of assessment measures 

during her intake interview for residential 

treatment. These measures included the ASI 

(which measured her functional status in seven 

domains) and the Self-Directed Search (which 

determined her vocational interests and skills). 

Julia is an only child. She lives with her 

mother, a nurse, and her father, an electrician. 

Her parents were given temporary custody of 

her daughter while she was waiting for 

placement at the residential program. The 

clinician learned, however, that she and her 

parents have had several physical fights 

recently, of which the child protective services 

agency was not aware. 

Julia has had 13 years of education. She had 

been a nursing major at the local community 

college 5 years ago but dropped out when she 

could no longer manage school due to her 

polysubstance use. Julia has been drinking to 

intoxication on Friday, Saturday, and Sunday 

since the age of 15. She has also injected heroin 

regularly (about three times per week over the 

last 5 years) and has been smoking or snorting 

cocaine on weekends. She often used more than 

one substance per day—usually cocaine and 

alcohol—when she could not get heroin. 

Julia has been arrested for assault, breaking 

and entering, and robbery. However, she was 

not convicted and has never been incarcerated. 

Julia usually got her money for drugs by stealing 

or by giving sexual favors. Julia has several 

close male and female friends who are also 

using drugs. She has had serious conflicts over 

the last 30 days with her parents, sexual 

partners, and friends. She reports that her 

current sexual partner, who sells drugs and is 

the father of her child, has physically and 

emotionally abused her. 

Julia has been hospitalized twice for suicide 

attempts. She says that periodically she 

becomes severely depressed, can’t eat or sleep, 

cries a lot, can’t sit still, and has trouble getting 

out of bed. She is easily irritated when she is 

depressed and sometimes has difficulty 

controlling her anger. Julia also has panic 

attacks and is, at times, fearful of crowds, stores, 

classrooms, and restaurants where she does not 

know people. She is also afraid they will see her 

having a panic attack and think that she is crazy. 

Julia has been prescribed imipramine (Tofranil), 

lithium (Lithonate), and diazepam (Valium), but 

none of these medications seem to help. She 

finds it easier to get herself out of bed after she 

has used heroin or cocaine. Julia admits that her 

drug use may be a form of self-medication 

because she “feels better” after she uses. 

Julia’s ASI composite scores reveal that she is 

most in need of treatment in the areas of alcohol 

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Clinical Issues 

and drug use, employment, social relations, and 

psychiatric problems. Julia herself rates her 

need for treatment in the areas of alcohol and 

drugs and in psychological functioning as 

extreme, but she views her need for employment 

and social counseling as slight. 

Julia’s result from the Self-Directed Search 

matches her vocational dream of becoming a 

nurse (like her mother). Julia was surprised to 

learn that her summary code was also consistent 

with dietician, physical/occupational therapist, 

and psychiatric technician. She was particularly 

interested in the physical and occupational 

therapy fields because she thought these 

occupations would limit her access to drugs and 

thus eliminate the temptation to steal them, 

while still allowing her to work with people in a 

medical setting. 

When Julia was approached about further 

vocational exploration, she said that the thought 

of going back to school made her highly anxious 

and that she did not think she could ever see 

herself getting up to go to work or performing 

adequately on the job. She felt that she had been 

using drugs too long and “hanging out” so long 

with other users that she did not even know 

how to talk to “straight people.” She also felt 

humiliated about all her arrests and about 

“doing nothing with her life” all these years, so 

she couldn’t imagine filling out an application to 

go back to school or interviewing for a job. 

Counseling strategy 

Aware of the close-knit structure of Italian 

American families and Julia’s desire to move 

back with her parents when she leaves the 

residence, Julia’s counselor initiated family 

sessions with Julia and her parents to deal with 

the family violence. Julia was also referred to a 

psychiatrist to evaluate her depression and 

anxiety. The psychiatrist prescribed the 

antidepressant fluoxetine hydrochloride 

(Prozac), which has just begun to help her feel 

somewhat more comfortable. Julia has begun to 

learn relaxation and coping skills so that she can 

manage her panic attacks more effectively and 

not continue to avoid public settings. Julia is 

also participating in an anger management and 

social skills group, in which she is learning the 

internal and external triggers for her anger. She 

has been role-playing new ways to cope with 

these anger triggers and learning how to express 

her feelings more effectively. 

Julia has also been discussing her life plans 

and goals. She would one day like to marry and 

have a father for her child and work with people 

in a medical setting. In the meantime, Julia has 

been gathering information about potential 

careers in physical or occupational therapy. She 

has gone to the career section of her local library 

to find information about the specific duties and 

requirements for each job. Armed with this 

information, Julia developed a plan with her VR 

counselor concerning the next steps to take and 

how she will accomplish them. These steps 

included selecting and applying for school, 

finding the money for tuition, arranging for 

child care, and finally, starting the program. 

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4 Integrating Onsite Vocational 

Services



Akey purpose of this TIP is to help 

treatment programs rethink their 

philosophies and restructure their 

services around the belief that productive 

activity (work) is crucial to the health and longterm recovery of clients. One way to ensure that 

clients receive the necessary vocational services 

is to provide them in-house as an integral part of 

the substance abuse treatment program, rather 

than by referral to outside agencies. Each 

program must decide to what extent it wants to 

and can provide onsite vocational services. This 

chapter is designed to guide programs in this 

important decisionmaking process. Even those 

programs that cannot offer a full range of 

vocational training and employment services 

within their program setting can benefit from 

the information in this chapter. The chapter also 

describes how programs in various treatment 

modalities, from therapeutic communities to 

low-intensity outpatient treatment, can begin to 

address the vocational needs of their clients. 

Employment and vocational services need to 

be a priority in every treatment program and 

should be addressed as a goal in treatment 

plans. The Consensus Panel recommends that if 

possible, a substance abuse treatment program 

should add at least one vocational rehabilitation 

(VR) counselor to its staff. Should the size of the 

program or other fiscal shortcomings prevent 

this, arrangements should be made to have a VR 

counselor easily accessible to the program. No 

matter the treatment modality or level of service, 

inclusion of a vocational specialist who is crosstrained in or at least sensitized to substance 

abuse disorder issues will create a new dynamic 

in the program. Through both formal and 

informal interactions, this staff member will 

begin to raise the awareness level of other 

treatment staff members about vocational issues. 

The vocational specialist can identify ways in 

which the staff members are already addressing 

vocational issues but simply not thinking of their 

efforts in vocational terms. For example, when 

one therapeutic community hired a VR specialist 

to help its treatment counselors provide 

vocational services to residents, she pointed out 

that many aspects of the program already 

addressed clients’ vocational needs. She 

demonstrated how the job assignments given to 

residents emphasized the development of 

prevocational skills and explained that they 

were really operating a work adjustment 

training program. However, a VR counselor can 

provide more intensive and specific counseling, 

assessment, resource development, and 

treatment planning. 

Unfortunately, some programs do not have 

the resources for such a staff specialist. 

However, a consortium or network of programs 

may sometimes be able to share a specialist as a 

consultant who provides training and other staff 

development activities on an occasional basis 

and guides work with particular clients. At the 

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Chapter 4 

same time, it must be acknowledged that even 

the most comprehensive program cannot meet 

the treatment and vocational needs of all clients. 

Welfare reform, health care reform, and other 

funding pressures can overwhelm treatment 

programs because they must meet the vocational 

needs of all clients with less support and in 

shorter periods of time. Referrals to outside 

vocational service agencies are necessary for 

many clients. 

Every treatment program should consider 

itself part of a collaborative interagency effort to 

help clients achieve productive work. For the 

purposes of this TIP, the onsite integrated 

services model is discussed separately from the 

integrated services through referral model 

(discussed in Chapter 5). In reality, most 

programs exist on a continuum with onsite 

programs making fewer referrals, but where 

referrals continue to be a key part of providing 

services to all clients. 

Planning an 

Integrated Program 

Any decision to integrate vocational services 

into a substance abuse treatment program must 

be supported by the board of directors, the 

administrative staff, and the alcohol and drug 

counselors. This level of support is necessary to 

effectively change the existing “culture” of the 

treatment program and ensure that vocational 

services are a core part of treatment and not just 

a supplementary service. 

To effect this change, the mission statement 

should be modified to encompass vocational 

goals and to ensure that all staff members 

embrace these goals (see Figure 4-1). An 

important philosophy to articulate in the mission 

statement is the belief that work is crucial to the 

health and long-term recovery of clients and that 

implementing vocational services is in itself 

therapeutic. As discussed later in this chapter, 

outcome studies must consider employment as 

one of the key variables in measuring program 

success. It is important to be aware that work in 

the competitive market may not be possible for 

all clients. Moreover, people often seek to 

contribute to their community, either by 

volunteer work or by some other type of 

educational or similarly productive involvement 

with the larger world that enriches their 

interactions with others and their sense of selfworth. Thus, the concept of employment 

Figure 4-1 

Steps for Planning an Integrated Program 

 Modify mission statement to incorporate vocational goals for clients. 

 Encourage all administrative, support, and treatment staff to embrace vocational programming as 

an essential component for all clients—on an equivalent level of importance with abstinence. 

 Perform a needs assessment of current and past clients to identify what vocational services 

are most needed. 

 Use needs assessment results to identify, develop, and deliver vocational services that make the 

most sense for the agency, clients, and community. 

 Hire a vocational specialist or retool/upgrade existing staff to handle vocational counseling 

responsibilities. 

 Develop vocational counseling competencies in all treatment staff. 

 Develop and provide necessary vocational support materials (e.g., employment library, computer 

with Internet access, training materials for job-seeking skills). 

 Integrate vocational outcomes into accountability studies when following up with former clients. 

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Integrating Onsite Vocational Services 

“success” may need to be broadened when the 

outcomes of substance abuse treatment 

programs are evaluated. 

Choosing a Program Model 

The treatment program must decide the 

parameters of what it can offer clients in terms 

of vocational services. Many factors will enter 

into this decision. To begin the decisionmaking 

process, the program must address 

several questions: 

 What type of substance abuse treatment does 

the program provide? 

 Who are the program’s clients and what are 

their vocational needs? 

 What are the staff members’ skills, 

experiences, and backgrounds that can 

influence how they learn and incorporate 

new ideas and approaches? 

 What vocational training and employment 

programs are available in the local 

community, as well as funding sources for 

vocational services? 

 What are the program’s capabilities for 

providing vocational services? 

The most important factors in choosing a 

program model are (1) the modality of the 

substance abuse treatment program and the 

intensity of services provided, and (2) the 

specific needs of clients. Treatment programs 

vary from the least intensive level of outpatient 

treatment to highly structured residential 

programs, such as therapeutic communities. 

The degree to which the program can structure 

the client’s daily life and the length of time spent 

in the program significantly dictate the range of 

onsite vocational services that can feasibly be 

offered. A therapeutic community in which 

clients generally reside for several months can 

offer a much wider range of vocational services 

than a short-term (14- to 28-day) residential 

program whose main objectives are to stabilize 

clients and initiate the recovery process 

before discharge. 

The vocational needs of the majority of the 

program’s clients, as well as other client-related 

factors such as their values and the realities they 

face in finding employment, are other key 

factors to consider in deciding the parameters of 

the onsite services offered. The important issue 

of cultural competence is discussed more fully in 

Chapter 5. Suffice it to say here that programs 

must ensure that staff members have a thorough 

knowledge of the diverse populations 

represented in their treatment program and the 

particular challenges that different groups face 

in securing and maintaining work. It is also 

important to understand various cultural 

attitudes toward work. 

In any program, clients’ ability to work will 

vary greatly. Some clients who have never 

worked or who are chronically unemployed will 

need habilitative and prevocational training. 

Others with more regular work histories may 

need help learning new job skills, finding work, 

or recognizing work-related relapse triggers. 

Some programs treat a large number of clients 

with a high level of coexisting disorders (e.g., 

serious mental illness). Clients with extensive or 

special needs outside the program’s vocational 

capacity should be referred to collaborating 

agencies. Collaboration is discussed in 

Chapter 5. 

One approach to evaluating the vocational 

needs of the client population is to survey clients 

who are currently in the program. A series of 

focus groups is an effective way to understand 

the particular needs of a program’s client 

population. In these groups clients can discuss 

their needs and support each other in 

articulating their problems, gaining confidence 

about themselves, exploring employment goals, 

and preparing for finding and maintaining 

work. Another approach is to follow up with 

former clients to document their current 

vocational status and ask them which services 

they received at the agency were most and least 

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Chapter 4 

helpful, and what services they would 

have wanted. 

Training and Developing 

Existing Staff 

As noted previously, hiring or contracting with a 

VR counselor familiar with substance abuse 

treatment issues is an effective strategy to begin 

addressing the vocational issues, awareness, and 

training needs of program staff. Another option 

is to collaborate with State VR agencies that offer 

inservice training on vocational issues to alcohol 

and drug counselors. Joint training of alcohol 

and drug counselors with VR specialists should 

be encouraged, when appropriate. Key 

resources for such training and education are 

State and Federal VR authorities, which are 

found in every State, as well as the 

Rehabilitation Research and Training Center 

(RRTC) on Drugs and Disabilities. Other 

resources include university-based rehabilitation 

continuing education programs located 

throughout the country. Whether an agency is 

large and multiprogrammed or smaller, 

appointing someone as case manager can help 

ensure efficient collaboration, both intraand interagency. 

Another strategy for bringing VR expertise 

into the program is to form linkages with 

undergraduate and graduate programs in VR 

counseling and to offer the treatment program 

as a training site for internships in which 

students in these programs can be cross-trained 

in substance abuse treatment issues—provided 

that supervision and support are adequate 

and appropriate. 

Recruiting and Hiring 

New Staff Members 

Integrating vocational services and ensuring that 

all staff members share the program’s values 

and mission will involve examining and 

changing job descriptions to recruit staff with 

vocational experience and training. Advertising 

and recruiting efforts can be broadened to 

include journals and programs of interest to VR 

counselors. Again, linking with a university to 

provide an internship site is a highly effective 

strategy for recruiting permanent staff members 

who possess the necessary skills. As part of 

their professional service obligations, university 

faculty should be open to providing inservice 

training programs on VR topics for the agency’s 

staff. In turn, treatment staff may be able to help 

university faculty by offering to give guest 

lectures on substance abuse issues, becoming a 

resource for the university’s employee 

assistance program, or helping with student 

intervention services. 

Developing Relationships 

With Employers 

A key aspect of incorporating vocational 

services into a program is to develop 

relationships with both large and small local 

employers. Many mutual benefits can result 

from ongoing relationships with employers 

because programs develop an understanding of 

the types of workers these employers are 

seeking and employers begin to perceive the 

program as a good source of job applicants. In 

geographic areas where there are multiple 

treatment programs, consideration should be 

given to a collaborative effort to develop 

relationships with potential employers. A 

centralized clearinghouse can also lead to 

better matches between jobs and the applicants 

for them. 

The VR field has developed several 

approaches to initiating and maintaining such 

relationships. Becoming familiar with a 

particular employer, researching its products 

and human resources, and using a businesslike 

approach (e.g., professional dress, business 

cards, promptness) can be effective approaches 

(Vandergoot, 1984). Another approach offers an 

employment service or pool of qualified 

potential workers to employers as an incentive 

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Integrating Onsite Vocational Services 

for establishing an ongoing relationship (Shafer 

et al., 1988). Documents describing these 

approaches can be obtained from the National 

Clearinghouse of Rehabilitation Training 

Materials (see Appendix C, “Published 

Resource Materials”). 

In addition, many large employers have onthe-job training programs. For example, a large 

hotel chain offered on-the-job training for entrylevel positions as front desk clerks, 

housekeepers, and laundry and kitchen 

personnel that allowed them to advance in their 

chosen job areas. Large employers also usually 

provide some level of employee benefits, such as 

medical leave, insurance, and access to child 

care. Relationships with small family-owned 

businesses can also be an important source of 

ongoing employment for clients. One program 

placed a client several years ago in a familyowned carpet business as a warehouse worker. 

That individual is currently the warehouse 

supervisor and hires many of the program’s 

clients, giving them a chance to return to or 

enter the workforce in a supportive work 

environment. Clients who have completed 

treatment and are successfully working are 

excellent resources for information about job 

opportunities and prospective employers. 

Some cities have business advisory groups 

that assist with return-to-work programs. 

Another good resource may be the Welfare to 

Work Partnership, a nonpartisan, nationwide 

effort designed to encourage and assist private 

sector businesses with hiring people on public 

assistance. This network of both large and small 

employers is committed to hiring individuals 

with multiple barriers and little work history. 

The partners are committed to working with 

many social service agencies to find solutions 

and promote a healthy workforce. 

Finding Employers for 

Ex-Offenders 

Ex-offenders are one group for which it is often 

particularly difficult to find job placements; 

therefore, treatment programs that involve job 

placement activities will need to make a special 

effort to locate employers for this population. 

Providers should be proactive when possible, in 

order to convince potential employers of the 

reliability of their clients. It will take time to 

develop strong and lasting relationships with 

employers willing to hire ex-felons, and 

providers working with this population should 

not expect immediate success. Once 

relationships with employers are formed, 

providers should exert effort to maintain these 

relationships and ensure that employers are 

satisfied with clients they hire. 

Programs should inform potential employers 

about any financial benefits for which they may 

be eligible if they hire an ex-felon. For example, 

under the Tax and Trade Relief Extension Act of 

1998 (P.L. 105-277) employers who hire ex-felons 

from low-income families are eligible for a tax 

credit of up to $2,400. Funds are also available 

for States from the Federal government under 

the Job Training Partnership Act (29 U.S.C. 

§§201-206) as amended by the Workforce 

Investment Partnership Act of 1998 (P.L. 105-

220), which States can use for a variety of 

services including on-the-job-training. Exoffenders are one of the groups specifically 

covered in this legislation. These latter funds 

are distributed through the States, and 

individual State departments of labor should be 

contacted for more information on the funds 

available. There are also Federal funds, 

distributed through State employment services 

(also known as One-Stop Career Centers), to pay 

for bonding for ex-felons and people in recovery 

from substance abuse disorders. This bonding 

service is provided free-of-charge to employers 

who are willing to hire ex-felons. 

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Chapter 4 

Implementing and 

Operating the Integrated 

Program 

The specific procedures that a program develops 

will depend on the scope of vocational services it 

decides to incorporate into its treatment 

protocol. However, in an integrated program, 

vocational services are regarded as therapeutic, 

and a client’s attitudes toward work, work skills, 

work history, and work goals are clinical issues 

that have an impact on recovery. Even if clients 

pass through the program very quickly, 

vocational concerns can be introduced and 

addressed in individual or group counseling, 

through brief screening in the form of workrelated questions as part of an intake interview, 

or as part of relapse prevention in discussing 

work-related triggers. 

Once the treatment program has decided to 

integrate vocational services, the degree to 

which the program can structure the client’s 

daily activities while in treatment and the length 

of time the client spends in the program dictate 

the range of onsite vocational services that can 

feasibly be offered. The following section 

describes three levels of treatment programs and 

the types of vocational services that can be 

incorporated into each setting. The three levels 

of programs include high-structure programs 

(therapeutic communities and day treatment 

programs), which can offer the broadest range of 

services; medium- and low-structure programs 

(intensive outpatient treatment, standard 

outpatient treatment); and short-term residential 

programs (programs shorter than 30 days). 

Strategies for other kinds of programs, such as 

detoxification programs, opioid management 

programs, and halfway houses, are 

also discussed. 

High-Structure Treatment Programs 

Clients in therapeutic communities both live and 

work in these facilities, and their daily lives are 

highly structured by the ground rules and 

operations of the program. The length of stay in 

these programs varies widely, ranging from 10 

days to 1 year or more. Clients in day treatment 

programs may spend about 6 hours a day at the 

program facility. Compared with a therapeutic 

community, the length of stay in day treatment 

programs is generally shorter, ranging from 4 to 

6 weeks to several months. Interactions among 

staff members and clients and their peers are 

potent aspects of these high-structure programs, 

in which clients tend to seek the approval and 

respect of other members of the circumscribed 

and structured community. 

Many clients in high-structure programs 

have little or no work history. Many lack 

education, are not competitive for training or 

career-track positions, and lack the financial 

skills to handle a paycheck or control impulse 

spending. Few have experience in setting and 

achieving personal goals or successfully 

completing treatment for their substance abuse. 

Many have a personal or family welfare history, 

and many have a criminal record. Clients’ low 

self-esteem and lack of appropriate role models, 

combined with distorted expectations and ideas 

of “success” and the lack of a positive vision for 

their lives, all strongly contribute to their 

difficulty in obtaining and maintaining 

stable employment. 

Therapeutic communities and day treatment 

programs are ideal sites in which to establish 

vocational services based on a classic 

rehabilitation model (Rubin and Roessler, 1995; 

Wright, 1995). Such a model includes the 

following components: 

 Prevocational stage testing and work 

skills evaluation 

 Work adjustment training, including 

education about work 

 Attention to activities of daily living 

 Formal vocational training and services (both 

classroom and on the job) 

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Integrating Onsite Vocational Services 

 Goal setting and developing a personal plan 

 Postplacement job retention strategies 

Some of these vocational components and ways 

they can be integrated into high-structure 

programs are discussed in more detail below. 

Work adjustment training 

Work adjustment training, as described in 

Chapter 2, uses work in a structured 

environment to teach accepted employment 

practices (i.e., education about work—the 

workplace, employer expectations, etc.). 

Therapeutic communities provide a wide range 

of internal work adjustment opportunities in the 

form of chores or job functions that support the 

day-to-day operations of the program and 

facility. Day treatment programs also can create 

such opportunities by establishing clientoperated departments or services that are 

important to the operation of the program. 

In a work adjustment environment, clients 

are assigned various jobs after they enter the 

program. Early work assignments are designed 

to enhance clients’ strengths and build selfesteem by helping clients “discover” skills they 

did not realize they had. These work 

assignments focus clients on the importance of 

completing a task, working as a team member, 

and developing a sense of pride and personal 

satisfaction in a job well done. Early work 

assignments usually are less complex, guarantee 

initial success for most clients, and offer an 

opportunity for advancement to more 

responsible positions in the structure. Later, as 

clients demonstrate a commitment to their 

treatment goals and an ability to handle work 

positions of increasing responsibility, 

assignments become more complex and are 

designed to address behavioral areas clinically 

identified as essential to progress in recovery. 

Other work skills emphasized in work 

adjustment training are attention to details, 

successful task completion, frustration, 

tolerance, and accountability. 

In addition to acquiring supervisory skills, 

clients learn how to handle on-the-job 

advancement and how to model appropriate 

work behavior for newer members of the 

program. For many clients in these programs, a 

key work-related issue is understanding and 

dealing with authority in constructive ways that 

will not jeopardize their job. 

When vocational rehabilitation and treatment 

for substance abuse are integrated in this way, 

clients not only work at various tasks with peers 

but also encounter these same peers in substance 

abuse disorder group counseling. Thus, workrelated issues are addressed by clients in clinical 

groups, and clinical themes arise in vocational 

activities. Substance abuse disorder recovery 

and “vocational recovery” are synchronized, 

and clients are afforded opportunities 

for insights into problems and the 

interrelatedness that occurs when services 

are so thoroughly integrated. 

Activities of daily living 

High-structure programs can establish groups 

that focus on job issues addressing positive 

workplace behavior such as appropriate 

grooming, dress, and proper socializing on the 

job, as well as self-defeating and negative 

behavior in the workplace. Work-related 

triggers for relapse, such as disappointments 

and frustrations, can also be addressed in 

recovery in vocationally oriented group and 

individual counseling and in work adjustment 

training. Financial management skills can be 

provided on both an individual and a group 

basis. Efforts to improve skills in activities of 

daily living should also focus on social supports: 

making friends, having hobbies, networking for 

job-related information, and structuring leisure 

time. The importance of a client’s hearing the 

same messages in all aspects of her treatment 

and from both alcohol and drug and vocational 

staff members should not be underestimated. 

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Chapter 4 

Formal vocational services 

Work adjustment training involves bringing all 

clients to a basic level of work readiness before 

actual job-seeking activities begin. All programs 

should establish specific criteria that a client 

must meet before beginning formal vocational 

counseling. These criteria will define the point 

in the treatment process when a client will begin 

receiving formal vocational services, which is 

dictated in part by the length of a given 

treatment program. Formal vocational services 

provided at this point can include assessment, 

counseling, planning, résumé and interview 

preparation, and teaching other job-seeking 

skills, as well as job placement and monitoring. 

These services are described in detail in Chapter 

2. A comprehensive vocational program would

also include a vocational library that both staff 

and clients could use as resources for vocational 

planning and job placement. Figure 4-2 

provides information about job clubs. 

Setting goals and developing a 


personal plan 


Developing and implementing a personal plan 

for change is another key aspect of vocational 

rehabilitation. The client develops the plan in 

consultation with vocational and treatment staff. 

The plan lays out the direction in which a client 

wishes to go and demonstrates that the client 

understands the steps necessary to achieve his 

goals. The plan can address vocational, 

educational, social, familial (including children), 

and housing goals, as well as relapse triggers 

and ongoing needs for substance abuse 

treatment. It generally requires the client to 

anticipate obstacles and develop contingencies 

or alternative strategies for coping with them. 

The idea of the plan may be introduced to 

clients early in the treatment process so that they 

can begin to think about it. However, clients in 

high-structure programs may not be ready to 

actually develop a plan until they have learned 

about the effects of substance abuse on all 

aspects of their lives and have learned about the 

world of work and their vocational strengths 

and deficits. The length of the individual’s 

proposed treatment is again a factor, and clients 

in shorter term treatment programs may be 

encouraged to develop plans that are more 

focused on specific, immediate vocational goals. 

Plans can also be used effectively in counseling 

groups because “going public” with a plan often 

enhances the client’s commitment to it. 

Counselors should evaluate the client’s plan 

to determine whether the vocational goals the 

client sets are realistic (not too high or too low) 

and whether achieving the goals will allow the 

client to make a sufficient living and support 

continued recovery. In many ways the process 

of developing the personal plan is more 

important than the actual content of the plan. 

Situations and goals change, but once clients 

have mastered the process, they can create new 

plans on their own as their future situations 

require. In any case, it should be emphasized 

that the plan will be most useful if both the goals 

and the timeframe for achieving them are as 

specific as possible. 

High-structure programs that incorporate the 

development of a detailed personal plan may 

wish to encourage formal presentations where 

the client describes his plan to selected peers and 

staff and receives feedback from the group. This 

“approval committee” can also include outside 

professionals involved with the client, such as a 

probation officer or a child welfare worker. For 

clients from particular ethnic groups, the 

approval committee might also have 

representatives of the community to which the 

client is returning at discharge. The presentation 

can be done in a formal way that symbolizes a 

passage from the exploration and information 

gathering that characterize the early stage of the 

treatment to action. The committee evaluates 

the client’s plan, makes suggestions, and, by 

approving it, endorses the plan and gives the 

client permission to carry it out. 

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Integrating Onsite Vocational Services 

Figure 4-2 

Job Clubs 

A job club can be established in most treatment settings—i.e., high-, medium-, or low-structure 

programs. However, outpatient programs may find them particularly useful for helping clients obtain 

jobs with a low investment of staff time. Some job clubs are run by a staff person, but most are 

organized and operated by clients with a staff person in the role of a consultant. 

The job club is a behavioral approach to job finding that is based on research showing that the 

difficulties faced by most job seekers often involve problems of learning, motivation, and the 

maintenance of behavior—problems for which the behavioral approach should be most relevant (Azrin 

and Besalel, 1982). This multistep approach, in which job seeking is regarded as full-time employment, 

provides a systematic method for conducting a job search. The group context provides important social 

support to members engaged in the stressful process of finding a job. 

To establish a job club, the substance abuse treatment program provides daily newspapers and 

other current sources of job information and office equipment (e.g., copy machine, typewriter, 

computer) and supplies. A phone line or lines reserved for job club members and an answering 

machine help them contact potential employers and allow them to receive messages. The program also 

can obtain a post office box for members’ mail from prospective employers. It is important to 

remember that some clients may not have a permanent address or phone number and that the person 

who answers the phone at their home may give a poor impression to the employer or may fail to take 

messages reliably. Job club members thus use the facility as a home base for conducting their search. 

Job clubs tend to become part of the treatment milieu and to integrate themselves into programs. There 

is a natural confluence of substance use disorder and vocational issues in these groups. 

The Internet has now become a good resource for job hunting. The cost of a computer and modem 

may no longer be prohibitive for most programs and may be a good investment if it improves clients’ 

vocational outcomes. In addition, the computer skills that clients gain in their job search may help 

them on the job. 

Medium- and Low-Structure 

Treatment Programs 

According to the model developed by the 

American Society of Addiction Medicine 

(ASAM), clients in intensive outpatient 

treatment spend from 9 to 20 hours a week in 

the treatment program, and clients in standard 

outpatient treatment spend less than 9 hours a 

week (ASAM, 1996). Lengths of stay vary 

widely but can be 6 months or longer in 

outpatient treatment. Lengths of stay in shortterm residential treatment have declined in 

recent years because of pressure to contain costs, 

from typical 28-day programs to programs as 

brief as 10 to 14 days. Clearly, the range of 

vocational services for clients in medium- and 

low-structure programs is narrower than the 

services offered in high-structure programs. 

However, even 1 hour of rehabilitation services 

a week for 24 weeks, or 1 hour a day for 14 days, 

can be a significant level of attention for clients 

with serious vocational needs. 

Most substance abuse treatment is provided 

in outpatient settings—generally in the lowest 

intensity modality (i.e., less than 9 hours a 

week). Thus, finding innovative ways to 

address the needs of clients in these programs, 

for which funds are often limited, is critical. As 

noted earlier, the Consensus Panel recommends 

that outpatient programs either hire a VR 

counselor or obtain such services through a 

VR consultant. 

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Chapter 4 

The time devoted to VR issues in outpatient 

programs can be used in several ways; some are 

described below. (Vocational activities that can 

be undertaken by methadone maintenance 

programs, halfway houses, and short-term 

residential treatment programs are described in 

a separate section.) 

Education about work and 

job seeking 

A brief introductory presentation and a 

question-and-answer session on work, 

jobseeking, and daily living skills can be 

completed in an hour. Many topics related to 

the world of work may be helpful to discuss 

with clients. These include what work is, work 

values, career exploration, résumé development, 

job searching, job interviewing, the workplace, 

workers’ and employers’ rights, discrimination, 

and maintaining employment. A series of 

presentations could be developed, with one 

session devoted to each of these topics. 

If staff time for these presentations is limited, 

the outpatient program should look to 

organizations in the community that can send 

volunteers to address client groups, such as the 

local Chamber of Commerce, the State 

employment service, or the State VR system. 

Private Industry Councils and local Workforce 

Investment Boards also have career counselors 

who could address client groups about the 

availability of education and training 

opportunities, local employment opportunities, 

and job readiness issues. For example, the 

director of human resources of a large 

corporation can provide a group with valuable 

information about how to make a good 

impression during an interview. Employers 

with whom the program has placed clients can 

be guests. In addition, alumni of the program 

who have unusual or interesting jobs or who 

have completed training courses for particular 

occupations (e.g., mechanic, electrician, 

beautician) can talk about what they do and the 

obstacles they faced in achieving their goals. 

Local entrepreneurs who have been successful at 

starting their own businesses often have 

motivational stories to tell. The emphasis at 

these presentations should not be on recruiting 

clients into specific occupations but on how 

ideas and motivation can be transformed into 

action to achieve desired goals. 

Another tactic is for counselors to give 

homework assignments related to work issues. 

For example, clients can be asked to bring in five 

employment ads from a newspaper that describe 

jobs that appeal to them. Another homework 

assignment might be for the client to register 

with a local job search agency or visit the 

local library to explore references about 

career options. 

Vocational assessment 

During the intake interview, outpatient 

programs typically collect information about the 

client’s vocational needs using various 

assessment tools. An example used by 

substance abuse treatment programs is the 

Addiction Severity Index (ASI) (McLellan et al., 

1980, 1992), one domain of which assesses the 

client’s education and employment skills, 

sources of financial support, and severity of 

problems at work. However, this is not an 

adequate substitute for an assessment done by a 

VR counselor. 

Assessment tools that clients can use 

independently can be an efficient use of 

resources. For example, Holland’s Self-Directed 

Search is an instrument that clients can complete 

themselves, and the results can be viewed as a 

form of vocational self-assessment (Holland, 

1985a). A client may learn from the process that 

she likes to produce a tangible product and does 

not like to deal with more process-oriented tasks 

that involve “shuffling papers” and “crunching 

numbers.” This information can also be highly 

useful from a clinical standpoint in addressing 

work-related stressors and substance use 

triggers. Clients can be encouraged to discuss in 

a group setting what they have learned, as well 

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Integrating Onsite Vocational Services 

as concerns they face about maintaining a job, 

returning to a job, or seeking a job while 

stabilizing in recovery. 

Incorporating vocational issues 

into group counseling 

Although many traditional outpatient programs 

are based on an individual counseling model, 

groups can be an effective way for clients to 

address work-related issues. Problems that 

clients have on the job may become more 

conspicuous in the context of the group than in 

the individual counselor’s office. Group 

members who have job interviews can be helped 

by the group to role-play any problems they 

anticipate in the interview, such as questions 

about their substance abuse or criminal history. 

Group members who are working can provide 

valuable advice about on-the-job behavior. 

Some outpatient treatment programs for 

substance abuse may hesitate to develop groups 

specifically for vocational rehabilitation because 

they receive reimbursement only for substance 

abuse treatment services. In the climate of 

welfare reform, they may be successful in 

convincing funding sources that VR issues are 

key to clients’ recovery and to bringing 

Temporary Assistance to Needy Families 

(TANF) and welfare-to-work resources to the 

substance abuse treatment site (see Chapter 6 for 

more information about funding). However, 

even if funding is not available, a VR group can 

be set up with volunteer presenters and experts 

from the community. 

Short-Term Residential Treatment 

As noted previously, stays in short-term 

residential programs, formerly known as 28-day 

programs, have been greatly reduced. 

Typically, the focus is to stabilize the client and 

initiate recovery before discharge to outpatient 

care. Because of their limited timeframe, such 

programs are the most difficult in which to 

integrate VR services, and they probably do not 

have a VR counselor on staff. Historically, the 

alcohol and drug counselor sometimes helped 

clients find jobs, but financial squeezes on these 

programs make current staff involvement or 

vocational assessment unlikely. 

However, staff members in short-term 

residential programs can do a vocation-oriented 

interview after program entry that includes 

some type of screen for vocational problems. 

Discharge planning around vocational issues is 

encouraged, as are referrals to outpatient VR 

services. The program staff should develop a 

knowledge of community resources for referral. 

Another way to incorporate vocational issues 

into these programs is to use self-report 

instruments, such as Holland’s Self-Directed 

Search or Vocational Preference Inventory, 

because these involve little staff time 

(see Appendix B for information about 

these instruments). 

Educational programs about work can also 

be woven into the curriculum of the short-term 

residential program. Typically, these programs 

are education-oriented and based on a revolving 

curriculum of modules about clients’ substance 

abuse and the consequences of not arresting the 

addiction process. With a minimal level of 

consultation from a VR counselor, it should be 

simple for programs to build in a module about 

vocational issues and what vocational 

rehabilitation involves. This module could be 

targeted to the needs of the majority of clients in 

a given program. It should motivate clients to 

seek VR services upon referral to ongoing 

outpatient treatment and other communitybased services. 

Vocational Strategies for Different 

Types of Services 

Detoxification 

Detoxification facilities, which typically provide 

stabilization, will not be able to provide VR 

services. Because most programs will gather 

some information about the client’s work history 

through a psychosocial interview and the 

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Chapter 4 

administration of the ASI or similar assessment, 

it is recommended that detoxification facilities 

address vocational needs as part of the 

discharge plan. In this way, the recovery 

program to which the client is referred will have 

information that gives a snapshot of the client’s 

potential vocational issues. 

Methadone maintenance programs 

Some methadone maintenance programs have 

introduced vocational services. In a 

demonstration project sponsored by the 

National Institute on Drug Abuse, a vocational 

readiness screening instrument was developed 

for methadone maintenance clients that 

measured five dimensions: the client’s 

vocational status, level of motivation, level of 

social support, ancillary needs, and barriers for 

vocational activity (Dennis et al., 1994; 

Karuntzos and Dennis, 1994). In this 

demonstration project, the screening instrument 

was administered by a VR counselor, but an 

alcohol and drug counselor with some 

vocational expertise could be trained to use it. 

An alcohol and drug counselor was trained to 

provide vocational counseling and build 

positive work attitudes and behaviors. The 

project hired a case manager to deal with 

barriers to employment such as transportation 

and child care. The project funded some clients’ 

return to school and purchased tools for other 

clients pursuing vocational goals. One key 

program component—creating relationships 

with employers—was identified as a critical 

aspect of success. 

The Opioid Maintenance Program of the 

University of New Mexico’s Center on 

Alcoholism, Substance Abuse, and Addictions is 

developing the position of a transitional agent. 

The case manager is part of a multidisciplinary 

team whose approach is designed to be 

harmoniously inclusive of basic living needs. A 

networking system within the community 

provides referrals for vocational training, 

educational opportunities, employment 

resources, and housing needs. Welfare to Work 

is also coordinated through this resource. 

A key component of these kinds of programs 

is teaching clients job readiness skills. For 

example, the frequent visits required (especially 

in the early stages of treatment) can be 

scheduled on an appointment basis, as opposed 

to a drop-in basis, to address punctuality, time 

management, and personal responsibility issues. 

For more information about methadone 

maintenance programs, see TIP 20, Matching 

Treatment to Patient Needs in Opioid Substitution 

Therapy (CSAT, 1995c). 

Utilizing a vocational case manager can help 

greatly when the primary counselor is very 

involved in the vocational counseling aspects of 

the client. A specific person who is responsible 

for trying to reduce barriers that could prohibit 

clients from job training, continuing education, 

job placement, aftercare, and so forth is essential. 

The primary counselor may not have enough 

time to deal with those issues. 

Halfway houses 

Halfway houses or other reentry facilities are an 

important element in the continuum of care. To 

be eligible to live in most halfway houses, clients 

must be in a training program or a job during 

the day. Most halfway house residents are 

trying to stabilize themselves in many aspects of 

their lives, including work, before they move out 

to live on their own. Thus, a support group for 

maintaining both sobriety and employment is 

appropriate in this setting. Such a group, 

meeting in the evening, could address issues 

related to helping residents keep their jobs and 

become more effective employees. The staff can 

help group members recognize triggers in the 

work environment that alert them to a risk of 

relapse. It is most helpful when staff members 

in halfway houses see a client’s job not as a 

“given,” but as a set of newly acquired skills that 

need strengthening. 

A halfway house or group of halfway houses 

can hire a VR counselor as a consultant to 

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Integrating Onsite Vocational Services 

conduct group sessions or hold educational 

seminars for staff. Community volunteers, 

including individuals who have completed the 

halfway house program, can be important 

resources for helping residents maintain 

employment and stabilize their recovery. 

Outcomes 

The measurement of treatment outcomes is no 

longer just a research issue. In the current 

health care environment and with recent 

reforms in the welfare system, all treatment 

programs must demonstrate to payors and other 

funders that clients are achieving the goals to 

which the program is dedicated—the goals by 

which the program defines “success.” 

Demonstrating the program’s success is also 

important for recruiting new staff members and 

for maintaining or improving the morale of the 

existing staff. 

For many years, abstinence was the only 

successful outcome recognized by most 

substance abuse treatment programs. However, 

treatment programs have begun to recognize the 

many different criteria that can be used to define 

success. Examples of criteria include (but are 

not limited to) 

 Abstinence or decreased substance use 

 Decreased involvement with the legal system 

 Success in employment 

 Success in education or training 

 Improved family relationships 

 Enhanced psychological functioning 

 Removal from welfare rolls 

 Return or maintenance of child custody 

 Improved physical health (e.g., decrease in 

emergency room visits) 

A similarly flexible approach should be 

considered in defining a successful vocational 

rehabilitation outcome. Outcomes must be 

defined and measured within a realistic 

framework. For clients with significant disabilities 

and who have strong family support, doing parttime or volunteer work may be a realistic goal. In 

the case of a single woman with young children 

who has minimal social supports and will soon 

lose welfare benefits, achieving gainful 

employment is an important goal, but perhaps 

harder to achieve. 

What, then, should be called a successful 

outcome in terms of vocational rehabilitation? 

Some vocational measures include 

 Number of hours worked per week (or per 

month, or in the past 6 months) 

 Entry into and/or completion of an educational 

or training program 

 Temporary or permanent job 

 Earning level and/or level of benefits 

 Employment evaluations, promotions, raises 

 Duration of employment 

 Job satisfaction 

 Return to school to pursue long-term 

vocational goals 

As described in TIP 14, Developing State 

Outcomes Monitoring Systems for Alcohol and Other 

Drug Abuse Treatment (CSAT, 1995a), all programs 

must have mechanisms in place to ensure the 

ongoing collection of reliable data. For example, 

one State has enhanced a version of the ASI so that 

it assesses 10 domains and is more relevant to 

Native American populations and other groups. 

This and other assessment instruments that are 

administered at intake should be periodically 

readministered and linked to outcomes. 

It is best to conceive of a continuum of 

outcomes, from part-time to full-time work, from 

volunteer work to full-time homemaker, all of 

which may be considered successful depending on 

what was realistic at baseline for the client. The 

personalized vocational goals that clients 

articulate in their rehabilitation plans may not fit 

the program’s measurement categories. However, 

helping clients attain these goals may represent a 

significant investment of staff energy, and 

programs will find ways to measure and report 

these outcomes. 

87 
 

 

 

 

 

Chapter 4 

More data are needed on employment 

outcomes across the array of substance abuse 

treatment modalities. Until recently, research 

has tended to focus on clients in methadone 

maintenance programs and has used mostly 

simple outcome measures (e.g., job versus no 

job). Building databases on employment 

outcomes from treatment programs is critical to 

future understanding of the dynamic connection 

between these two areas. In general, the field 

has focused on whether substance abuse 

treatment results in improved employment. 

However, it is also important to determine 

whether implementing vocational services and 

focusing on clients’ vocational needs result in 

better substance abuse treatment outcomes. 

Important work also remains to be done in 

identifying treatment-level and client-level 

variables (such as clients’ satisfaction with 

services) that are related to good employment 

outcomes. Accurate outcome data can also 

support future funding requests to legislative 

and other decisionmaking bodies and help 

ensure the fiscal viability of integrated treatment 

and vocational services. 

To understand long-term employment 

outcomes, it is important for programs to obtain 

followup data after clients leave treatment. 

Vocational outcomes can be better during the 

posttreatment period, when clients are farther 

along in the recovery process and can focus 

more energy and attention on job performance. 

Outside of formal research studies, followup 

data are often difficult to obtain because many 

clients are lost to the program when they 

complete treatment. One program that has a 

high rate of success in contacting clients for 

followup interviews makes sure that at 

discharge it obtains the names, addresses, and 

telephone numbers of two significant others in 

the client’s life who are not in the same 

household. The program should have the client 

update his address and telephone number 

before leaving. 

The program should also have the client sign 

an authorization for followup that allows the 

program to contact the significant others whose 

names the client provided. Each substance 

abuse treatment program must define successful 

outcomes appropriate to the population it serves 

and ensure that funders understand the 

importance of these outcomes and the services 

necessary to achieve them. There are many 

variations of employment success, including 

obtaining and maintaining a full-time job, one or 

more part-time jobs, seasonal jobs (in which 

clients are unemployed for part of the year), or 

sheltered employment making or selling handcrafted goods. 

Figure 4-3 provides information about a 

client outcomes initiative developed by CSAT. 

Uniform Data Collection
1

It is not uncommon for different funding 

agencies to require substance abuse treatment 

programs to report different types of data or to 

report the same data but in different forms. 

Program administrators are beginning to call on 

agencies to standardize reporting categories, not 

just to ease the programs’ reporting burden but 

to facilitate comparisons among data sets. 

Another significant problem is that funders 

generally ask for aggregate data that are not 

broken down by the severity of clients’ 

substance abuse disorders or VR needs. 

Interpretation of such data is difficult, and 

reported results can be misleading, especially 

when the outcomes of two programs with 

different case mixes are compared. However, 

Federal minimum data sets do require pre- and 

posttreatment status reports concerning client 

employment, and such data can currently be 

analyzed concerning client characteristics, type 

and intensity of substance abuse treatment, 

and the like that lead to success in the 

employment domain. 

88 
Substance abuse treatment agencies involved in 

providing vocational services must lobby 

strongly to have outcome indices related 

to employment inserted in such uniform 

data packages. 

 

Integrating Onsite Vocational Services 

Figure 4-3 

Focus on Client Outcomes: 

The Future for Substance Abuse Treatment Providers 

CSAT is developing client outcome evaluations that will be disseminated to State and local 

governments and treatment providers. With these tools, treatment programs can measure their 

effectiveness and make comparisons on a regional and nationwide basis. A substantial initiative by 

CSAT, the two Treatment Outcome Performance Pilots (TOPPS I and II), which involve 14 and 19 

States, respectively, is developing and pilot testing instruments and measures of substance abuse 

treatment outcomes. These measures will examine changes in several domains including employment, 

substance use, health status, psychological function, legal status, and family and social relationships. 

These domains represent consensus among States on the areas where substance abuse treatment 

is expected to result in changes. Treatment providers will need to address these domains via 

on- or offsite programming or referrals in order to remain competitive for Federal funding for 

substance abuse treatment programs. 

89 

 

 

5 Effective Referrals and 

Collaborations



Adopting a holistic view of clients in 

substance abuse treatment is especially 

important for any service provider 

making referrals to other providers or agencies. 

At the point of referral, there is both an 

opportunity to address a client’s unmet needs 

and a potential danger of losing the client. 

Collaboration is crucial for preventing clients 

from “falling through the cracks” among 

independent and autonomous agencies. 

Effective collaboration is also the key to serving 

the client in the broadest possible context, 

beyond the boundaries of the substance abuse 

treatment agency and provider. 

This chapter explores the elements of 

integrated services using a community– 

collaborative model. This model is based on an 

agency’s ability to make effective referrals 

within a network of numerous agencies, 

including vocational services, serving common 

clients. Only when these service providers are 

truly interconnected can they work together 

toward the common goal of successful client 

outcomes. The phrase authentically connected has 

been coined to describe an integrated network in 

which agencies function as equal players with 

each other and with the client to identify and 

address the complex interplay of needs that is 

typical of clients with substance abuse disorders. 

Collaboration as the 

Cornerstone of 

Effective Referral 

When the many agencies that work with clients 

who have substance abuse disorders work 

independently of each other, the result is that 

the client is subject to fragmented services, none 

of which might address the client as a whole 

person. One of the biggest challenges to any 

collaborative or network-based model occurs 

when each of numerous agencies wants to use a 

different assessment tool to gather the same 

information. At best, this produces a 

fragmented portrait of the client; at worst, it 

creates frustration and confusion for the client, 

who may drop out of treatment as a result. 

A shared vision among potential 

collaborators facilitates strategies to achieve 

common goals (Nelson et al., 1999). The biggest 

benefit of collaboration among health agencies is 

the improved health of clients and therefore of 

the community. One study found that health is 

dependent on how people perceive the quality 

of their community. Leadership and vision 

among collaborative agencies can make a 

difference in the quality of a community health 

care system and in the cost-effectiveness of the 

care provided (Molinari et al., 1998). 

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Chapter 5 

Collaboration among agencies is the key to 

preventing fragmentation. In addition to 

reducing the likelihood of clients falling through 

the cracks between disparate and unconnected 

agencies, collaboration can foster a more holistic 

view of the client. Sometimes just a simple 

change of perspective can make the difference 

between circumstances being viewed as “needs” 

and being viewed as assets. For example, a 

single parent who cannot find a babysitter on a 

particular evening misses a treatment session. 

This client is then labeled “noncompliant” by 

one treatment provider, but another provider 

who focuses on child care and parenting skills 

recognizes the client’s adherence to her parental 

responsibility as a positive asset. With effective 

collaboration, service providers will learn to 

recognize these differing viewpoints through 

their contact with professionals with expertise in 

different areas. 

Another approach to prevent fragmentation 

is to designate one agency as the primary contact 

both for the client and for the other agencies. 

The primary agency provides a holistic 

assessment that accompanies the client 

throughout the referral process. The assessment 

must be comprehensive enough to satisfy all the 

agencies and organizations participating in the 

client’s care and might include 

medical/psychiatric history and conditions, 

substance use patterns, work history, housing 

situation, physical/sexual abuse history, 

involvement in family violence and the criminal 

justice system, and other data about the client. 

In addition to decreasing paperwork and 

minimizing fragmentation, this process 

could help to strengthen linkages and 

communication among various agencies 

providing different services. 

Barriers to Collaboration 

The traditional referral system from substance 

abuse treatment programs to outside agencies 

can create obstacles to effective collaboration. 

Examples of obstacles are designation of which 

agency has major responsibility for a client, 

structural barriers driven by funding sources 

(e.g., payment to only one treatment agency), 

difficult-to-treat clients, and differing 

staff credentials. 

The issue of which agency “takes credit” for 

a client is a difficult question arising from 

competition among different agencies, each of 

which has an interest in maintaining a certain 

“head count” to ensure continued funding. This 

barrier highlights the need to change the way 

that agencies are credited for their participation 

in a client’s recovery. In many treatment 

systems, only one agency can receive credit for 

clients who are served by several service 

providers. It would be preferable to allow all 

participating agencies to take credit for these 

clients. For example, this happens in 

communities that have collaborative 

relationships based on shared outcomes 

negotiated across agencies. These cross-agency 

outcomes can occur across service systems (e.g., 

substance abuse treatment and social services) 

or across provider networks (e.g., residential 

and outpatient providers). Outcomes are 

negotiated both across agencies and with 

funders of services. Funders play a critical role 

because they must “change the rules” that allow 

only one agency to receive credit for a client. 

This change from a rules-driven system to a 

results-based system encourages all 

participating agencies to be recognized for their 

contribution to client outcomes. Also, it is 

important that each provider understand the 

role of the other providers so that it does not 

seem as if they are competing. Each provider 

must create an appropriate working relationship 

with the other providers so the client can benefit 

from all. 

Structural barriers may also be posed by 

program policies that are determined by the 

program’s primary funding source. Such 

policies may dictate, for example, that clients 

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Effective Referrals and Collaborations 

cannot engage in concurrent activities, such as 

vocational training and treatment of substance 

abuse disorders. If the State or a managed care 

system does not allow clients to participate in 

concurrent services, then collaboration efforts 

will be difficult, or even impossible. However, 

in some cases, this is simply a program 

philosophy and not a formal policy, and efforts 

should be made to change this mode of 

operation. Another major barrier in the past has 

been confidentiality requirements. One answer 

to addressing this problem is joint training. 

In the present system, there are no rewards 

for serving difficult-to-treat clients, and 

sometimes agencies set criteria under which 

only the clients with the greatest potential for 

success are accepted. Incentives are needed for 

programs to accept those clients who have the 

greatest problem severity or multiple needs. 

This is known as “case mix adjustment.” The 

incentives should be based on three factors: (1) 

identification of difficult-to-treat clients based on 

analysis of differential outcomes and clients’ 

characteristics, (2) analysis of the additional 

average costs of serving these clients, and (3) 

provision of either explicit incentives for serving 

these clients or a more equitable approach. A 

key element in a more equitable approach is for 

funders to recognize that serving difficult-totreat clients is as valuable as serving clients with 

fewer risk factors, even though success rates will 

be lower as a result. Referring difficult-to-treat 

clients should be viewed not as a matter of 

“handing off” problematic clients, but rather as 

securing additional services to meet these 

clients’ needs. 

Staff licensing can sometimes be a barrier to 

collaboration because it is defined categorically. 

For example, sometimes the referring agency has 

a policy requiring that the staff members of the 

receiving agency have the same licenses and 

credentials as the referring agency’s staff. In 

addition to requiring specific types of expertise, 

a referring agency sometimes requires the staff 

members of the other agency to be 

“professionals” with advanced degrees. The 

unfortunate consequence is that credentialing 

standards, rather than transdisciplinary 

collaboration, often dictate the services 

clients receive. 

Finding Potential Collaborators 

Programs must look at their clients with the 

assumption that it is not feasible or effective to 

provide everything that clients need “under one 

roof.” A more fruitful approach is to collaborate 

with other agencies on the basis of client needs 

and overlapping client caseloads. This 

procedure is called data matching. Figure 5-1 

provides an example of this process. 

Agencies and organizations that provide 

vocational training in collaboration with 

substance abuse treatment programs can be 

divided into two levels—agencies providing 

specific training for employment (Level 1), and 

agencies with resources and services needed by 

clients at the same time they are receiving 

substance abuse treatment and employment 

rehabilitation services (Level 2). Examples of 

Level 1 resources include 

 City-, county-, and State-operated vocational 

rehabilitation (VR) services 

 Public and private employment and job 

placement services 

 Public and private employers in 

the community 

 Vocational–technical colleges 

 Community colleges 

 Privately owned VR facilities 

 Criminal justice vocational training programs 

Examples of Level 2 resources include 

 Economic Development Centers (One-Stop or 

Workforce Development Centers) 

 Shelters for survivors of domestic violence 

 Mental health agencies 

 Homeless shelters 

 Child welfare agencies 

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Chapter 5 

Figure 5-1 

Data-Matching Software 

The use of data-matching tools such as unique client identifiers (e.g., the client’s first and last name and 

middle initial and the last four digits of the client’s Social Security number) can help agencies 

determine overlapping client caseloads. The software ArcView (Environmental Systems Research 

Institute, Inc., 380 New York Street, Redlands, CA 92373-8100) can aid in assessing the effectiveness of 

collaborative relationships among service providers by providing data on the numbers of clients being 

served by multiple agencies. Some of the locations in which data matching has been implemented 

include Chicago, San Diego, Los Angeles, and Alameda County, California. This software compares 

data from specific client populations with those from other populations. The user can then determine 

the proportions of clients receiving substance abuse treatment services who are counted in the 

caseloads of other agencies. This makes it possible to determine, for example, what percentage of 

clients who are receiving substance abuse treatment have children in remedial education. By 

identifying areas of overlap such as this, data-matching tools can influence decisions about the makeup 

of a multidisciplinary team, the coincidental needs of clients, and what types of collaborative 

relationships with other agencies are most likely to benefit a program’s client population. 

 Child care services 

 Family services 

 Housing authorities 

 Evening adult education programs 

 Alternative education programs 

 Literacy programs 

 Adult basic education programs and general 

equivalency diploma (GED) programs 

 Young Men’s Christian Associations 

(YMCAs), Young Women’s Christian 

Associations (YWCAs), Young Men’s 

Hebrew Associations (YMHAs), and Young 

Women’s Hebrew Associations (YWHAs) 

 Social service organizations 

 HIV/AIDS programs 

 Health and disability organizations 

 Independent living centers 

 Religious groups 

 Self-help meetings 

 Accessible meetings 

Often, collaborating agencies must be 

educated about the nature of substance abuse 

disorders, including the cycles of relapse and 

recovery. Alcohol and drug counselors may also 

benefit from applying the relapsing and 

remitting model in areas other than substance 

abuse disorders. For example, clients may also 

“relapse” into and out of employment, 

medication management, or violent situations. 

The failure of any one of these supports can then 

be a trigger for failure of any of the others. All 

collaborators, including those providing 

treatment for substance abuse disorders, should 

be aware that their efforts are likely to be 

ineffective unless all the client’s life areas are 

addressed. To that end, agencies must recognize 

the existence, roles, and importance of each 

other in achieving their goals. It is preferable to 

have formal written agreements that outline the 

responsibilities of each agency. 

Although the prison population has grown 

substantially in the last several years, vocational 

training programs for inmates are limited. The 

vocational training programs that are available 

to incarcerated individuals will vary according 

to the setting of the incarceration, and treatment 

programs will need to be in contact with penal 

institutions in order to find out what particular 

types of substance abuse treatment and 

vocational training are available (see Chapter 8 

for more information about working with exoffenders). Providers interested in more 

information concerning the particular 

94 
 

Effective Referrals and Collaborations 

procedures and problems involved in 

establishing service agreements with criminal 

justice agencies (including prisons, detention 

centers, and community supervision agencies 

for ex-offenders) should consult Chapters 1 to 4 

in TIP 30, Continuity of Offender Treatment for 

Substance Use Disorders From Institution to 

Community (CSAT, 1998d). 

Figure 5-2 summarizes the steps that 

substance abuse treatment providers can take to 

establish an authentically connected network 

with other agencies or to screen potential 

collaborators. The next section provides more 

detailed information about this process. 

Multidisciplinary Teams 

In its conventional sense, a multidisciplinary 

team is composed of members from different 

service areas (e.g., substance abuse treatment, 

vocational rehabilitation, mental health). This 

method of service, which is more common in 

programs that provide multiple services inhouse, is just one way of functioning in a 

multidisciplinary manner. In an authentically 

connected referral network, however, members 

of the multidisciplinary team provide their 

services in different locations. Still, in an 

authentically connected network, a 

multidisciplinary team approach can be fostered 

by regularly scheduled case conferences. 

In the authentically connected model, the 

agencies are interdependent. They cross-train 

their staffs in concepts and methodologies from 

different disciplines and promote awareness of 

resources that each agency might provide. 

Instead of being dependent on certification, 

learning about other disciplines, and becoming 

recertified every few years, service providers are 

taught how to learn on their own. 

Careful consideration must be given to the 

formation of a multifocal treatment team. One 

approach is to view the team as a pie divided 

into sections, with the team members 

proportionally reflecting the needs of clients in 

areas such as coexisting mental disorders, job 

skills and employment, and child custody and 

care. The community must be considered as a 

whole throughout the treatment and referral 

process, and all available resources in the local 

geographic area should be considered to meet 

Figure 5-2 

Steps for Establishing an Authentically Connected Network 

The Consensus Panel developed the concept of authentically connected networks, which include the 

following steps to their establishment: 

1.	
 Determine the services that are available in the local area by developing an updated inventory and

by resource mapping.

2.	
 Hold discussions with agencies identified as potential collaborators. Discussions can include topics

such as the following:

♦	 Emphasis on the benefits of collaboration

♦	 Cross-training of staff

♦	 How the other agency conducts business (e.g., “turf” issues)

3.	
 Develop working agreements or memorandums of understanding between collaborators to

organize information sharing and communicate respective roles.

4.	
 Determine the agency’s criteria for accepting clients (e.g., what types of clients and levels of

severity do they accept?).

5.	
 If warranted, establish a partnership with the agency, as well as agreements regarding the flow of

information and feedback between the agencies to ensure provider accountability.

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Chapter 5 

client needs. Multidisciplinary teams can be 

composed of credentialed specialists as well as 

self-help and grassroots organizations. The 

more diverse the team, the more likely that the 

client will be viewed holistically. 

True collaboration is a higher order of 

referral than either cooperation or coordination. 

Referral is a term that is used to mean many 

different things. Whereas a traditional referral is 

unidirectional (e.g., the client is sent for services 

to an outside agency), an authentically 

connected referral network is multidirectional 

and incorporates the ideals of collaborative 

relationships, accountability, cultural 

competence, client-centered services, and 

holistic assessment. 

Authentically Connected 

Referral Networks 

Integrating Cultural Competence 

Into Treatment and Referral 

People live in different environments, and 

service providers have a responsibility to 

understand the contexts in which their clients 

operate. Client-focused treatment and referral 

must be based on an understanding of the 

family relationships, cultures, and communities 

of the clients. Culture can be broadly defined as 

incorporating demographic variables (e.g., age, 

sex, family), status variables (e.g., 

socioeconomic, educational, vocational, 

disability), affiliations (formal and informal), 

and ethnographic variables (e.g., nationality, 

religion, language, ethnicity). In many cases the 

client’s belief system is intricately woven with 

culture, and providers must start where the 

client is and acknowledge the spiritual part of 

the work. Substance abuse treatment programs 

should be open to faith-based organizations in 

their communities, which can be valuable 

collaborative partners. 

Throughout this chapter, the expression 

cultural competence refers to the capacity to view 

and understand individual clients within these 

contexts (Center for Substance Abuse Treatment 

[CSAT], 1999a). It is a core philosophy that must 

be integrated into and must guide the entire 

treatment and referral process. Too often, 

cultural competence is equated with the 

completion of a workshop, a multicultural staff, 

or proficiency in the language(s) spoken among 

the client population served. However, 

diversity of staffing does not ensure the cultural 

competence of the treatment program. Cultural 

competence is not achieved solely by attending 

workshops or by having a diverse, multilingual 

staff. When taken seriously, cultural 

competency is a continual learning process that 

is dynamic and is constantly expanded, refined, 

and defined by the community being served. 

Building an integrated service model based 

on community partners must begin from the 

clients’ base, taking into account their values 

and building on the strengths of their culture to 

create referrals that are appropriate and effective 

for their particular needs. Issues of culture can 

begin during the intake and assessment process, 

when clients are asked about their ethnic 

identification, their religion, and their 

participation in culturally based activities. 

Providers should feel comfortable discussing 

these issues with their clients and not make 

assumptions based on outward appearances, 

whether they are related to attire, complexion, or 

language. In programs working with highly 

diverse, multicultural populations, it may not be 

possible to be intimately familiar with all the 

details of each group’s customs and culture. In 

any case, it is probably more important for 

providers to be aware of what they do not know 

and to have access to resources that can help, 

such as local community centers working in 

collaboration with their program. 

Moreover, a delicate balance is needed 

between a client’s current circumstances and the 

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Effective Referrals and Collaborations 

historical and cultural issues that come into play. 

Some cultures may be relatively “closed” to 

nonparticipants. One must sometimes maintain 

a presence for years until he is accepted as a 

participant or observer. Although outwardly 

some groups may seem more approachable, 

gaining the trust of any client takes time. 

Client-Centered Versus AgencyCentered Treatment and Referral 

Substance abuse treatment that is both clientcentered and client-focused is more likely to 

improve the lives of clients. Collaboration 

among agencies providing requisite services is 

an initial step toward client-centered care. 

Referral can be a way for agencies to hold each 

other accountable for getting results for clients. 

Referrals are necessary and appropriate when 

the substance abuse treatment program cannot 

provide special services needed by their clients. 

Some of the areas for which referrals may be 

needed include job readiness, job training, 

medical care, and ethnic/cultural expertise. 

If the rationale for integrated treatment is a 

successful outcome for the client, there must be 

some way of measuring whether the referral is 

successful. From the referring provider’s 

perspective, referral represents an act of faith, 

hope, and trust that the agency to which the 

client is referred will be accountable and will 

share the goal of client success along with the 

referring agency. Referrals also represent an 

opportunity for change, growth, and 

development. Far too often, however, a referral 

consists merely of handing a client a list of 

names and telephone numbers and assuming or 

hoping that the client will take the initiative to 

make the necessary contacts. 

Distinct from this traditional model is one in 

which collaborations are fostered and 

maintained among agencies providing services 

to clients with overlapping needs, such as 

substance abuse treatment, employment, 

housing, education, and child care. In this 

context, the multidisciplinary team approach 

comes into play, but rather than coexisting 

under one roof, team members work within the 

various agencies engaged in collaboration. 

Referrals are negotiated among interlinked and 

interdependent agencies that share mutual goals 

and outcomes. These authentic connections and 

shared outcomes can then serve as an agreedupon basis for the involved agencies to measure 

their results instead of merely going through the 

motions of collaboration. Figure 5-3 lists the 

characteristics of authentically connected 

referral networks. 

Elements of Effective Referrals 

In general, an authentically connected referral 

network is composed of a set of defined 

relationships formed as clients’ needs dictate, 

using sound principles of case management and 

building in flexibility and adaptability to meet 

the needs of individual clients (see also TIP 27, 

Comprehensive Case Management for Substance 

Abuse Treatment [CSAT, 1998a]). 

Although authentically connected referral 

networks share several features such as those 

listed in Figure 5-3, this similarity does not 

constitute a mandate for all treatment programs 

to form identical referral networks. Rather, in 

order for such an authentically connected 

network to be effective, each program must 

understand its own mission as well as those of 

the other agencies. 

Mechanism for information 

dissemination 

The authentically connected model calls for a 

communication mechanism that allows the 

timely dissemination of information to all 

agencies and stakeholders. An authentically 

connected network also includes continually 

updated information about available resources. 

For example, a network might use a Web site to 

post referral information, which can readily be 

updated (see the “Inventory” section later in this 

97 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Chapter 5 

Figure 5-3 

Characteristics of Authentically Connected Referral Networks 

 Multiple agencies work as equal partners with each other and with the client; referring agencies 

make the initial contact to the referral source and keep abreast of client progress. 

 Clients and agencies have mutual responsibility and trust; interagency accountability and data 

sharing exists. 

 Communication mechanisms for timely information dissemination are accessible to all agencies and 

stakeholders. 

 The full range of stakeholders is identified, including local community services, and feedback is 

elicited from all of them. 

 Relationships among providers are collaborative and flexible in the assumption of multiple job tasks 

related to client needs. 

 The network is client-, vision-, and mission-driven. 

 Change and growth of the referring organization are demonstrated as a result of the referral 

process; dynamic network. 

 The network is open to new paradigms, approaches, use of technology on behalf of clients (e.g., 

electronic portfolios), and individualization of client treatment plans and services. 

 There is ongoing provider training and involvement in continuing education and staff development. 

 Shared assessment of network effectiveness is ongoing. 

 Cross-training of staff among collaborating agencies is ongoing. 

 Accountability is results- and progress-based, with interagency negotiation of shared outcomes. 

 The referral process is concurrent. 

chapter for more information about electronic 

communication). 

Focus on communitywide outcomes 

Focusing on communitywide outcomes allows 

community leaders and agencies, as well as 

clients, to set priorities based on client 

populations in individual communities. 

Authentically connected referral networks also 

educate the larger community about substance 

abuse in general. In so doing, they encourage 

responsiveness on the part of the community 

and the network as a whole, rather than from 

the agency only. The use of a community 

scorecard is one method to rate a community’s 

responsiveness to treatment issues. 

Vision-driven service provision 

Authentically connected referral networks are 

vision driven and have client needs as the 

primary focus of the agencies’ existence. The 

emphasis is on shared purpose while 

acknowledging the organizational “cultures” 

among collaborating agencies. In contrast, 

“rule-driven” systems are agency centered and 

tend to be focused on agency policies. 

Provider credibility and consistency 

Mutual provider credibility and trust are at the 

core of the referral relationship. In the absence 

of trust, even the most sophisticated system will 

fail. Clients’ trust must be built on the reliability 

of the provider and the provider’s ability to be a 

consistent, accessible presence for the client. To 

be otherwise is to risk reinforcing a history of 

repeated abandonment and disappointment. 

The need for trust speaks to the credibility of 

providers and whether they are truly client 

oriented or are merely protecting the status quo 

of the program. 

A sense of uniformity and cooperation is 

fostered by effective referrals. In a wellcoordinated referral system, providers have 

98 
 

some sense of being part of a systematic network 

rather than one of many disparate and 

independent agencies. Clients and providers 

alike find it easier to work through a 

collaborative, uniform system. 

Building an Authentically 

Connected Referral 

Network 

Fostering collaborative interagency relationships 

in the community is only one step in the 

development of an authentically connected 

network. Once the participants in the network 

are identified and information about them 

gathered, the collaborating agencies can then 

begin to develop an interconnected service 

system that reflects the needs of the local 

community. The next step is to form a focus 

group involving all the agencies. This group 

will develop a shared vision of the services the 

community needs in regard to substance abuse 

treatment. Lastly, the collaborators can then 

determine which provider is best equipped to 

offer which services; this step takes the form of 

resource mapping, which is discussed below. 

Resource Mapping and Inventory 

Resource mapping 

Resource mapping consists of gathering 

information about agencies and programs in the 

community with which linkages can be made to 

provide collaborative services to clients. This 

mapping of available resources should include 

the funding sources of these programs. In a 

collaborative effort, money can be pooled from 

the various funding streams and then 

“decategorized” so that it no longer drives the 

roles of service providers. A proposal can be 

sent to Federal, State, and local funding sources 

for approval of small demonstration projects or 

experimental initiatives. If these efforts are 

successful, this model might be accepted on a 

Effective Referrals and Collaborations 

Inventory 

Many agencies that are willing to make referrals 

find that they may not know of all the resources 

and services available to meet their clients’ 

needs. To fill in knowledge gaps, some 

communities maintain a database or inventory 

of available resources and geographically map 

them with computer software to facilitate the 

logistics of referrals. Such an inventory needs to 

include not only programs and agencies but also 

collaboratives. One way to make this 

information useful is to create a directory that is 

updated periodically. This directory could be 

posted on the Internet and also include 

information on eligibility criteria and available 

slots. For substance abuse treatment providers, 

an inventory of the full range of vocational 

opportunities available in the surrounding area 

can be a useful resource. Another important 

source of information is the State Occupational 

Information Coordinating Committees 

(SOICCs), which can provide labor market 

information. Computer technology can be a 

valuable resource for managing and updating 

information and matching data across 

systems and agencies, within the limits of 

confidentiality (see Chapter 7 for discussion of 

confidentiality issues). 

Organizational Alignment and 

Capacity Building 

Organizational alignment means that a service 

provider’s vision, structure, mission, and 

policies are all based on the same underlying 

philosophy. All the activities and services the 

organization provides must be evaluated to 

determine the degree to which they contribute 

to client success. Having a mechanism for 

measuring client outcomes is important; 

information systems that track referrals and 

fiscal responsibility play key roles in 

identifying successful referrals as well as 

troubleshooting for cases in which needs were 

not adequately met. 

more global level. 99 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Chapter 5 

Capacity building is the process by which 

organizational alignment is achieved; it involves 

elements such as program assessment and 

staff development. 

Program assessment 

For substance abuse treatment programs, 

capacity building includes changing the way in 

which assessment is viewed. At the client level, 

assessment involves determining a client’s needs 

and assets and viewing the individual within the 

concentric contexts of family, culture, and 

community. At the agency level, assessment 

means evaluating the collaborative network of 

service providers and determining how well 

they are serving clients. This allows the 

collaborating agencies to better understand their 

missions and how they overlap and support 

each other. There is a potential pitfall, however, 

that must be monitored. As an organization 

begins to engage in capacity building, it will find 

that its initial costs may be higher than under the 

old method. Programs and funders will need to 

be educated that in the short run, the new 

authentically connected referral model will be 

more expensive, and capacity building initially 

will incur more overhead costs. However, once 

the network is in place, it will maximize the use 

of funds by avoiding duplication of services and, 

most important, it will result in higher client 

rehabilitation success rates. 

Staff development 

Cross-training initiatives are key to building the 

capacity to serve clients more directly and 

efficiently. Communication mechanisms must 

be established among collaborative agencies to 

provide and receive feedback that can be used to 

improve services. For example, in the Substance 

Abuse Treatment Initiative in Sacramento 

County, California, the entire staff of the County 

Health and Human Services Department (about 

1,500 people) completed training in addiction 

and recovery. In addition, it should be noted 

that alcohol and drug counselors should be 

cross-trained in VR issues. The initiative was 

intended to ensure that staff members 

conducting intake interviews in county health 

and human services agencies understood 

concepts related to substance abuse and were 

able to identify individuals and intervene when 

appropriate. The Child Welfare League of 

America has published a book (Young et al., 

1998) reviewing the lessons learned from this 

and other projects across the fields of substance 

abuse treatment and child welfare services. 

Several other California counties and the State of 

Oklahoma have implemented cross-training 

based on the curriculum developed by 

Sacramento County. 

Capacity building also affects staff hiring, 

promotion, and compensation practices, which 

must be geared toward enhancing client 

outcomes rather than based solely on an 

individual’s credentials. Newly hired staff 

members should be informed that their 

responsibilities include becoming proficient in a 

sophisticated network of referral to and from 

other agencies with which collaborations have 

been formed. 

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6 Funding and Policy Issues



Public substance abuse treatment 

programs have traditionally relied on 

three funding streams: Federal substance 

abuse block grants, Medicaid reimbursement, 

and State general funds. These traditional 

funding sources have now been joined by new 

potential funding sources at both the Federal 

and State levels. Most of these provide funding 

for substance abuse treatment within the context 

of other services such as job training, child 

protective services, or criminal justice. 

This chapter offers guidance for 

administrators and providers as they attempt to 

navigate through this changed funding 

environment. Because of the extreme 

complexity of this new environment, it is crucial 

that providers develop a strategic approach to 

obtain sustainable funding that supports the 

provision of client-centered services. The first 

question to ask before seeking funds from any 

funding source is, how would these funds help 

our agency to achieve our mission and meet our 

clients’ needs? 

The hidden costs involved in relying upon 

short-term grant funding are often not well 

understood. Not only is a cost incurred for 

every grant sought, but every grant obtained 

incurs costs to maintain, administer, and meet 

funders’ reporting requirements. A strategic 

approach is to consider ways to reduce the 

burden of grant administration on a 

program’s budget. 

A client-centered funding strategy focuses on 

connecting clients with the services they need to 

achieve both recovery from substance abuse and 

self-sufficiency through sustainable 

employment—not necessarily with providing all 

these services within the substance abuse 

treatment program (as described in Chapter 5). 

In addition to substance abuse treatment and 

vocational services, clients often need housing, 

child care, transportation, primary medical care, 

or protection from domestic violence before they 

can reasonably be expected to find and succeed 

in a job. As this section will show, public funds 

are available for all of these services through a 

variety of Federal, State, and local channels. 

Having first identified the services that their 

clients need, providers then should identify the 

funding streams for those services in their State 

and community. 

The best way to obtain any of these services 

for clients may be to contract with an outside 

agency that specializes in the provision of that 

service. Such an agency may already have 

funding to provide services to individuals with 

substance abuse disorders or may be in a 

stronger position to obtain such funding than 

the substance abuse treatment program (see 

Chapter 5 concerning referral networking). 

Managed Care Contracts 

As a Funding Source 

The growth of managed care offers alcohol and 

drug counselors opportunities to contract to 

provide substance abuse treatment to the 

enrollees of managed care health plans. Such 

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Chapter 6 

contracts can be a sustainable, flexible funding 

source without the restrictions that often apply 

to grant funding. 

For example, nonprofit providers that receive 

publicly funded grants may not carry funds over 

from year to year and are restricted in the extent 

to which they can switch funds among budget 

categories. However, no such restrictions apply 

to payments received through managed care 

contracts. Any savings that a provider can make 

on a contract, while providing the agreed-upon 

level of service, represent funds that can be 

spent on other program services or set aside for 

future use. In addition, managed care contracts 

usually do not carry the sometimes onerous 

reporting requirements that may apply 

to grants. 

Alcohol and drug counselors who are 

interested in obtaining managed care contracts 

must have an understanding of how managed 

care works. Managed care evolved as a system 

of controlling health care costs. Costs are 

controlled by limiting the length of care that is 

reimbursed and by negotiating costs on a 

capitated (i.e., per-patient) or fee-for-service 

basis. Contracts are awarded through a 

competitive bidding process. To achieve 

economies of scale, managed care companies 

generally prefer to contract with a single service 

provider. Small providers can improve their 

competitive position by collaborating with other 

providers to submit a single bid. It is also in 

providers’ interests to form a coalition to 

establish reasonable contractual rates, thus 

minimizing managed care companies’ ability to 

shop for the lowest cost provider. 

Impact of Policy and 

Funding Shifts 

Thus far, this chapter has offered a snapshot 

(which is, of necessity, partial and incomplete) of 

the highly complex new funding environment 

that has been created as a result of these policy 

shifts and in which alcohol and drug counselors 

must now learn to operate. This new 

environment necessitates a radical rethinking of 

traditional approaches to the provision of 

substance abuse treatment. The field has 

traditionally been independent and focused on 

the goal of helping clients achieve abstinence 

from substance use. However, the imperatives 

of welfare and health care reform mean that 

this traditional narrow focus can no longer 

be sustained. 

To maintain financial solvency in this new 

era of policy and funding shifts, alcohol and 

drug treatment agencies must forgo their 

traditional independence and focus on building 

collaborative partnerships to meet their clients’ 

needs. Substance abuse treatment must become 

an integral component of a community-based, 

collaborative network of services, including 

welfare, primary health care, mental health, 

vocational, and family support services. Some 

of the public funding sources that treatment 

providers and their community partners can use 

to support the range of services that clients with 

substance abuse disorders need were described 

above. The potential of managed care contracts 

as a funding source was also discussed. 

The transformation of substance abuse 

treatment from an independent service to an 

integrated element in a community-based 

collaborative service network cannot be 

expected to occur overnight; rather, it is a 

process of transition. This section describes how 

providers can begin to make the changes and 

develop the relationships necessary to enable 

them to serve their clients effectively in an 

environment that operates under assumptions 

fundamentally different from those under which 

they operated in the past. 

It must be noted that existing categorical 

funding mechanisms do not provide incentives 

for collaboration. Both State and Federal 

governments need to make policy changes to 

provide such incentives in order to foster the 

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Funding and Policy Issues 

development of community-based collaborative 

service networks (see the subsection “Creation 

of Flexible Funding Mechanisms”). 

Like the process of recovery from substance 

abuse disorders, the process of change by 

providers in response to the imperatives of a 

new policy and funding climate can be broken 

down into a series of steps: 

1. Learn to be flexible.

2.	
 Understand the local implications of the

new environment.

3.	
 Orient the program’s mission to

clients’ needs.

4.	
 Assess the program’s resources and those of

the community.

5. Embrace collaboration as a strategy for

meeting clients’ needs.

6.	
 Adopt a sustainable funding strategy.

7.	
 Accept accountability for outcomes.

8.	
 Advocate for substance abuse

treatment services.

Step 1: Learn To Be Flexible 

The defining feature of the new funding 

environment is change. Although the recent 

shifts in policy and funding are significant, there 

is no doubt that further change will occur in the 

future as new policies undergo further 

refinement and as States and localities embrace 

their devolved authority. For example, new 

Federal legislation affecting job-training reform 

was enacted shortly after the Consensus Panel 

convened for this TIP. The potential impact of 

this new legislation—the Workforce Investment 

Act of 1998—has not yet been assessed. 

Flexibility is a key attribute associated with 

success in an environment characterized 

by change. 

Providers must accept not only the need to 

change in response to an altered environment, 

they must also accept the need to continually 

adapt. They must develop and implement 

flexible strategies that will continue to serve 

them as further change occurs. In addition, 

providers must learn to regard substance abuse 

treatment as a service that can be delivered in a 

variety of ways in a variety of settings rather 

than as a program characterized by a defined 

setting and defined, sequential components. 

Step 2: Understand the Local 

Implications of the New 

Environment 

A second defining feature of the new 

environment is local variability. Although 

certain features of new policies on welfare are, 

for example, federally mandated, in general 

States and localities have considerably more 

authority than they previously did to make 

decisions about policy implementation and 

funding that can significantly affect the 

provision of substance abuse treatment. One 

result of increased State and local discretion is 

that decisions implemented in one State or 

community may differ greatly from the choices 

made elsewhere. 

As previously noted, in some States the 

Single State Agency (SSA) has been subsumed 

within a larger State agency, such as the 

department of community or behavioral health. 

Federal funds that are administered by the 

department of education in one State are the 

responsibility of the department of community 

health in another State and of the executive 

office of the governor in a third. In some States 

substance abuse treatment has become the 

responsibility of local communities, and it has 

become an optional service. 

Given the extent of local variability, 

providers have no choice but to find out which 

agencies in their State and locality are making 

important policy and funding decisions that 

affect the delivery of substance abuse treatment. 

Contacts in the SSA may be a useful source of 

such information. Active involvement in a State 

or community providers association is another 

effective strategy for learning who the key 

“budget holders” are and where the key 

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Chapter 6 

decisions are made. Subscriptions to journals in 

the substance abuse treatment field can also be 

important sources of information. Examples of 

journals include Alcohol and Drug Abuse Weekly, 

Substance Abuse Funding News, Substance Abuse 

Report, and Drug Abuse Monitor. In addition, a 

great deal of information about policy changes 

and funding sources can now be obtained via 

the Internet; for example, The Welfare 

Information Network, and The Finance Project. 

Providers should ask their SSA for a copy of 

the agency’s annual plan for the allocation of 

substance abuse prevention and treatment block 

grant funds. This plan can provide crucial 

information about the State’s funding priorities 

for substance abuse treatment. Some States, for 

example, have made a policy decision not to 

allocate block grant funds to methadone 

maintenance programs or to give such programs 

low funding priority. 

Providers can also ask their SSA to publish 

an annual inventory of all funding sources for 

substance abuse treatment services. The annual 

inventory published by the State of Arizona is a 

model that other States could emulate (see the 

section titled “The Role of the SSA” later in 

this chapter). 

Other important pieces of information for 

providers to know are the amount that their 

State allocates from its general funds to support 

substance abuse treatment and the level at 

which their State provides matching funds when 

required to obtain Federal funds. Some States 

contribute the minimum required in matching 

funds, whereas others have set higher levels. A 

local providers association or sources in the SSA 

may be the best places for providers to begin 

their search for this information. 

Step 3: Orient the Program’s 

Mission to Clients’ Needs 

To succeed in the new environment, providers 

must have a clear understanding of the 

demographic characteristics and service needs of 

their client population. They must know, for 

example, how many of their clients are on 

welfare, how many have children, and how 

many are involved with the criminal justice 

system. Armed with this information, they are 

able to clarify their mission—what they need to 

do to meet their clients’ needs, who they need as 

partners, and what resources are needed from 

partner agencies. 

Step 4: Assess the Program’s 

Resources and Those of the 

Community 

Having thoroughly assessed their client 

population and aligned their mission to focus on 

their clients’ needs, providers next need to 

assess their existing capability and resources to 

meet those needs. A realistic appraisal of the 

program’s strengths and limitations is a crucial 

part of this process. It is not necessary—indeed, 

it is not possible—for any program to meet all its 

clients’ needs with in-house resources. Rather, a 

program should begin to identify potential 

collaborators in its community that are already 

providing services needed by its clients (see 

Chapter 5). 

Figure 6-1 outlines a process by which 

programs can assess their clients, their mission, 

their strengths and limitations, and their 

community resources and relationships. 

Step 5: Embrace Collaboration as a 

Strategy for Meeting Clients’ Needs 

It must be acknowledged at the outset that 

collaboration presents many challenges. 

104 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Funding and Policy Issues 

Figure 6-1 

Agency Self-Assessment Categories 

Client Agency Mission “Agency Fit” Endpoints 

 Demographics  Capacity  Analyze agency’s  Sustainable 

 Culture  Staffing service delivery profile employment 

 Family  Cultural competence versus what clients  Better client 

 Trends  Readiness for need outcomes 

 Focus groups collaboration  Choose to provide  Improved 

 Client feedback  Accountability services in-house or by community 

 Inclusion of  Resources referral conditions 

clients in  Technological  Identify community  Multiple access 

planning capability resources and partners points 

Disability issues  Desired outcome 

 Client centeredness 

 Service needs 

 Build relationships 

 Changes in 

organizational structure 

 Specialization and 

market segmentation 

Collaboration is difficult for many reasons, not 

the least of which is that at some level it requires 

relinquishing control over certain processes. 

Once a program has adopted an approach 

that is centered on meeting clients’ needs and 

has realistically assessed its own strengths and 

limitations, collaboration becomes a strategy that 

enables it to meet its clients’ needs more 

effectively than it otherwise could. 

Collaborative relationships with providers of 

services whose clientele may overlap with that 

of the substance abuse treatment program (such 

as welfare, vocational rehabilitation, law 

enforcement, and public housing agencies) are 

also a strategy for ensuring that all individuals 

with substance abuse disorder problems—no 

matter what their point of entry into the human 

services system may be—have access 

to treatment. 

Providers may also find it mutually 

beneficial to collaborate with other substance 

abuse treatment programs. For example, a 

coalition of several providers may be in a better 

competitive position when seeking a contract to 

provide substance abuse treatment services to a 

managed care organization. One partner whose 

strength is screening and assessment can 

undertake that function for the entire coalition, 

whereas a partner who already has a highly 

developed information system can perform the 

coalition’s data collection and analysis. 

Similarly, a provider that has specialized 

culturally sensitive services for one ethnic 

population may be able to help another agency 

that does not have such services. 

Collaboration can also be a strategy for 

obtaining services such as cost-effective staff 

training. For example, two or more providers 

could share the cost of holding a staff training 

workshop on vocational and substance 

abuse issues. 

Step 6: Adopt a Sustainable 

Funding Strategy 

Once a program’s mission becomes clientcentered, the next step is to adopt a clientcentered funding strategy. This means that 

rather than pursuing all possible sources of 

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Chapter 6 

funding, a program focuses on seeking 

sustainable funds that will enable it to achieve 

its mission and meet its clients’ needs. 

Such an approach may initially seem 

counterintuitive. The experience of many 

substance abuse treatment programs is that 

competing for the largest and broadest range of 

funding is the key to success. However, this 

approach fails to take into account the hidden 

costs of reliance on short-term grant funding. 

The U.S. Department of Housing and Urban 

Development (HUD) provides an example of 

collaboration encouraged by funding. To apply 

for funds to provide services for homeless 

individuals (many people in substance abuse 

treatment are homeless under HUD’s 

definition), communities must form coalitions 

and work collaboratively toward implementing 

strategies aimed at eliminating homelessness. 

These collaborations must define how money 

will flow to ensure that clients receive the 

needed services, from substance abuse treatment 

and medical services to food, etc. HUD requires 

that these coalitions seek more involvement 

from the private sector, especially the business 

community. This holds tremendous potential 

for matching clients with jobs and pooling 

resources to ensure that clients are successful. 

Adopting a sustainable funding strategy 

means identifying and pursuing institutional 

funding sources such as Title XIX of the Social 

Security Act (which covers Medicaid 

reimbursement), Title IV of the Social Security 

Act (which covers treatment for parents who are 

clients of child protective services agencies), 

private health insurance reimbursement, and 

contracts to provide substance abuse disorder 

services to managed care companies, welfare 

and public housing agencies, and so on. 

Also part of a sustainable funding strategy is 

forging agreements with other agencies to 

provide services required by a substance abuse 

treatment program’s clients. For example, 

clients on welfare who have substance abuse 

problems might be referred to a vocational 

services agency or a community-based 

organization (CBO) that has funding through 

the Department of Labor’s Welfare-to-Work 

program. Such a strategy leverages 

nontreatment funds to meet clients’ 

needs for services that will help them along 

the path to self-sufficiency through 

sustainable employment. 

Before being ready to pursue sustainable 

funding mechanisms, an alcohol and drug 

administrator must understand how funding 

streams flow in its State and community (Step 

2), must have identified potential collaborators 

that are providing services needed by the 

alcohol and drug agency’s clients (Step 4), and 

must have accepted collaboration as a strategy 

for more effectively meeting its clients’ needs 

(Step 5). 

Step 7: Accept Accountability 

For Outcomes 

There has been a trend in recent years toward 

demanding greater accountability by all kinds of 

publicly funded programs, including substance 

abuse treatment programs. Evidence of 

effectiveness is frequently a prerequisite for 

continued funding. Federal agencies such as the 

Department of Health and Human Services 

(HHS) are known to be interested in offering 

more grants that are linked to performance. 

Providers who recognize the need to form 

collaborative partnerships to meet clients’ needs 

must be prepared to be accountable for 

treatment outcomes. The collection of 

outcomes data at the community level serves 

two purposes: 

1.	
 Documentation of overlapping caseloads

among substance abuse treatment, welfare,

public housing, family services, criminal

justice agencies, disability organizations,

and health organizations.

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Funding and Policy Issues 

2. Evidence of the effectiveness of substance

abuse treatment for specific groups of clients

such as welfare recipients, public housing

residents, clients of child protective services,

individuals involved in the criminal justice

system, and individuals with coexisting

disabilities (mental, physical, emotional,

HIV, etc.).

Outcomes data serve to document the value 

substance abuse treatment adds to the services 

of other agencies; that is, how substance abuse 

treatment helps reduce costs and enhance client 

success for other agencies. For example, 

substance abuse treatment can enable former 

welfare recipients to sustain employment, 

which in turn might decrease drug-related 

violence and criminal activity in a public 

housing complex. 

Providers have a responsibility to make 

resources available for the collection of 

outcomes data, whether or not such resources 

are earmarked by funders. It is not sufficient to 

collect data about the numbers of clients treated. 

Although many States collect outcomes data, it 

is in programs’ interests to collect and analyze 

their own data. Computer technology now 

makes it easier for programs to do this. 

In addition, programs can use their clients’ 

experiences to provide powerful anecdotal 

evidence of the benefits of treatment to 

individuals and communities. Examples include 

a woman who regained custody of her children 

or a man with a history of incarceration for 

drug-related offenses who now works to prevent 

substance abuse among at-risk youth in a public 

housing complex. 

In the postwelfare-reform environment, it is 

essential that the practical effects of work-first 

policies are documented. A great deal of 

evidence demonstrates that mandatory work 

programs are unlikely to succeed when they fail 

to take into account individuals’ needs for 

substance abuse treatment, vocational 

rehabilitation, and family and workplace 

support services. 

Step 8: Advocate for Substance 

Abuse Treatment Services 

As noted earlier under Step 2, States and 

communities now have much greater discretion 

over policy implementation in welfare, 

substance abuse treatment, and other related 

services. Increased State and local discretion 

means that providers must put a great deal of 

effort into understanding how the new policies 

are being implemented in their community. It 

also presents the substance abuse treatment field 

with much greater opportunities for influencing 

the direction of State and local policies on 

substance abuse treatment. Decisions made at 

the State and community levels can be changed 

by advocacy. It is more important than ever, 

therefore, for providers to become actively 

involved in the policymaking process, providing 

concrete data to document the effectiveness of 

substance abuse treatment services. 

State and community provider associations, 

in addition to being useful arenas for providers 

to share information about policy developments 

and funding sources, can also be effective 

advocacy organizations for substance abuse 

treatment. In several States and communities, 

provider associations have sponsored town hall 

meetings and other forums to educate 

community leaders and legislators about the 

benefits of substance abuse treatment. In 

communities where no providers’ association 

exists, providers are strongly advised to form 

one. For example, Rhode Island’s provider trade 

association offers multiple services for alcohol 

and drug treatment staff, including a forum for 

meeting and discussion, education/training, and 

a political power base for client and provider 

advocacy. In California, statewide advocacy 

groups represent the county substance abuse 

treatment agencies, providers, and other related 

organizations. These groups meet regularly 

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Chapter 6 

with the SSA in a policy forum that serves as an 

arena for exchanging information and providing 

the opportunity to influence policy decisions. 

Providers have a responsibility to make their 

voices heard when States and communities set 

priorities that exclude or adversely affect 

substance abuse treatment. By presenting data 

on the extent of untreated substance abuse 

disorders among women on welfare, for 

example, they can draw attention to the shortage 

of publicly funded treatment slots for women 

and the need for support services such as child 

care that make it possible for women with 

children to obtain treatment. 

The substance abuse treatment field in 

general has not advocated effectively for the 

benefits of treatment. Policymakers and many 

members of the public support reforms such as 

work-first initiatives because such policies are 

consistent with deeply held beliefs in 

mainstream American culture about personal 

responsibility for life choices, but also because 

they are often genuinely unaware of the 

substantial body of evidence that substance 

abuse treatment works. 

Providers must become more actively 

involved in educating the public and community 

leaders about the effectiveness of substance 

abuse treatment. The ability to present 

compelling data that demonstrate the benefits of 

treatment not only to individuals but also to 

communities as well as to society in general is a 

prerequisite for effective advocacy. Thus, 

advocacy is strongly linked to accountability. 

Future Considerations 

Providers must clarify their mission, understand 

their clients’ needs, develop a client-centered 

focus, and become full partners in a 

collaborative service network that endeavors to 

meet the multiple needs of clients recovering 

from substance abuse disorder. This represents 

nothing less than a transformation of the 

substance abuse treatment field. 

State and Federal agencies have a 

responsibility to facilitate this transformation not 

only by adopting policies and procedures that 

encourage and reward collaboration, 

accountability, and client-centered approaches 

to care but also by embracing these principles in 

their own behavior. This final section examines 

the changes necessary at State and Federal levels 

to model the transformation of substance abuse 

treatment services at the provider level. 

The Role of the SSA 

The overarching message of this chapter is that 

substance abuse treatment services must cease to 

be a self-sufficient entity not engaged with the 

wider health and human services community 

and must become an integral part of a 

community-based service network. It follows, 

therefore, that the future role of the SSA must 

extend further outside the traditional 

boundaries of the substance abuse treatment 

field than has previously been the case for SSAs. 

Welfare reform enacted by Congress in 1996 

both created new Federal mandates for States to 

carry out and devolved to States many decisions 

about implementation of the new policy. Most 

of these mandates and decisions are not carried 

out by SSAs, yet their impact on both clients and 

providers of substance abuse treatment services 

is substantial. In addition, new funding streams 

controlled by other State agencies may be used 

to support the provision of substance abuse 

prevention and treatment services as well as 

vocational and other services needed by 

individuals with substance abuse disorders who 

are subject to the work requirements and benefit 

from time limits imposed by welfare reform. 

As a result of State government 

restructuring, in many States the SSA is no 

longer a free-standing agency but a division 

within a larger department such as community 

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Funding and Policy Issues 

or behavioral health. Such restructuring should 

not, however, be an excuse for lack of outreach 

efforts. It could, indeed, facilitate outreach 

because at least other divisions within the same 

agency may provide some of the other services 

that deal with clients with a substance 

abuse disorder. 

These changes make it necessary for SSAs to 

adopt a much broader view of substance abuse 

policy and their role in its implementation. 

Although Federal substance abuse block grant 

funds still represent an important funding 

source for substance abuse treatment services, 

substance abuse policy at the State level must 

transcend decisionmaking about the distribution 

of the SSA’s “own” block grant funds and take 

into account the reality that clients with 

substance abuse disorders are also likely to be 

clients of the State’s welfare, criminal justice, 

public housing, child protection, and community 

health services. 

SSAs, like providers, must adopt a clientcentered approach that focuses on ensuring that 

the multiple needs of clients with substance 

abuse disorders are met across a spectrum of 

fragmented agencies and services. Outreach to 

other government agencies that provide services 

to individuals with substance abuse disorders 

must become a key objective for SSAs. 

SSAs also have a responsibility, in addition to 

collecting and analyzing data on the outcomes of 

substance abuse treatment, to ensure that 

lessons learned through data analysis are 

applied in ways that improve outcomes for 

clients. Data collection is only useful if it results 

in policy and program changes that benefit 

clients. For example, the fact that nationally 

only 27 percent of all publicly funded treatment 

slots are allocated to women has great 

consequences for links between employment 

programs for welfare recipients and treatment 

programs needed to make these clients selfsufficient while addressing the critical needs of 

their children at the same time. The data point 

of 27 percent is the beginning of such a policy 

discussion, but when a community does not 

focus on gender in its discussion of who receives 

treatment benefits or amalgamates both genders 

and their needs into a single group, it becomes 

more difficult to use existing data to support 

requisite system reforms. 

Creation of Flexible Funding 

Mechanisms 

Most funding mechanisms remain narrowly 

focused and fail to provide incentives for the 

interagency collaboration that is required to 

make the envisioned client-centered care 

network a reality. At the Federal level, it is 

likely that a multiplicity of categorical funding 

sources will remain for the foreseeable future, 

although there is a trend in some Federal 

agencies toward awarding more performancedriven grants. It is extremely cumbersome for 

providers to have to deal with such a vast 

number of funding sources, all of which operate 

under different procedures and rules. 

One approach that may represent a way out 

of this dilemma is to promote mechanisms that 

permit flexible or “wraparound” funding that 

involves a shared fiscal responsibility at the local 

level. Simply put, shared fiscal responsibility 

involves empowering local multidisciplinary 

coalitions to tie together funds from a variety of 

categorical sources to support an integrated 

network of services. This approach also might 

be termed “bottom-up block grants.” 

Several States—including Georgia, 

California, Minnesota, and Oregon—have 

passed legislative incentives for funding 

that allow wraparound or shared fiscal 

responsibility at the local level. In some States, 

the branch may be able to use existing 

executive authority to create such incentives. 

Nonlegislative approaches are also possible. 

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Chapter 6 

The Washington, DC –based Finance Project 

has published a series of reports on shared 

fiscal responsibility outside the substance 

abuse treatment field.

At present, States that wish to provide 

incentives for some kinds of shared fiscal 

responsibility must obtain a waiver from the 

Federal government. 

Family-Centered Treatment 

Strategies 

The criminal justice orientation of the public 

substance abuse treatment system devalues the 

treatment of women and ignores the 

intergenerational effects of substance abuse on 

children. For example, as mentioned earlier, 27 

percent of publicly funded admissions are 

women. Some treatment agencies and funders 

do not collect data on the children of 

their clients. 

In addition to a reconsideration of the 

allocation of public treatment slots to women, 

there is a need to integrate prevention and 

treatment activities focused on families to 

recognize that substance abuse treatment for a 

mother represents substance abuse prevention 

for her children. Substance abuse treatment for 

the mother leads to better parenting skills, which 

in turn decreases the number of neglect and 

child abuse cases. Such prevention also may 

mean the difference between a child’s 

continuing dependency on the social service and 

criminal justice systems or his becoming a 

contributing member of society. 

Current categorical funding mechanisms and 

a traditional focus on clients over families serve 

as major disincentives to such integration. 

Federal and State 

Funding Sources 

While the major source of public funding for 

substance abuse treatment comes through the 

SSAs, a variety of funds useful to substance 

abuse treatment providers are also available 

from other sources. This chapter describes 12 

major sources of public funding that may be of 

use to treatment programs. Different sources 

will pay for different types of services and many 

stipulate the specific population for which the 

funds can be used. 

The agencies responsible for administering 

Federal funds at the State level vary 

enormously. For example, the department of 

economic development in one State, the 

department of education in another, and the 

department of health in a third may handle 

vocational rehabilitation (VR) funds. Also, in 

some States the SSA has been subsumed within 

another State agency. 

Many States also offer their own funding 

sources that may be used to support substance 

abuse treatment and related services. However, 

State funding sources are too numerous, and the 

State-level administrative structures responsible 

for such funding too diverse, for a list to be 

useful. Providers need to become familiar with 

the organization of their State government and 

find out which divisions are responsible for 

which funds. 

Federal sources of discretionary, time-limited 

project grants that may also be available are 

summarized in Appendix F. 

Substance Abuse Prevention and 

Treatment (SAPT) Block Grant 

The bulk of these funds, which support a full 

range of substance abuse prevention and 

treatment services, are awarded to States by 

formula (42 U.S.C. §300). Thirty-five percent of 

the SAPT block grant funds are earmarked for 

prevention and treatment activities relating to 

alcohol abuse and 35 percent for prevention and 

treatment activities relating to drugs. Twenty 

percent of the grant is to be used for primary 

prevention activities and 5 percent for the 

administration and support of the SSAs. 

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Funding and Policy Issues 

Other SAPT block grant “set asides” were 

established for programs that target special 

populations, such as services for women, 

especially for pregnant and postpartum women 

and their substance-exposed infants, and, in 

certain States, for HIV screening. 

Each State’s SSA is responsible for delivering 

these Federal funds to counties and individual 

providers. Treatment programs should contact 

the appropriate SSA for more information. 

Medicaid 

Title XIX of the Social Security Act (42 U.S.C. 

§§1396-1396v) provides funding for substance 

abuse treatment of Medicaid-eligible individuals 

as an optional benefit at the States’ discretion. 

The availability of Federal Medicaid funds is 

conditional upon the provision of State matching 

funds; the level of matching funds required is 

variable based on a number of factors. Medicaid 

eligibility varies by State and is based on 

income, age, participation in other Federal 

programs (such as Supplemental Security 

Income [SSI] and adoption assistance/foster 

care), and pregnancy status. States have 

discretion over whether to provide a substance 

abuse treatment benefit to their Medicaid 

populations, and different States have different 

levels of coverage (e.g., residential, outpatient, 

day or night treatment). Many States have 

opted not to provide such services. 

In most States, Medicaid funds do not flow to 

the SSA, and the agency administering the 

Medicaid program varies by State. Many States 

now require Medicaid-eligible individuals to 

enroll in a managed care program. Interested 

parties should contact their State’s Department 

of Health and Human Services for 

further information. 

Welfare-To-Work Initiatives 

The Temporary Assistance for Needy Families 

(TANF) program has several purposes: (1) to 

provide assistance to needy families so that 

children may be cared for in their own homes or 

in the homes of relatives; (2) to end needy 

parents’ dependence on government benefits by 

promoting job preparation, work, and marriage; 

(3) to prevent and reduce the number of out-ofwedlock pregnancies; and (4) to encourage the 

formation and maintenance of two-parent 

families. As discussed earlier (in Chapter 2), 

benefits are time-limited and work is 

mandatory; more information on TANF can also 

be found in Chapter 7. 

Each State receives a block grant based on its 

previous level of spending on Aid to Families 

With Dependent Children (AFDC), the Federal 

welfare program that TANF replaces in 

accordance with the Personal Responsibility and 

Work Opportunity Reconciliation Act of 1996. 

For many States, this block grant represents a 

financial windfall. Although TANF funds 

cannot be used to provide medical services, 

some substance abuse treatment (e.g., outpatient 

counseling, residential services) can be paid for 

by TANF funds. Providers need to know the 

amount of the grant in their State and whether 

any of those funds were set aside for substance 

abuse treatment services. 

The U.S. Department of Labor’s welfare-towork program also awards grants to support 

employment services for TANF recipients and 

the noncustodial parents of children receiving 

TANF. Three-quarters of the funds go to States 

in the form of formula grants and one-quarter go 

to local communities in competitive grants. Any 

services that overcome barriers to employment, 

such as job training, transportation, child care, 

and substance abuse treatment, are eligible for 

funding. Formula funds are directed to Private 

Industry Councils (PICs) or Workforce 

Investment Boards (WIBs), Workforce 

Development Boards, and similar bodies at the 

State and community levels; the precise funding 

channels vary by State. This program’s specific 

recognition of a substance abuse disorder as a 

barrier to employment is an innovation. As 

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Chapter 6 

previously noted, some States consider 

participation in substance abuse treatment to be 

a valid work activity, whereas others do not. 

The Department of Labor also offers job 

training funding for economically 

disadvantaged individuals through the Job 

Training Partnership Act (JTPA) (29 U.S.C. 

§§201-206). Eligible services include basic and 

remedial education, job skills assessment, onthe-job training, job-search assistance, work 

experience programs, internships, school-towork transition programs, and transportation 

and relocation assistance. Specific groups 

eligible for services include unemployed adults, 

youth, the disabled, dislocated workers, Native 

Americans, migrant and seasonal farm workers, 

and veterans. Funds are channeled to States, 

which oversee the planning and operation of 

local programs; programs can contact their State 

department of labor for further information. 

Alcohol and drug counselors should consider 

partnering with agencies receiving JTPA funds 

in their locality to offer vocational services to the 

substance abuse treatment agency’s clients. 

However, the JTPA act is superseded by the 

Workforce Investment Act of 1998 (P.L. 105-220) 

and was repealed July 1, 2000. 

The Workforce Investment Act consolidates 

more than 60 Federal programs into 3 block 

grants to States for employment, training, and 

literacy. This job training reform measure 

replaces programs currently under JTPA, the 

Stewart McKinney Act, and the Carl Perkins 

Act. Under this new law, States will receive 

block grants for adult employment, training for 

disadvantaged youths and families, and literacy. 

The legislation establishes a system of “onestop” centers that are intended to provide job 

seekers with the information and advice they 

need to obtain training and employment. 

Individuals who seek services at the one-stops 

will be given vouchers with which to fund 

training. The current local decisionmaking 

entities—PICs or WIBs—will continue to exist 

under a new name but will have less stringent 

membership requirements with respect to 

union- and community-based representation. 

The bill establishes State WIBs and requires 

States to submit a plan that outlines a 5-year 

strategy for their statewide workforce 

investment systems. States are required to 

designate local workforce areas, and local WIBs 

are to be appointed by the chief elected local 

officials. Functions of the local WIBs include, 

among other things, development of the local 

plan; designation, certification, and oversight of 

one-stop operators; identification of eligible 

providers of intensive and training services; and 

development and entry into memoranda of 

understanding with one-stop partners. 

The one-stop delivery system in each local 

workforce investment area is to provide core 

services and access to intensive services, 

training, and related services. Included in those 

program elements for youth activities are 

comprehensive guidance and counseling, which 

may include drug and alcohol use counseling 

and referral. For adult training, the bill requires 

use of Individual Training Accounts but allows 

for use of contracts for training services for 

CAOs or other private organizations that serve 

“special participant populations,” defined as 

those who face multiple barriers to employment. 

Furthermore, with regard to vocational 

rehabilitation, the bill calls for evaluation 

activities on identifying what works well rather 

than continuing to seek to define the chronic 

problems connected to the employment of 

individuals with disabilities. 

Treatment and Prevention in 

Public Housing 

HUD offers funding for substance abuse 

treatment of public housing residents under the 

Public Housing Drug Elimination Program (42 

U.S.C. §11901). HUD awards grants to Public 

Housing Authorities (PHAs), Tribes, or Tribally 

Designated Housing Entities (TDHEs) in order 

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Funding and Policy Issues 

to create programs to eliminate substance abuse 

and substance-abuse–related crime in 

their developments. 

Services eligible for funding include 

substance abuse prevention, intervention, 

referral, and treatment as well as job training 

(aimed at assisting prevention efforts), and 

security improvements in public housing 

complexes. Funds are channeled to local public 

housing authorities, which contract with 

service providers. 

Vocational Rehabilitation 

These funds, administered by the U.S. 

Department of Education, support services to 

enable people with disabilities to participate in 

the workforce. Funds are provided according to 

the Workforce Investment Act of 1998 (P.L. 105-

220 §106) and the Carl D. Perkins Vocational and 

Technical Education Act of 1998 (P.L. 105-220). 

Chapter 7 of this TIP provides further 

information on both of these Acts. 

Services eligible for funding include 

substance abuse disorder assessment and 

treatment, prescription medications, equipment 

that enables disabled individuals to have access 

to and function in the workplace (such as 

wheelchairs, hearing aids, and adapted 

computers), and transportation. Vocational 

rehabilitation will also fund training and 

secondary education, as well as vocational 

testing and evaluation. Funds are channeled to 

State agencies with responsibility for vocational 

rehabilitation. The location of this agency within 

the State government varies by State. 

Child Protective Services 

Title IV of the Social Security Act (42 U.S.C. 

§1862) provides funding for foster care and 

services to prevent child abuse and neglect. 

Eligible services include substance abuse 

treatment for parents who are ordered by a 

court to obtain treatment and are at risk of losing 

custody of their children, and child care while a 

parent is in residential treatment. The estimated 

overlap between clients of child protective 

services agencies and parents with a substance 

abuse disorder is 60 to 80 percent (National 

Center on Addiction and Substance Abuse at 

Columbia University [CASA], 1999; Young et al., 

1998). Title IV funds are usually administered 

by State social services departments. 

Title IV funds represent a large, open-ended 

potential funding source for substance abuse 

treatment for women who are involved in the 

child welfare system, an underserved 

population. Women with children may be 

unlikely to enter residential treatment if the 

facility cannot accommodate their children, if 

adequate child care is not available, or if doing 

so means giving up their children to foster care 

(Strawn, 1997). For more information on child 

abuse and neglect issues and substance abuse 

treatment, see the TIP, Substance Abuse Treatment 

for Persons with Child Abuse and Neglect Issues 

(CSAT, 2000a). 

Expanded Health Insurance 

Coverage for Children 

Title XXI of the Social Security Act (P.L. 105-33 

§4901a) provides Federal funding for the 

Children’s Health Insurance Plan (CHIP), a 

public–private initiative to provide health 

insurance coverage for children who are 

ineligible for Medicaid and not covered by 

private insurance. Funds are awarded to States 

by formula, and States have considerable 

discretion in deciding what services to cover. In 

some States, substance abuse treatment for 

adolescents is a covered service. The agency 

administering CHIP funds varies by State; it 

may be a State agency or a private entity. 

Interested providers should contact their State’s 

Department of Health and Human Services to 

find out what services are covered and who is 

the funding intermediary in their State. 

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Chapter 6 

Social Services Block Grant 

Title XX of the Social Security Act (42 U.S.C. 

§§1397–1397f) provides flexible funding that 

States can use for child care, transportation, 

detoxification, and substance abuse treatment 

services, and social services for clients with 

substance abuse problems. This block grant is 

administered by HHS, and eligibility is Statedetermined. Providers should contact State 

Departments of Health and Human Services for 

further information. 

Criminal Justice 

The U.S. Department of Justice (DOJ) Weed and 

Seed program administered under P.L. 105-277 

is intended to reduce drug activity in target 

communities. Substance abuse treatment for 

residents of the target communities is an eligible 

service. Funds are channeled through the offices 

of State attorneys general. Most grantees are 

law enforcement agencies that are working as 

part of a community coalition. Treatment 

providers should contact the Executive Office 

for Weed and Seed (EOWS) at the DOJ for 

further information on this program. 

The DOJ Office of Justice Program’s (OJP) 

Drug Courts Program Office (DCPO) 

administers the Drug Court Grant Program, 

which originated under Title I, Subchapter XII-J 

of the Omnibus Crime Control and Safe Streets 

Act, as amended by Title V of the Violent Crime 

Control and Law Enforcement Act of 1994 (“the 

1994 Act”).1 This legislation authorized the 

Attorney General to make grants to States, State 

courts, local courts, units of local government, 

and Indian tribal governments to establish drug 

courts in response to the needs of increased 

numbers of nonviolent, substance-abusing adult 

and juvenile offenders. Congress has 

appropriated substantial sums of money for the 

Drug Court Grant Program each year since the 

program’s inception. Most recently, in the 

Omnibus Consolidated and Emergency 

Supplemental Appropriations Act, 1999, of 

October 1998, Congress appropriated $40 

million specifically for the Drug Court Grant 

Program, “as authorized by Title V of the 

1994 Act.”

2 

In January 1997, the DOJ released Defining 

Drug Courts: The Key Components, a report 

developed through a cooperative agreement 

between the OJP, DCPO, and the National 

Association of Drug Court Professionals, that 

describes the 10 key components of a drug court 

and specifies performance benchmarks for each 

component. This report was endorsed by the 

Conference of Chief Justices, Conference of State 

Court Administrators, and National Association 

of Pretrial Services Agencies. The 10 key 

components and their performance benchmarks 

provide the foundation for the guidelines 

available on the DCPO Web site for those 

completing grant applications. The report is 

available through the National Criminal Justice 

Reference Service Clearinghouse at (800) 421-

6770, and on the DCPO Web site.

At its Web site, the DCPO specifies that drug 

courts funded under the grant program must be 

defined as “a specially designed court calendar 

or docket, the purposes of which are: to achieve 

a reduction in recidivism and substance abuse 

among nonviolent adult and juvenile substance 

abusing offenders; and to increase their 

likelihood for successful rehabilitation through 

early, continuous, and intensive judicially 

supervised treatment, mandatory periodic drug 

testing, and the use of graduated sanctions and 

other rehabilitation services. A separate or 

special jurisdiction court is neither necessary nor 

encouraged.”3 In addition, drug courts must 

include two specific critical elements: 

1.	
 Diversion, probation, or other supervised

release involving the possibility of

prosecution, confinement, or incarceration

based on noncompliance with program

requirements or failure to show satisfactory

progress

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Funding and Policy Issues 

2. Programmatic offender management and
 

aftercare services4
 

Funds available for the treatment of clients 

making the transition from incarceration to the 

community vary from State to State. Chapter 4 

of TIP 30, Continuity of Offender Treatment for 

Substance Use Disorders From Institution to 

Community (CSAT, 1998d) describes the ways in 

which funding practices differ between States. 

Providers seeking additional information 

concerning Federal funding opportunities (such 

as vocational training pilot programs for 

criminal offenders) should contact the Office of 

Correctional Education (OCE) in the Department 

of Education. The OCE coordinates all 

correctional educational programs in the 

department, and provides technical support 

relating to correctional education.

Education

The Rehabilitation Services Administration 

(RSA), which is housed under the U.S. 

Department of Education’s Office of Special 

Education and Rehabilitative Services, oversees 

programs that help individuals with physical or 

mental disabilities obtain employment 

(Rehabilitation Act of 1973, 29 U.S.C. §701ff). 

Employment is obtained through the provision 

of such supports as counseling, medical and 

psychological services, job training, and other 

individualized services. RSA’s major formula 

grant program provides funds to State VR 

agencies to provide employment-related services 

for individuals with disabilities, giving priority 

to individuals who are severely disabled. 

In addition, general equivalency diploma 

(GED) programs are offered free of charge by 

many public school systems. High school 

equivalency or remedial programs for students 

with special needs may also be offered by some 

State education departments. Academic 

tutoring is offered at many libraries by literacy 

volunteers. Other private, nonprofit social 

services agencies such as Travelers Aid and 

vocationally oriented mental health programs 

(e.g., Fountain House in New York City), also 

offer educational remediation and 

GED preparation. 

Transportation

Finding adequate transportation is a major 

challenge facing people who are making the 

transition from welfare to work. Two-thirds of 

new jobs are in the suburbs, but three of four 

welfare recipients live in rural areas or central 

cities. There are several programs that help to 

provide transportation for people transitioning 

to work (Federal Transit Administration, 1998). 

Under TANF, funds may be used for a range of 

transportation services as long as these 

expenditures reasonably accomplish a purpose 

of the TANF program, such as promoting job 

preparation and work. 

The U.S. Department of Labor provides 

Welfare-to-Work (WtW) funds to States and 

local communities to help create additional job 

opportunities for the hardest-to-employ TANF 

recipients. WtW funds also can be used for 

transportation assistance to help these recipients 

move into unsubsidized employment. 

The Federal Transit Administration, which is 

housed within the U.S. Department of 

Transportation, oversees the Job Access and 

Reverse Commute grant program. This 

program, funded under the Transportation 

Equity Act of 1998 (49 U.S.C. §5309), helps States 

and local communities develop flexible 

transportation services that connect welfare 

recipients and other low-income persons to jobs 

and other employment-related services. These 

projects are aimed at developing new or 

expanded transportation services, such as 

shuttles, vanpools, new bus routes, connector 

services to mass transit, employer-provided 

transportation, and guaranteed ride home 

programs. The Job Access and Reverse 

Commute grant program also is intended to 

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Chapter 6 

establish a collaborative regional approach to job 

access challenges and involves organizations 

such as transportation providers, agencies that 

administer TANF WtW funds, human services 

agencies, employers, metropolitan planning 

organizations, States, and affected communities 

and individuals. 

Empowerment Zones and 

Enterprise Communities 

The Empowerment Zone and Enterprise 

Community Initiative (26 U.S.C. §1391) provides 

tax incentives and performance grants and loans 

to create jobs and expand business opportunities 

in the 87 urban areas and 38 rural areas that 

have been designated as Empowerment Zones 

(EZs) or Enterprise Communities (ECs). The 

initiative also focuses on activities to support 

people looking for work, including job training, 

child care, and transportation. Within each EZ 

or EC, residents decide what projects and 

activities should occur in their own 

neighborhoods. Grants can be used for a wide 

range of activities that assist residents, including 

job creation efforts linked to welfare reform, job 

training, and substance abuse prevention. 

Although the authorizing legislation made clear 

that the provision of substance abuse treatment 

services should be a priority, grantees have 

considerable discretion over the kind of 

activities they wish to support and in many 

cases have not chosen to fund substance abuse 

treatment services. 

HUD and the U.S. Department of Agriculture 

(USDA) designated the original EZs and ECs; 

originally there were 72 urban areas and 38 rural 

areas, and 1997 legislation authorized HUD to 

designate 15 more urban areas and USDA to 

designate 5 more rural areas. HUD reviews the 

strategic plan and annual performance reports 

from each EZ or EC. Providers can contact HUD 

for a list of designated EZs and ECs as well as 

more information about activities funded under 

this program. 

Community Development 

Block Grants 

Alcohol and drug counselors may apply for 

community development block grant funds to 

support capital improvements such as roof 

repairs and building renovations. These grants 

were authorized by the Housing and 

Community Development Act of 1974 (42 U.S.C. 

§5301). They are administered by HUD, are

distributed by formula to qualifying cities and 

urban counties and, through the States, to small 

communities that do not qualify for direct 

entitlement grants. The program’s objectives are 

to benefit low- and moderate-income persons, 

aid the elimination of slums or blight, and meet 

other urgent community development needs. 

Funds may be used to carry out a wide range 

of community development activities directed 

toward neighborhood revitalization, economic 

development, and the provision of improved 

community facilities and public services. 

Endnotes 

1. Title I, Subchapter XII-J of the Omnibus

Crime Control and Safe Streets Act, as

amended by Title V of the Violent Crime

Control and Law Enforcement Act of 1994

(“the 1994 Act”), 42 U.S.C. §§3796ii et seq.

(1994 & Supp III 1998) (repealed 1996). U.S.

DOJ regulations for the Drug Court Program

can be found at 28 C.F.R.

2.	
 Omnibus Consolidated and Emergency

Supplemental Appropriations Act, 1999, P.L.

No. 105-277, 112 Stat. 2681-63 (1998).

3. U.S. DOJ, Office of Justice Programs, Drug

Court Program Office. FY 1998 Program

Plan [Online].

116 
 

 

Funding and Policy Issues 

4. U.S. DOJ, Office of Justice Programs, Drug Plan [Online]. 

Court Program Office. FY 1998 Program 

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7 Legal Issues



Alcohol and drug counselors providing 

vocational rehabilitation (VR) services 

directly or through referral need to be 

aware of legal and ethical issues in three areas: 

discrimination against recovering individuals, 

welfare reform, and confidentiality. 

Part I, Discrimination, examines 

 The Americans with Disabilities Act (ADA) 

and the Rehabilitation Act, which protect 

individuals with disabilities, including 

individuals with substance abuse disorders 

(but not those who are currently engaged in 

illegal drug use and who are not 

in treatment) 

 How those laws apply to individuals 

recovering from substance abuse disorders 

when they seek equal access to social service 

agencies and programs, including vocational 

and educational training programs 

 The Workforce Investment Act of 1998, 

which reorganized the delivery of federally 

funded vocational training services, and how 

the Act might affect individuals in substance 

abuse treatment 

 How the laws protecting individuals with 

disabilities apply to individuals recovering 

from substance abuse disorders when they 

seek equal treatment in the area 

of employment 

 Remedies available to those who 

suffer discrimination 

Part II, Welfare Reform, looks at the new 

Federal legislation governing public assistance 

and how it can affect individuals recovering 

from substance abuse disorders. 

Part III, Confidentiality, outlines the 

requirements of the Federal confidentiality law 

and regulations and describes ways in which 

counselors can communicate with vocational 

training programs and employers. 

Part I: Discrimination in 

Employment and 

Employment-Related 

Services 

Clients in substance abuse treatment who are 

entering or are in the job market sometimes 

encounter employer rejection or discrimination 

because of a history of substance use. For 

example, a computer training program might 

refuse to accept an applicant with a substance 

abuse disorder history. Or, a business may fire a 

secretary when it discovers that her request for 

medical leave was to allow her to enter a 

treatment program for alcoholism. 

The section below outlines the protections 

Federal law currently affords people with 

substance abuse disorders, as well as the 

limitations of those protections and the available 

legal remedies. It describes how counselors can 

help clients deal with the issue of discrimination 

as they enter the job market. Also discussed are 

the protections offered by State antidiscrimination laws, new legislation that reorganizes 

federally funded vocational training programs, 

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Chapter 7 

and how the Drug-Free Workplace Act may 

affect the employment of former illegal 

drug users. 

Federal Statutes Protecting People 

With Disabilities 

There are two Federal statutes that protect 

people with disabilities: sections 503 and 504 of 

the Federal Rehabilitation Act (29 United States 

Code [U.S.C.] §791 et seq. (1973)) and the ADA 

(42 U.S.C. §12101 et seq. (1992)). Together, these 

laws prohibit discrimination based on disability 

by private and public entities that provide most 

of the benefits, programs, and services an 

individual in treatment for a substance abuse 

disorder is likely to need in order to enter or 

reenter the world of work.1 These statutes 

outlaw discrimination by a wide range 

of employers. 

Agencies, establishments, programs, 

and services covered 

Together, the Rehabilitation Act and ADA 

prohibit discrimination against individuals with 

disabilities in services, programs, or activities 

provided by 

 State and local governments and their 

departments, agencies, and other 

instrumentalities (29 U.S.C. §794(b) and 42 

U.S.C. §§12131(1) and 12132). 

 Most public accommodations, including 

hotels and other places of lodging, 

restaurants and other establishments serving 

food or drink, places of entertainment 

(movies, stadiums, etc.), places the public 

gathers (auditoriums, etc.), sales and other 

retail establishments, service establishments 

(banks, beauty shops, funeral parlors, law 

offices, hospitals, laundries, etc.), public 

transportation depots, places of public 

display or collection (museums, libraries, 

etc.), places of recreation (parks, zoos, etc.), 

educational establishments, social service 

centers (day care or senior citizen centers, 

homeless shelters and food banks, etc.), and 

places of exercise and recreation (42 U.S.C. 

§§12181(7) and 12182). 

Employers covered 

The Rehabilitation Act and ADA provide 

protection against discrimination by a wide 

range of employers,2 including 

 Employers with Federal contracts worth 

more than $10,000 

 Employers with 15 or more employees 

 Federal, State, and local governments 

and agencies 

 Corporations and other private organizations 

and individuals receiving Federal 

financial assistance 

 Corporations and other private organizations 

and individuals providing education, health 

care, housing, social services, or parks 

and recreation 

 Labor organizations and employment 

committees 

Kinds of protection offered 

Together, the Rehabilitation Act and ADA cover 

discrimination in an extraordinarily broad range 

of establishments, services, programs, and 

employers. 

In public accommodations 

The Rehabilitation Act and ADA prohibit 

discrimination on the basis of disability “in the 

full and equal enjoyment of the goods, services, 

facilities, privileges, advantages, or 

accommodations of any place of public 

accommodation” (42 U.S.C. §12182(a)).3 Public 

accommodations—including training programs 

—are prohibited from 

 Denying a disabled person the opportunity to 

participate in or benefit from goods, services, 

facilities, privileges, advantages, or 

accommodations 

 Affording a disabled person an opportunity 

to participate that is not equal to that 

afforded to others 

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Legal Issues 

 Providing a disabled person with a separate 

or different opportunity, service, benefit, etc. 

(unless it is necessary in order to provide an 

opportunity, service, etc. that is as effective 

as that provided to others) 

 Imposing or applying eligibility criteria that 

screen out or tend to screen out individuals 

with disabilities 

 Failing to make reasonable modifications in 

policies, practices, or procedures when 

modifications are necessary to afford 

disabled individuals equal services, etc. 

(unless it can be shown that such 

modifications would fundamentally alter the 

nature of the services, etc.) 

Limitations 

The Rehabilitation Act and ADA have two 

major limitations: 

 They protect only an individual with 

disabilities who is “qualified,” a term that is 

defined as someone “with a disability who, 

with or without reasonable modifications to 

rules, policies, or practices . . . meets the 

essential eligibility requirements for the 

receipt of services or the participation in 

programs...” (42 U.S.C. §12131(2)). For 

example, an organization that sponsors 

week-long bicycle trips for teenagers would 

be justified in refusing to enroll a 10-year-old 

hearing-impaired boy because he is under 

age. (Of course, if the organization has made 

previous exceptions, its position would be 

more doubtful.) On the other hand, a 

therapeutic treatment community that 

requires clients to perform work in the 

facility might be required to make 

modifications to its program for a substance 

user who had lost the use of his hands. 

They exclude from protection an individual 

with a disability who “poses a direct threat to 

the health or safety of others,” defined as “a 

significant risk to the health or safety of 

others that cannot be eliminated by a 

modification of policies, practices, or 

procedures, or by the provision of auxiliary 

aids or services” [italics added]. 

Organizations running programs or offering 

services “must make individualized 

assessment, based on reasonable judgment 

that relies on current medical knowledge or 

on the best available objective evidence, to 

ascertain the nature, duration, and severity of 

the risk; the probability that the potential 

injury will actually occur; and whether 

reasonable modifications of policies, 

practices, or procedures will mitigate the 

risk” (28 Code of Federal Regulations [CFR] 

§36.208; Supplemental Information 28 CFR

Part 35, Section-by-Section Analysis, §35.104; 

45 CFR §84.3(k)(4)). For example, an 

organization that sponsors mountainclimbing vacation adventures might be 

justified in refusing to allow the participation 

of someone who is blind on the grounds 

that her inability to see could endanger 

other novices. 

In employment 

Employers may not 

 Limit or classify a job applicant or employee 

because of a disability in a way that 

adversely affects that individual’s 

opportunities or status 

 Use standards or criteria that have the effect 

of discriminating on the basis of disability or 

that perpetuate discrimination by others who 

are subject to the employer’s control 

 Use qualification standards, employment 

tests, or other selection criteria (including 

medical examinations) that screen out or 

tend to screen out an individual with a 

disability, unless the standard, test, or 

criterion is shown to be job-related for the 

position in question and is consistent with 

business necessity 

 Deny equal employment or benefits, 

including hiring, promotion, tenure, layoff, 

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Chapter 7 

rates of pay, job assignments and 

classifications, leaves of absence, sick leave, 

fringe benefits, selection and financial 

support for training, or employersponsored activities 

 Deny equal employment or benefits because 

of the known disability of an individual with 

whom an applicant or employee has 

a relationship 

 Fail to make reasonable accommodations to 

the known limitations of an individual with 

a disability, unless such accommodation 

would impose an undue hardship on 

business operations 

 Deny employment opportunities to avoid 

having to make reasonable accommodations 

(42 U.S.C. §12112(a) and (b); 45 CFR 

§84.11(b))

An employer may not ask an applicant about 

a disability before making an offer of 

employment, but can ask about her ability to 

perform specific job functions. An employer 

may also make a job offer contingent on the 

applicant’s passing a postoffer medical 

examination if such an exam is required of all 

applicants for the particular job category (42 

U.S.C. §12112(d)); 45 CFR §84.14; 29 CFR 

§1630.13).

Limitations 

In the employment context, the Rehabilitation 

Act and ADA have two major limitations: 

1.	
 They protect only a “qualified individual

with a disability”; that is, someone “who,

with or without reasonable accommodation,

can perform the essential functions of the

employment position that such individual

holds or desires” (42 U.S.C. §12111(8)).

“Reasonable accommodation” includes “job

restructuring, modified work schedules,

reassignment to a vacant position... and

other similar accommodations...” (42 U.S.C.

§12111(9)).

2. Employers are not required to hire or retain

individuals who “pose a direct threat to the

health or safety of other individuals in the

workplace” (42 U.S.C. §12113(b)). A direct

threat is “a significant risk to the health or

safety of others that cannot be eliminated by

reasonable accommodation”

(42 U.S.C. §12111(3)).

The Rehabilitation Act explicitly adopts ADA’s 

standards with regard to complaints of 

employment discrimination (29 U.S.C. §794(d)). 

Range of disabilities protected 

Both the Rehabilitation Act and ADA extend 

protection from discrimination4

 to individuals 

 Who have a physical or mental impairment that 

substantially limits one or more major life 

activities. Major life activities are “functions 

such as caring for one’s self, performing 

manual tasks, walking, seeing, hearing, 

speaking, breathing, learning, and working.” 

 Who have a record of having an impairment that 

substantially limits one or more major life 

activities, including “a history of such 

impairment or a misclassification of having 

such impairment.” 

 Who are regarded as having such an 

impairment: those with an impairment that 

does not substantially limit major life 

activities but that is treated by others as such, 

those whose impairment results solely from 

the attitudes of others toward the condition 

or disease, and those who have no 

impairments but are treated as though they 

have a disability. This includes persons who 

are denied services or benefits because of 

myths, fears, and stereotypes associated with 

a disability.5 

Examples of the kind of discrimination covered 

by these laws include individuals who may be 

turned down from certain positions because of 

poor eyesight (such as piloting airplanes) in 

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Legal Issues 

spite of adequately corrective lenses; because of 

a past history of mental illness or substance 

abuse that an employer assumed will lead to 

trouble on the job; or because the individual is 

known to be HIV-positive, even though he has 

no symptoms that impair his ability to do 

the job. 

Protections for individuals with 

substance abuse disorders 

For those seeking benefits and services, an 

individual with a substance abuse disorder is 

included in the definition of “individual with a 

disability” in many, but not all, instances. The 

Federal regulations implementing ADA and 

the Rehabilitation Act make a distinction 

between individuals whose substance abuse 

disorder involves alcohol and those who use 

illegal drugs. 

Alcohol abusers 

In general, the Rehabilitation Act and ADA 

protect alcohol-dependent persons who are 

seeking benefits or services from an organization 

or agency covered by one of the statutes (29 

U.S.C. §706(8)(C)(iii) and 42 U.S.C. §12110(c)), 

if they are “qualified” and do not pose a direct 

threat to the health or safety of others (28 CFR 

§36.208(a)). This means that an organization

or program cannot refuse to serve an 

individual unless 

 The individual’s alcohol abuse is so severe, or 

has resulted in other debilitating conditions, 

that he no longer “meets the essential 

eligibility requirements for the receipt of 

services or the participation in programs... 

with or without reasonable modifications to 

rules, policies, or practices...” (42 U.S.C. 

§12131(2))

 The individual poses “a significant risk to the 

health or safety of others that cannot be 

eliminated by a modification of policies, 

practices, or procedures, or by the provision 

of auxiliary aids or services” (36 CFR 

§ 36.208(b); Supplemental Information 28

CFR Part 35, Section-by-Section 

Analysis, §35.104) 

For example, a hospital might take the 

position that an alcohol-dependent patient with 

dementia was not “qualified” to participate in 

occupational therapy because he could not 

follow directions. Or, an alcohol-dependent 

individual whose drinking results in assaultive 

episodes that endanger elderly residents in a 

long-term care facility might pose the kind of 

“direct threat” to the health or safety of others 

that would permit his exclusion. 

The Rehabilitation Act also permits programs 

and activities providing services of an 

educational nature to discipline students who 

use or possess alcohol or illegal drugs (29 U.S.C. 

§706(8)(C)(iv)).

Users of illegal drugs 

The Rehabilitation Act and ADA distinguish 

between former users of illegal drugs and 

current users. 

Individuals who no longer are engaged in the 

illegal use of drugs and have completed or are 

participating in a drug rehabilitation program 

are protected from discrimination to the same 

extent as alcohol abusers (29 U.S.C. 

§706((8)(C)(ii) and 42 U.S.C. §12210(b)). In other

words, they are protected so long as they are 

“qualified” for the program, activity, or service 

and do not pose a “direct threat” to the health or 

safety of others. Service providers may 

administer drug tests to ensure that an 

individual who formerly used illegal drugs no 

longer does so (28 CFR §36.209(c) and 28 CFR 

§35.131(c)). For example, if an applicant for a

vocational training program claims he no longer 

uses illegal drugs and has completed a course of 

rehabilitation, the training program could 

administer drug tests to determine that he is no 

longer using illegal drugs. 

Individuals currently engaging in the illegal use 

of drugs are offered full protection only in 

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Chapter 7 

connection with health and drug rehabilitation 

services (28 CFR §36.209(b) and 28 CFR 

§35.131(b)). (However, drug treatment

programs may deny participation to individuals 

who continue to use illegal drugs while they are 

in the program (28 CFR §36.209(b)(2).) The laws 

explicitly withdraw protection with regard to 

other services, programs, or activities (29 U.S.C. 

§706(8)(C)(i) and 42 U.S.C. §12210(a)).

A hospital that specializes in treating burn 

victims could not refuse to treat a burn victim 

because he uses illegal drugs, nor could it 

impose a surcharge on him because of his 

addiction. However, the hospital is not required 

to provide services that it does not ordinarily 

provide, for example, drug treatment (Appendix 

B to 28 CFR Part 36, Section-by-Section Analysis, 

§36.302). On the other hand, a vocational

training program could refuse to admit a user of 

illegal drugs, unless the individual had stopped 

and was participating in or had completed 

drug treatment. 

The protections ADA provides to clients in 

substance abuse treatment are summarized in 

Figure 7-1. 

The Workforce Investment 

Act of 1998 

In 1998, Congress passed the Workforce 

Investment Act to improve the workforce, 

reduce welfare dependency, and increase the 

employment and earnings of participants (§106 

of P.L. 105-220). The Act requires that local 

“one-stop delivery systems” be established for 

those looking for work, and it provides Federal 

funding for these programs. 

A major emphasis of the legislation is its 

“work-first” approach, which strongly 

encourages the unemployed to find work before 

requesting training. The Act establishes three 

tiers of service (§134(c)(1) of P.L. 105-220) 

available through a “one-stop operator”: 

1. Core services (assessment, information, and

job search help) are available to everyone.

2. Intensive services (specialized assessments,

counseling, skills training) are available to

those who (1) fail to find employment after

receiving core services and (2) are

determined by the one-stop operator “to be

in need of more intensive services in order

to obtain employment” (§134(d)(3)(A)(i) of

P.L. 105-220).

3. Training services (including occupational and

on-the-job training) are available to those

who have been unable to obtain or retain

employment after receiving core and

intensive services. The one-stop operator

must determine that the individual seeking

services is in need of training and has the

skills and qualifications to successfully

participate in the selected training program.

The training program must be directly

linked to employment opportunities in the

community (§134(d)(4)(A) of P.L. 105-220).

Training must generally be run by certified

providers and paid for through vouchers

(called Individual Training Accounts),

although there are some exceptions.

(See Figure 7-2 for a more detailed description of 

the three tiers of services.) 

The Workforce Investment Act requires 

States to give recipients of public assistance and 

other low-income individuals priority in the 

allocation of intensive and training services 

(§134(d)(4)(E) of P.L. 105-220). It also recognizes 

that “low-income individuals with substantial 

language or cultural barriers, offenders,6 the 

homeless, and other hard-to-serve populations 

as defined by the [State]... face multiple barriers 

to employment.” Members of these “special 

participant populations” may sidestep the 

voucher system and take part in training “of 

demonstrated effectiveness” that is offered “by a 

community-based or other private organization 

to serve special participant populations that face 

multiple barriers to employment” (§§134(d)(4) 

(G)(iv) and (G)(ii)(III) of P.L. 105-220). 

124 
Figure 7-1 

Americans With Disabilities Act and Rehabilitation Act Protections 

Alcohol Illegal drugs 

Current abuse Recovering Current abuse* Rec

Educational or Training Program 

Individuals qualified for services are protected 

Protected Protection limited to health 

and rehabilitation services 

Individuals qualifieprotected 

—Exceptions Individuals are not protected if 

 Their alcohol abuse is so 

severe that they no longer meet the eligibility requirements. 

 They pose a significant risk to 

health or safety of others that cannot be eliminated by service modification or auxiliary aids/services. 

No 

Exceptions 

Substance abuse treatment 

programs may expel clients who continue to use illegal drugs while attending the program. 

Individuals are not direct threat to the hothers. Service prodrug tests to ensure a history of illegal dusing illegal drugs. 

Employment Individuals qualified for the job 

are protected if they can perform job duties without posing a threat to health, safety, or property. 

Protected No Protection Individuals qualifie

protected if they 

 Participate in a s

rehabilitation prlonger using ille

 Have successful

and are no longe

—Exceptions See box above. No 

Exceptions 

Not Applicable Employer may adm

ensure that an indivillegal drug use is n

*Current abuse is defined as the illegal use of drugs that occurred recently enough to conclude that it is still a problem.

125 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Chapter 7 

Figure 7-2 

Services Provided Under the Workforce Investment Act of 1996 

Core Services include 

¢ Assessment of individuals’ skill levels, aptitudes, abilities, and supportive service needs 

¢ Job search and placement assistance and, where appropriate, career counseling 

¢ Information about current job vacancies, the skills those jobs call for, and the kinds of jobs that are 

generally available in the community, including pay levels and skill requirements 

¢ Information about training available through the one-stop delivery system 

¢ Information about and referral to supportive services, including child care and transportation 

¢ Assistance with establishing eligibility for welfare-to-work activities and financial aid programs for 

training and education not funded by the Act 

¢ Followup services (including counseling about the workplace) for those placed in unsubsidized 

employment (§134(d)(2) of P.L. 105-220) 

Intensive Services include 

¢ Comprehensive and specialized assessments of the skill levels and service needs of individuals, 

including diagnostic testing and in-depth interviewing and evaluation to identify employment 

barriers and appropriate employment goals 

¢ Development of individualized employment plans identifying employment goals, appropriate 

achievement objectives, and appropriate combinations of services required to achieve 

employment goals 

¢ Counseling, including group, individual, and career 

¢ Case management for those seeking training services 

¢ Short-term prevocational services to prepare individuals for unsubsidized employment or training 

(including development of learning, communication, interviewing, and personal maintenance skills 

and instruction about punctuality and professional conduct) (§134(d)(3) of P.L. 105-220) 

Training Services include 

¢ Occupational skills training, including training for nontraditional employment 

¢ On-the-job training 

¢ Programs that combine workplace training with related instruction 

¢ Training programs operated by the private sector 

¢ Skill upgrading and retraining 

¢ Entrepreneurial training 

¢ Job readiness training 

¢ Adult education and literacy activities 

¢ Customized training conducted by an employer or group of employers committed to employing 

individuals upon successful completion of the training (§134(d)(4) of P.L. 105-220) 

The effect on clients in substance 

abuse treatment 

The work-first approach may result in additional 

barriers for clients seeking vocational training. 

The three-tier system will mean that clients in 

substance abuse treatment who lack job skills 

will have to go through the process of 

assessment and job search (part of the “core 

services”) before they receive any individualized 

(“intensive”) service such as testing, counseling, 

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Legal Issues 

development of an individualized employment 

plan, or prevocational services. Only those who 

are unable to obtain or retain employment after 

participating in both “core” and “intensive 

services” will be eligible for “training services.” 

Clients seeking a training program must find 

one that is directly linked to employment 

opportunities in the community and must have 

the skills and qualifications to participate in the 

program successfully. 

Those in substance abuse treatment (or with 

a history of substance abuse) may not be refused 

service because of their “disability.” The Act 

explicitly incorporates current Federal 

antidiscrimination laws, including ADA and the 

Rehabilitation Act, as well as laws relating to 

wages, benefits, health, and safety (§188(a) and 

§181(a) and (b) of P.L. 105-220). However, as

stated above, those currently using illegal 

substances are not protected by ADA. 

Recipients of public assistance and low-income 

individuals should be given priority for 

“intensive” and “training” services. 

Clients who participate in services under the 

Act may be tested for illegal drugs. The Act 

permits States to test job training participants for 

the use of controlled substances. States may 

sanction individuals who test positive by 

banning them for up to 6 months from the 

program for a first positive test and for up to 2 

years for subsequent positive tests. States that 

choose to test participants for the use of 

controlled substances must establish a 

procedure that ensures “a maximum degree of 

privacy” (§181(f) of P.L. 105-220). 

Two final comments: The Workplace 

Investment Act is new, and it is not clear how 

different States will implement it. In addition, 

counselors should keep in mind that although 

federally funded programs may dominate this 

area, there are programs funded by private 

enterprise or nonprofits that offer more 

individualized and flexible services. 

Protections in the area of 

employment 

Alcohol-dependent and alcohol-using 

individuals 

The Rehabilitation Act and ADA provide limited 

protection against employment discrimination to 

individuals who abuse alcohol but who can 

perform the requisite job duties and do not pose 

a direct threat to the health, safety, or property 

of others in the workplace (29 U.S.C. 

§706(8)(C)(v); 42 U.S.C. §12113(b); 42 U.S.C.

§12111(3)). For example, the Acts would protect

an alcohol-dependent secretary who binges on 

weekends, but reports to work sober and 

performs his job safely and efficiently. 

However, a truck driver who comes to work 

inebriated and unable to do her job safely would 

not be protected. Nor would the employee 

whose promptness or attendance is erratic, 

unless the employer tolerates nonalcoholic 

employees’ lateness and absences from work 

(see Shaw et al., 1994). 

ADA (42 U.S.C. §12114(c)) also permits an 

employer to 

¢ Prohibit all use of alcohol in the workplace 

¢ Require all employees to be free from the 

influence of alcohol at the workplace 

¢ Require alcoholic employees to maintain the 

same qualifications for employment, job 

performance, and behavior that the employer 

requires other employees to meet, even if any 

unsatisfactory performance is related to the 

employee’s alcoholism 

Users of illegal drugs 

Individuals who no longer are engaged in the illegal 

use of drugs and have completed or are 

participating in a drug rehabilitation program 

are offered some protection: The Rehabilitation 

Act and ADA (29 U.S.C. §706(8)(C)(ii) and 42 

U.S.C. §12210(c)) protect employees and 

prospective employees who 

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Chapter 7 

¢ Have successfully completed a supervised 

drug rehabilitation program or otherwise 

have been rehabilitated and are no longer 

engaging in the illegal use of drugs 

¢ Are participating in a supervised 

rehabilitation program and are no longer 

engaging in illegal drug use 

¢ Are erroneously regarded as engaging in 

illegal drug use 

Employers may administer drug testing to 

ensure that someone who has a history of illegal 

drug use is no longer using.7 ADA (42 U.S.C. 

§12114(c)) also permits an employer to

¢ Prohibit all use of illegal drugs in 

the workplace 

¢ Require all employees to be free from the 

influence of illegal drugs at the workplace 

¢ Require an employee who engages in the 

illegal use of drugs to maintain the same 

qualifications for employment, job 

performance, and behavior that the employer 

requires other employees to meet, even if any 

unsatisfactory performance is related to the 

employee’s drug abuse 

The Drug-Free Workplace Act 

Another Federal law, the Drug-Free Workplace 

Act (41 U.S.C. §701 et seq.), may also affect 

clients in recovery. The Act requires employers 

who receive Federal funding through a grant 

(including block grant or entitlement grant 

programs) or who hold Federal contracts to 

certify they will provide a drug-free workplace. 

The certification means that affected 

employers must 

¢ Notify employees that “the unlawful 

manufacture, distribution, dispensing, 

possession or use of a controlled substance is 

prohibited in the workplace and specify the 

actions that will be taken against employees 

[who violate the] prohibition” 

¢ Establish an ongoing drug awareness 

program to inform employees of the dangers 

of drug abuse in the workplace, the 

availability of any drug counseling or 

employee assistance program, and the 

penalties that may be imposed for violations 

of the employer’s policy 

¢ Take appropriate action against an employee 

convicted of a drug offense when the offense 

occurred in the workplace 

¢ Notify the Federal funding agency in writing 

when such a conviction occurs 

Individuals currently engaging in the illegal use 

of drugs have no protection against 

discrimination in employment, even if they are 

“qualified” and do not pose a “direct threat” to 

others in the workplace (29 U.S.C. §706(8)(C)(i) 

and 42 U.S.C. §12210(a)). 

The protections offered to clients in substance 

abuse treatment are summarized in Figure 7-1. 

State Laws 

Most States have also enacted laws to protect 

people with disabilities (or “handicaps”). And 

some States’ laws protect persons with substance 

abuse disorders. Each State’s law is different 

and a treatment provider seeking help under 

State law should get in touch with the State or 

local agency charged with enforcing State civil 

rights laws. 

Federal Law 

An ounce of prevention 

The old adage “an ounce of prevention is worth 

a pound of cure” is particularly applicable to the 

area of employment discrimination. It is always 

easier to persuade an employer to hire an 

applicant before he has made a decision to reject 

him. In a variety of ways, counselors of 

individuals in treatment for substance abuse 

disorders can help hard-to-employ clients 

enhance their chances for employment. 

Counselors should be prepared to help clients, 

whether directly or through referrals, with the 

following tasks. 

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Legal Issues 

Focusing on jobs for which 

clients can qualify 

Clients in substance abuse treatment often lack 

perspective about the world of work. To many, 

there is a great divide between jobs with status 

(professional or high-visibility) and jobs that 

they believe have no status (e.g., fast food, other 

service industry jobs). Counselors can help 

clients understand and accept that there are 

many low-profile jobs that provide livelihood 

and satisfaction to millions of people. They can 

help clients develop realistic plans that could 

require starting at the bottom in order to attain a 

desirable goal. Such plans could include finding 

a training program that would lead to a good 

job. This kind of counseling will be increasingly 

important as the many aspects of welfare reform 

are implemented. 

Helping clients avoid common pitfalls 

¢ Clients should avoid volunteering 

information about their substance use 

histories. Job seekers should generally 

avoid volunteering information employers 

may view negatively. A substance abuse 

disorder history falls in that category. 

Unless it is likely to surface (if, for example, 

the client is in a methadone program and will 

be tested for drug use) or may benefit the 

client (who, for example, is applying for 

a job as a counselor), a substance abuse 

disorder history is not a subject the client 

should introduce. 

¢ Clients should avoid outright lies. Although 

volunteering information that employers 

may view negatively is unwise, lying is not 

advisable either. If an employer asks about 

the client’s education or experience, the client 

would be foolish to manufacture degrees or 

an impressive employment history. The 

employer is bound to discover the truth and 

fire the client, no matter how valuable the 

client believes he has become in the 

meantime. The law generally sides with the 

employer in this situation. 

¢ Clients should have a strategy for dealing 

with “illegal questions.” ADA prohibits 

employers from asking a job applicant about 

a disability—including a substance abuse 

disorder—before making an offer of 

employment. The employer can ask about 

the applicant’s ability to perform specific job 

functions and may condition a job offer on 

the applicant’s passing a postoffer medical 

examination all applicants must pass. How, 

then, should an individual with a substance 

abuse disorder history respond to the 

question, “Have you ever used any of the 

following: heroin, cocaine, marijuana, etc.?” 

There are four ways to deal with this kind 

of question: 

1. The client can answer “yes,” and add that

she has participated or is participating in a

supervised rehabilitation program (or has

otherwise been rehabilitated) and is no

longer engaged in illegal drug use. This is

the “correct” legal answer. If the client is

rejected, she can pursue one of the remedies

outlined below.

2. The client can answer “no,” which is a lie,

and run the risk of being found out later. If

the lie is uncovered, the client will most

likely be fired, no matter how well she

performed the job. In these circumstances,

the law offers no remedies.

3. The client can inform the employer that the

question is illegal. However, no matter how

diplomatically this is put, it will likely

offend the employer and indicate that the

applicant does have a substance abuse

disorder history.

4.	
 Sometimes, the client can try to address an

illegal question by supplying the

information the employer seems to be

seeking. If it appears that the employer is

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Chapter 7 

concerned about abuse of sick time, or 

employees who fall asleep on the job, the 

applicant may be able to offer the reassurance 

that she’s rarely sick or is not a night owl. 

The counselor can help the client sort 

through the alternatives. Failing to disclose a 

substance abuse disorder history is rarely an 

illegal act (unless an application form requires 

attesting to the accuracy of information). It is for 

the client to decide how she wants to handle this 

problem, for she is the one who has to live with 

the consequences. 

Enforcement: the pound of cure 

Discrimination against individuals with 

substance abuse disorders continues despite the 

existence of the Rehabilitation Act and ADA. 

However, these laws offer those who believe 

they have suffered discrimination a choice 

of remedies. 

The alternatives listed below must be 

pursued within certain time limits established 

by State and Federal laws. An individual who is 

considering filing a complaint with any one of 

the agencies mentioned below should consult an 

attorney at an early date to determine when a 

complaint must be filed. 

For discrimination by a program or 

activity 

Filing a complaint with the Federal agency that 

funds the program, activity, or service (42 

U.S.C. §12133; 29 U.S.C. §794(a); 28 CFR Part 35, 

Subparts F and G). For example, if the program 

is educational, it may receive funding from the 

Department of Education; if it involves health 

care, it may be funded by the Department of 

Health and Human Services. Once a complaint 

is filed, the agency is supposed to investigate 

and attempt an informal resolution. If a 

resolution is reached, the agency drafts a 

compliance agreement that is enforceable by the 

U.S. Attorney General. Federal agencies are 

required by ADA and sections 503 and 504 of 

the Rehabilitation Act to establish an appeals 

process and to designate the person in charge 

of compliance. 

If no resolution is achieved, the agency issues 

a “Letter of Findings” that contains findings of 

fact, conclusions of law, a description of the 

suggested remedy, and a notice of the 

complainant’s right to sue. A copy is sent to the 

U.S. Attorney General. The agency must then 

approach the offending program about 

negotiating. If the program refuses to negotiate 

or negotiations are fruitless, the agency refers 

the matter to the U.S. Attorney General with a 

recommendation for action. 

Advantages: A complaint to the Federal 

funding agency may get the offending 

program’s attention (and change its decision) 

because the funding agency has the power to 

deny future funding to those who violate the 

law. It is also inexpensive (no lawyer is 

necessary); however, if the complainant opts to 

be represented by an attorney, he may be 

awarded attorneys’ fees if he prevails. 

Disadvantage: Depending upon the kind of 

complaint and which Federal agency has 

jurisdiction, this may not be the most 

expeditious route. 

Filing a complaint with the State 

administrative agency charged with 

enforcement of the antidiscrimination laws (42 

U.S.C. §12201(b)). Such State agencies often 

have the words “civil rights,” “human rights,” 

or “equal opportunity” in their title. Advantage: 

This route is inexpensive. Disadvantages: Some 

of these agencies have large backlogs that 

generally preclude speedy resolution of 

complaints. Depending upon the State, 

remedies may be limited. 

Filing a lawsuit in State or Federal court. 

One can file a court case requesting injunctive 

relief (temporary or permanent) and/or 

monetary damages. The court has the discretion 

to appoint a lawyer to represent the plaintiff (42 

U.S.C. §§12188 and 2000a-3(a); 28 CFR §36.501). 

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Legal Issues 

Disadvantages: Unless one can find a not-forprofit organization that is interested in the case, 

a lawyer willing to represent the aggrieved 

party pro bono (free of charge), or a lawyer 

willing to take the case on contingency or for the 

attorneys’ fees the court can award the side that 

prevails, this may be an expensive alternative. It 

can also take a long time. Advantages: The 

complainant can ask for injunctive relief (a court 

order requiring the program to change its 

policy) and/or monetary damages. It may give 

the complainant a better sense of control over 

the process. A lawyer may produce results 

quickly: a lawyer’s approach to an offending 

program can have prompt and salutary effects. 

No one likes to be sued. It is costly, unpleasant, 

and often very public. It is often easier to reexamine one’s position and settle the case 

quickly out of court. The advantages and 

disadvantages of filing a case in State court will 

depend upon State law, State procedural rules, 

and the speed with which cases are resolved. 

Requesting enforcement action by the U.S. 

Attorney General, who can file a lawsuit asking 

for injunctive relief, monetary damages, and 

civil penalties (42 U.S.C. §12188 and 2000a-3(a); 

28 CFR §36.503). 

For employment discrimination 

Filing a complaint with the Federal Equal 

Employment Opportunity Commission 

(EEOC) (42 U.S.C. §12117) or the State 

administrative agency charged with 

enforcement of the antidiscrimination laws (42 

U.S.C. §12201(b)). If the EEOC finds reasonable 

cause to believe that the charge of discrimination 

is true and it cannot get agreement from the 

party charged, it can bring a lawsuit against any 

private entity. If the offending entity is 

governmental, the EEOC must refer the case to 

the U.S. Attorney General, who may file a 

lawsuit. The complainant can intervene in any 

court case brought by either the EEOC or the 

Attorney General. 

The EEOC or the U.S. Attorney General can 

also seek immediate relief by filing a case for a 

preliminary injunction in a Federal court. The 

court can order injunctive relief, including 

reinstatement or hiring, back pay, and attorneys’ 

fees (42 U.S.C. §2000e-5). 

Advantage: A complaint to the EEOC, the U.S. 

Department of Justice, or a State or local 

antidiscrimination agency or State Attorney 

General is relatively inexpensive because it does 

not require a lawyer. Disadvantage: Some of 

these agencies have large backlogs that generally 

preclude speedy resolution of complaints. 

Filing a lawsuit in State or Federal court. 

After an aggrieved party has filed a complaint 

with the State administrative agency and/or the 

EEOC, she can file a lawsuit (42 U.S.C. 

§2000e-5(f)). 

Disadvantage: This may be an expensive 

alternative and may also take a long time. 

Advantage: It can get fast results (see section 

above on discrimination by a program 

or activity). 

Employment Discrimination 

Against People With Criminal 

Records 

Many individuals with substance abuse disorder 

histories also have criminal records. Most 

employers are reluctant to hire people with 

criminal records. Although there are rulings 

that prohibit employers from asking applicants 

about arrests that did not result in convictions, 

there are few protections for ex-offenders who 

have been convicted of misdemeanors or 

felonies. As is the case for individuals with 

substance abuse disorder histories, the best 

strategy is to prepare for difficulties in advance. 

See Chapters 3 and 8 for more on this issue. 

A Closing Note 

For individuals in treatment for substance abuse, 

Federal law provides protection against 

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Chapter 7 

discrimination by programs, services, and 

employers. Many States have also adopted laws 

prohibiting discrimination against “individuals 

with disabilities” or “handicaps,” and some of 

these statutes also protect those recovering from 

substance abuse disorders. Some States also 

offer limited protection to ex-offenders. To learn 

more about State law—the protections it offers 

and the available remedies—providers can call 

the State or local “human rights,” “civil rights,” 

or “equal opportunity” agency. Advocacy 

groups for individuals with disabilities are also a 

good source of information. Local legal services 

offices, law school faculties, and bar associations 

may also have information available or may be 

able to provide an individual lawyer willing to 

make a presentation to staff. 

Part II: The Revolution in 

Rules Governing Public 

Assistance 

In 1996, Congress enacted a major overhaul of 

welfare called “The Personal Responsibility and 

Work Opportunity Reconciliation Act.” It 

transformed the Aid to Families With 

Dependent Children (AFDC) program, which 

“entitled” needy individuals with dependent 

children to assistance, into Temporary 

Assistance for Needy Families (TANF), a 

program offering limited relief. Unlike AFDC, 

TANF imposes work requirements on aid 

recipients, limits the amount of time an adult 

can receive benefits, and bars benefits to certain 

categories of persons, including individuals with 

felony drug convictions. States may screen 

recipients for alcohol and drug use and sanction 

those who test positive. TANF promises to have 

a major impact on clients who are also parents. 

Also in 1996, as part of the Contract With 

America Advancement Act, Congress amended 

the Social Security disability laws to eliminate 

benefits for any individual whose substance 

abuse disorder is or would be a contributing 

factor to an award of Supplemental Security 

Income (SSI) or Disability Insurance (DI) benefits 

(§105 of P.L. 104-121). Those receiving SSI or DI 

benefits are also generally eligible for food 

stamps and Medicaid; thus, the loss of SSI or DI 

benefits carries with it the possible loss of these 

benefits, including support for substance 

abuse treatment. 

Finally, as part of the Adoption and Safe 

Families Act of 1997, Congress has required the 

States to shift the focus of child abuse prevention 

and intervention services from family 

reunification to children’s health, safety, and 

permanent placement. There is now a 15-month 

limit on “family reunification services,” which 

are provided when children have been removed 

from the home and placed in foster care. This 

limit applies to substance abuse treatment and 

mental health services; individual, group, or 

family counseling; and transportation to or from 

services (42 U.S.C. §675(5), as amended by §§103 

and 305 of the Adoption and Safe Families Act 

of 1997). States must begin proceedings to 

terminate parental rights when children have 

been in foster care for 15 of the most recent 22 

months (42 U.S.C. §675(5)(C), as amended by 

§301 of the Adoption and Safe Families Act

of 1997). 

These three pieces of legislation promise to 

put great pressure on clients in substance abuse 

treatment to regain and retain sobriety, find 

work, and assume responsible parenting, all 

within a relatively short period of time. The 

following section provides an overview of 

these changes and a brief discussion of the 

practical implications for substance abuse 

treatment clients. 

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Changes in the Rules Governing 

Public Assistance 

Personal Responsibility and Work 

Opportunity Reconciliation Act 

The Personal Responsibility and Work 

Opportunity Reconciliation Act (1996) affects 

clients receiving TANF in the following ways: 

 Mandatory work requirements. With few 

exceptions, recipients of TANF must work 

within 2 years. Those who fail to comply 

with the work requirements will see their 

benefits reduced or eliminated. (States may 

not penalize single parents with a child 

under 6 who cannot find child care.) States 

may also cut Medicaid coverage to parents 

who do not comply with the work 

requirement (42 U.S.C. §607(e)). 

 Time limits. No family may receive assistance 

for more than 5 cumulative years (or a lesser 

period of time, at the State’s option). Once a 

parent has been on public assistance the 

allotted time, he or she may be cut from the 

rolls, although certain hardship exceptions 

can be made (42 U.S.C. §608(a)(7)). 

 Drug testing. States may screen welfare 

recipients for alcohol and drug use and 

sanction those who test positive by reducing 

or eliminating their benefits. 

 Drug felony ban. Those applying for public 

assistance must disclose any drug-related 

conviction of any household member. States 

can then deny public assistance and food 

stamps to people whose drug felony 

convictions occurred after August 22, 1996. 

States must take an affirmative step to opt 

out of this ban (§115 of P.L. 104-193, as 

amended by §5516 of P.L. 105-33). 

 Probation/parole violation ban. Offenders who 

violate the terms of their probation or parole 

lose their public assistance and food stamps. 

In some States, offenders who have been 

mandated into treatment and leave treatment 

may be subject to this provision (42 U.S.C. 

§608(a)(9)). 

Contract With America 

Advancement Act of 1996 

The Contract With America Advancement Act of 

1996 affects individuals who have been found 

disabled because of their substance abuse 

disorder and are receiving SSI or DI benefits. 

 Alcoholism and drug addiction removed as 

qualifying disabling conditions. Individuals 

who might previously have been classified 

disabled and found eligible for SSI or DI 

because of their substance abuse disorder 

may no longer be found disabled if their 

substance abuse disorder “would (but for 

this subparagraph) be a contributing factor to 

the [Social Security] Commissioner’s 

determination that the individual is 

disabled” (§105(a)(1) of P.L. 104-121, the 

“Contract With America Advancement Act 

of 1996”). However, if an individual who has 

previously been classified disabled because 

of substance abuse has another, coexisting 

mental or physical disability that qualifies as 

a disabling condition, he may still be eligible 

for these benefits. 

 Representative payee required. The benefits of 

any individual who receives SSI or DI for 

another disabling impairment must be paid 

to a representative payee if “such payment 

would serve the interest of the individual 

because the individual also has an alcoholism 

or drug addiction condition (as determined 

by the Commissioner) and the individual is 

incapable of managing such benefits” 

(§105(a)(2) of P.L. 104-121). 

 Mandatory referral to treatment. Individuals 

whose benefits are paid to a representative 

payee must be referred “to the appropriate 

State agency administering the State plan for 

substance abuse treatment services. . . “ 

(§105(a)(3) of P.L. 104-121). 

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Chapter 7 

Changes in the Rules Governing 

Families Involved With Child 

Protective Services 

Congress has established a series of programs to 

fund and support States’ efforts to help families 

in crisis, including family preservation, family 

reunification, foster care, and adoption 

assistance.8 These programs require States to 

adopt policies, timetables, and restrictions that 

may have the following results: 

¢ States may take a less tolerant view when children 

are living in households with one or more 

substance-abusing adults. The Federal 

legislation requires a shift in focus from a 

concern with “family preservation” to 

children’s health and safety as “the 

paramount concern” (42 U.S.C. §671(a)(15), 

as amended by the Adoption and Safe 

Families Act of 1997). This means that 

children may be placed in foster care more 

readily than before. 

¢ Parents will have a shorter time period to achieve 

sobriety if they are to retain their children. 

Family reunification services are now limited 

to 15 months after the child has been 

removed from the family and placed in foster 

care. This time limit applies to any substance 

abuse treatment and mental health services; 

individual, group, or family counseling; and 

transportation services provided as part of 

family reunification services (Id. at §675(5)). 

¢ There may be speedier termination of 

parental rights. 

¢ There is greater emphasis on permanent 

placement of children. States must hold a 

“permanency” hearing within 12 months of a 

child’s placement in foster care to determine 

whether to return the child, initiate 

proceedings to terminate parental rights, or 

place the child in another permanent living 

arrangement (Id. at §675(5)(C)). 

¢ There will be limits on how long children can 

remain in foster care. States must begin the 

process of terminating parental rights or 

finding long-term foster care placement for 

children who have been in foster care for 15 

of the most recent 22 months (Id. at 

§675(5)(C)). 

Parents who are unable to achieve sobriety 

after a year of treatment will be at greater risk of 

losing their parental rights as States implement 

the 15-month time limit on family preservation 

services and enforce the requirements regarding 

prompt determinations about children’s 

permanent placement. 

Changes in the Rules Governing 

Immigrants 

There are some new restrictions on benefits for 

immigrants. A lawful immigrant may or may 

not be eligible for benefits, depending on a 

variety of factors, including her immigrant 

status, the kind of benefit the immigrant applies 

for (e.g., TANF, SSI, DI, Medicaid, food stamps), 

when the immigrant arrived in this country, 

how long she has been here, her age, and other 

facts about her personal history (42 U.S.C. 

§602(a)(33); 42 U.S.C. §2115). 

The changes in the rules governing public 

assistance, disability benefits, and immigrants 

are fairly new, and States have some choice in 

the way they implement them. To learn more 

about how the State is implementing these laws, 

programs can consult their agency’s counsel, if 

one exists, or a board member who is an 

attorney. Or, they can seek help from a lawyer 

familiar with the State law and regulations in 

this area who works for the State’s Department 

of Social or Human Services, the State Attorney 

General’s office, the Single State Agency, the 

local Legal Aid Society or Legal Services office, a 

family law clinic (perhaps at a law school), or a 

private practice specializing in family law. 

Often bar associations have lists of attorneys 

who work pro bono on issues such as these. 

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Legal Issues 

Combined Impact of Welfare 

Reform and Changes in Child 

Welfare Laws 

The combined effects of the new welfare reform 

requirements, the amendments to the disability 

laws, and the changes in the child welfare laws 

threaten to put clients who rely on public 

assistance or who are involved with a child 

protective services (CPS) agency under 

tremendous pressure. Clients will no longer 

receive disability benefits (SSI or DI) based on 

their substance abuse problems and may lose 

eligibility for food stamps and Medicaid as well. 

Clients with children may face reduction or 

elimination of their benefits if they fail to 

achieve and maintain sobriety, comply with 

work requirements, or enter the workforce 

within 5 years. Clients whose benefits are 

reduced or eliminated may have difficulty 

providing their children with the requisite level 

of food, clothing, shelter, and medical care. At 

the same time, clients involved with a CPS 

agency may be required to meet additional 

requirements within a limited time period. 

Those with substance abuse problems, 

minimal work experience, and a lack of 

parenting skills can feel overwhelmed by these 

growing demands. Maintaining sobriety, by 

itself, is a difficult achievement for many. If 

they have to comply with work requirements 

and assume new parenting responsibilities, they 

may see all of this as impossible. For some, the 

response will be denial of the reality that “the 

system” has changed. Others may be overcome 

by hopelessness and be inclined to give up. 

Others will relapse. 

As welfare reform, amendments to the 

disability laws, and changes in child protection 

laws are implemented, counselors will see 

increasingly stressed clients in need of 

supportive counseling and a web of support 

services. In these changed times, however, 

support will not suffice. If a client in substance 

abuse treatment is to emerge with a source of 

income and his family intact, the counselor must 

combine support with a firmness rooted in the 

understanding that the rules in this area have 

changed and become less forgiving. The 

challenge for counselors is to continue 

supporting clients while conveying to them the 

urgency of their attaining or maintaining 

sobriety and finding gainful employment. 

Part III: Confidentiality 

Of Information About 

Clients 

Programs providing treatment or VR services to 

individuals with substance abuse disorders 

frequently need to communicate with 

individuals and organizations as they gather 

information, refer clients to services the program 

does not provide, and coordinate care with 

other human service providers. This section 

outlines the laws protecting client confidentiality 

and examines how staff can protect clients’ 

privacy while providing appropriate treatment 

or VR services. 

Information about individuals applying for 

or receiving substance abuse prevention, 

screening, assessment, or treatment services is 

subject to a Federal statute and regulations that 

guarantee confidentiality (42 U.S.C. §290dd-2; 42 

CFR, Part 2). State laws also protect information 

about individuals’ health or mental health status 

or treatment, as well as information about 

certain diseases, and may restrict disclosure of 

information about substance abuse.9

 The 

Federal law, however, is generally more 

restrictive than State laws. Federal law 

preempts less restrictive State laws, but does 

not preclude enforcement of State law that is 

more restrictive. 

This section describes what the Federal law 

and regulations require and examines their 

impact on substance abuse treatment programs. 

It details the rules regarding the use of consent 

forms to get a client’s permission to release 

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Chapter 7 

information and examines how consent forms 

may be used to refer a client to or coordinate a 

client’s care with another service provider. 

Situations that commonly arise when a client in 

substance abuse treatment is receiving VR 

services at the program or elsewhere are 

reviewed, including how a program can 

properly gather information about a client from 

collateral sources and how a program can 

communicate with vocational programs or 

clients’ employers in a variety of circumstances. 

Also discussed are some exceptions in the 

Federal confidentiality rules, the notice clients 

must receive about the confidentiality 

regulations, clients’ right to review their own 

records, and security of records. 

Overview: Federal Law and 

Regulations Protect the Client’s 

Right to Privacy 

A Federal law and a set of regulations guarantee 

the strict confidentiality of information about all 

persons who seek or receive alcohol and drug 

abuse prevention, assessment, and treatment 

services. The legal citation for the laws and 

regulations is 42 U.S.C. §290dd-2 and 42 CFR 

Part 2. (Citations in the form “§2...” refer to 

specific sections of 42 CFR Part 2.) 

The Federal law and regulations are 

designed to protect clients’ privacy rights in 

order to attract people into treatment. The 

regulations tightly restrict communications 

about substance-abusing clients; unlike either 

the doctor–patient or the attorney–client 

privilege, the substance abuse treatment 

provider is prohibited from disclosing even the 

client’s name. A counselor may not 

acknowledge to an outside party that a 

particular client is a participant in the program. 

Violating the regulations is punishable by a fine 

of up to $500 for a first offense or up to $5,000 

for each subsequent offense (§2.4). 

The Federal rules apply to any program that 

specializes, in whole or in part, in providing 

treatment, counseling, or assessment and 

referral services for people with alcohol or drug 

problems (42 CFR. § 2.12(e)). Although the 

Federal regulations apply only to programs that 

receive Federal assistance, this includes indirect 

forms of Federal aid such as tax-exempt status, 

or State or local government funding coming (in 

whole or in part) from the Federal government. 

Whether the Federal regulations apply to a 

particular program depends on the kinds of 

services the program offers, not the label the 

program chooses. Calling itself a “prevention 

program” or “outreach program” or “screening 

program” does not absolve a program from 

adhering to the confidentiality rules. 

The primary aim of confidentiality rules is to 

allow clients (and not the provider) to determine 

when and to whom information will be 

disclosed. Some may view these laws and 

regulations as an irritation or a barrier to 

achieving program goals. Most of the 

nettlesome problems that can crop up under the 

Federal law and regulations can be avoided 

through planning ahead. Familiarity with the 

rules will ease communication. It can also 

reduce the confidentiality-related conflicts 

among program, client, and outside agency or 

person to a few relatively rare situations. 

General Rules 

The Federal confidentiality law and regulations 

protect any information about a client who has 

applied for or received any alcohol or drug 

abuse–related service from a program that is 

covered under the law. Services applied for or 

received can include screening, referral, 

assessment, diagnosis, individual counseling, 

group counseling, or treatment. The regulations 

govern from the time the client applies for or 

receives services or the program first conducts 

an assessment or begins to counsel the client. 

The restrictions on disclosure apply to any 

information that would identify the client as an 

individual with a substance abuse disorder, either 

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Legal Issues 

directly or by implication. The rule also applies to 

former clients or patients. It applies whether or 

not the person making an inquiry about the 

client already has the information, has other 

ways of getting it, has some form of official 

status, is authorized by State law, or comes 

armed with a subpoena or search warrant. 

When Confidential Information 

May Be Shared With Others 

Through Client Consent 

Although the Federal law and regulations 

protect information about clients, they do 

contain exceptions. The most commonly used 

exception is the client’s written consent. The 

Federal regulations’ requirements regarding 

consent are strict, somewhat unusual, and must 

be carefully followed. A proper consent form 

must be in writing and must contain each of the 

items contained in §2.31: 

1.	
 The name or general description of the

program(s) making the disclosure

2.	
 The name or title of the individual or

organization that will receive the disclosure

3. The name of the client who is the subject of

the disclosure

4. The purpose or need for the disclosure

5. How much and what kind of information

will be disclosed

6. A statement that the client may revoke (take

back) the consent at any time, except to the

extent that the program has already acted

on it

7. The date, event, or condition upon

which the consent expires if not

previously revoked

8. The signature of the client

9. The date on which the consent is signed

(§2.31(a))

A general medical release form, or any 

consent form that does not contain all the 

elements listed above, is not acceptable. (See 

sample consent form in Figure 7-3.) Most 

disclosures of information about a client in 

substance abuse treatment are permissible if the 

client has signed a valid consent form that has 

not expired or been revoked.10 

Specific aspects of the client consent 

procedure are discussed further below: the 

purpose of the disclosure and how much and 

what kind of information will be disclosed; the 

client’s right to revoke consent; and the 

expiration of consent forms. Two other issues 

are also considered: the required notice to 

the recipient that the information may not be 

disclosed and the effect of a signed 

consent form. 

Purpose of the disclosure and how 

much and what kind of information 

will be disclosed 

These two items are closely related. All 

disclosures, and especially those made pursuant 

to a consent form, must be limited to 

information that is necessary to accomplish the 

need or purpose for the disclosure (§2.13(a)). It 

would be improper to disclose everything in a 

client’s file if the person making the inquiry only 

needs one specific piece of information. 

A key step in completing the consent form is 

specifying the purpose or need for the 

communication of information. Once the 

purpose has been identified, it is easier to 

determine how much and what kind of 

information will be disclosed, tailoring it to what 

is essential to accomplish that particular purpose 

or need. 

Suppose, for example, that a counselor wants 

to refer a client to a vocational training program 

to improve his work-related skills. The 

counselor perhaps simply wants to call the 

training program to set up an appointment for 

the client. Making this kind of call from a 

substance abuse treatment program will almost 

always mean disclosing, albeit indirectly, that 

the client is in substance abuse treatment. 

Therefore, the client must sign a consent form. 

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(name of person and organization) 

for the purpose of 

(need for disclosure) 

the following information 

Chapter 7 

Figure 7-3 

Sample Consent Form 

Consent for the Release of Confidential Information 

I, , authorize XYZ Clinic to receive from/disclose to 

(name of client or participant) 

(nature of the disclosure) 

I understand that my records are protected under the Federal and State confidentiality regulations and 

cannot be disclosed without my written consent unless otherwise provided for in the regulations. I also 

understand that I may revoke this consent at any time except to the extent that action has been taken in 

reliance on it and that in any event this consent expires automatically on 

unless otherwise specified below. (date, condition, or event) 

Other expiration specifications: 

Date executed 

Signature of client 

Signature of parent or guardian, where required 

In this instance, the purpose of the disclosure 

would be “to set up an appointment with the Big 

Tree Training Program.” The disclosure would 

then be limited to a statement that “Sam O’Neill 

(the client) is in treatment at a substance abuse 

treatment program.” No other information 

about Sam O’Neill would be released. 

On the other hand, if the treatment provider 

and the vocational training program want to 

coordinate care for the client, they will need to 

communicate over a longer period of time and 

the counselor will need to release more detailed 

information. In this case, the “purpose of the 

disclosure” would be “coordination of services 

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Legal Issues 

for Sam O’Neill” and “how much and what kind 

of information will be disclosed” might be 

“treatment status, treatment issues, and progress 

in treatment.” 

If the program is treating a patient who is on 

probation at work and whose future 

employment is contingent on treatment, the 

“purpose of disclosure” might be “to assist the 

patient to comply with the employer’s 

mandates” or “to supply periodic reports about 

attendance” and “how much and what kind of 

information will be disclosed” might be 

“attendance” or “progress in treatment.” Note 

that the kinds of information that will be 

disclosed to a provider with whom a program is 

coordinating the client’s care will be quite 

different from the kind of information a 

program will disclose to an employer. The 

program might well share some clinical 

information about a client with a vocational 

training provider if that would assist in 

coordinating services. Disclosure to an 

employer should be limited to a brief statement 

about the client’s attendance or progress in 

treatment. Disclosure of detailed clinical 

information to an employer would, in most 

circumstances, be inappropriate. 

Client’s right to revoke consent 

The Federal regulations permit the client to 

revoke consent at any time, and the consent 

form must include a statement to this effect. 

Revocation need not be in writing. If a program 

has already made a disclosure prior to the 

revocation, the program has acted in reliance on 

the consent and is not required to try to retrieve 

the information it has already disclosed.11 If 

clients have been mandated into treatment by 

the criminal justice system as a condition of 

probation or parole or of any proceedings 

against them, they should sign a “criminal 

justice system consent form.” This form 

prohibits the client from revoking consent to 

disclosures to the criminal justice mandating 

agency (§2.35). For a full explanation of the 

differences between this and the usual consent 

requirements, see TIP 25, Substance Abuse 

Treatment and Domestic Violence (CSAT, 1997c), 

pages 104–105. 

Expiration of consent form 

The Federal rules require that the consent form 

contain a date, event, or condition on which it 

will expire if not previously revoked. A consent 

form must last “no longer than reasonably 

necessary to serve the purpose for which it is 

given” (§2.31(a)(9)). If the purpose of the 

disclosure can be expected to be accomplished in 

5 or 10 days, it is better to fill in that amount of 

time rather than a longer period. It is best to 

individualize the ending date that the consent 

form is in effect rather than have all consent 

forms within an agency expire within 60 or 90 

days. When uniform expiration dates are used, 

agencies can find themselves in a situation 

where there is a need for a disclosure, but the 

client’s consent form has expired. This means 

at the least that the client must come to the 

agency again to sign a consent form. At worst, 

the client has left or is unavailable (e.g., 

hospitalized), and the agency will not be able to 

make the disclosure. 

The consent form does not need to contain a 

specific expiration date but may instead specify 

an event or condition. In the example discussed 

above, if a counselor is calling a training 

program to set up an appointment for the client, 

the consent form could provide that it will 

expire after the client “has had his first 

appointment at the Big Tree program.” On the 

other hand, if the counselor wants to coordinate 

services with the training program, it might be 

appropriate to have the consent form expire 

“when services by either agency end.” A 

consent form permitting disclosures to an 

employer might expire at the end of the client’s 

probationary period. However, a program that 

continues to provide services after a client has 

revoked a consent authorizing disclosure to a 

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Chapter 7 

third-party payor does so at its own 

financial risk.



Somewhat different rules may apply when a 

client comes for assessment or treatment as an 

official condition of probation, sentence, 

dismissal of charges, release from detention, or 

other disposition of a criminal justice 

proceeding. A consent form (or court order) is 

still required before a program can disclose 

information about a client who is the subject of a 

referral from the criminal justice system (CJS). 

However, the rules concerning the length of time 

that a consent is valid and the process for 

revoking the consent are different (§ 2.35). 

Specifically, the regulations require that the 

following factors be considered in determining 

how long a criminal justice consent will remain 

in effect: 

¢ The anticipated duration of treatment 

¢ The type of criminal proceeding 

¢ The need for treatment information in 

dealing with the proceeding 

¢ When the final disposition will occur 

¢ Anything else the client, program, or justice 

agency believes is relevant 

These rules allow programs to draft the 

consent form to expire “when there is a 

substantial change in the client’s justice system 

status.” A substantial change in justice status 

occurs whenever the client moves from one 

phase of the criminal justice system to the next. 

For example, for a client on probation, a change 

in status would occur when the probation ends, 

either by successful completion or revocation. 

Until one of those events occurs, the program 

could provide periodic reports to the client’s 

probation officer and could even testify at a 

probation revocation hearing, since no change in 

status would occur until after that hearing. 

The Federal regulations also permit the 

program to draft the consent form so that it 

cannot be revoked until a specified date or 

condition occurs. The regulations permit the CJS 

consent form to be irrevocable so that a client 

who has agreed to enter treatment in lieu of 

prosecution or punishment cannot then prevent 

the court, probation department, or other agency 

from monitoring her progress. Note that 

although a CJS consent may be made irrevocable 

for a specified period of time, that time period 

must end no later than the final disposition of 

the juvenile or criminal justice proceeding. 

Thereafter, the client may freely revoke consent. 

Signature when the client is a minor 

(and the issue of parental consent) 

A minor12 must always sign the consent form in 

order for a program to release information, even 

to his parent or guardian. The program must 

get the parent’s signature in addition to the 

minor’s signature only if the program is 

required by State law to obtain parental 

permission before providing treatment to minors 

(§2.14). (“Parent” includes parent, guardian, or 

other person legally responsible for the minor.) 

In other words, if State law does not require 

the program to get parental consent in order to 

provide services to a minor, then parental 

consent is not required to make disclosures 

(§2.14(b)). If State law requires parental consent 

to provide services to a minor, then parental 

consent is required to make any disclosures. The 

program must always obtain the minor’s consent for 

disclosures and cannot rely on the parent’s signature 

alone. Substance abuse treatment programs 

should consult with their Single State Agency or 

a local lawyer to determine whether they need 

parental consent to provide services to minors. 

The Federal confidentiality regulations do 

permit the director of a substance abuse 

treatment program to communicate with a 

minor’s parents without the minor’s 

consent, when 

¢ The minor is applying for services 

¢ The program director believes that the minor, 

because of extreme substance abuse or 

medical condition, does not have the capacity 

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Legal Issues 

to decide rationally whether to consent to the 

notification of her parents or guardian 

¢ The program director believes that the 

disclosure is necessary to cope with a 

substantial threat to the life or well-being of the 

minor or someone else 

Thus, if a minor applies for services in a State 

where parental consent is required to provide 

services, but the minor refuses to consent to the 

program’s notifying her parents or guardian, the 

regulations permit the program to contact a 

parent without the minor’s consent, only if those 

conditions are met. Otherwise the program 

must explain to the minor that while she has the 

right to refuse to consent to any communication 

with a parent, the program can provide no 

services without such communication and 

parental consent (§2.14(d)). The regulations add 

a warning, however, that such action might 

violate a State or local law (§2.14(b)). 

Required notice against 

redisclosing information 

Once the consent form has been properly 

completed, there remains one last requirement. 

Any disclosure made with client consent must 

be accompanied by a written statement that the 

information disclosed is protected by Federal 

law and that the person receiving the 

information cannot make any further disclosure 

of it unless permitted by the regulations (§2.32). 

This statement, not the consent form itself, should 

be delivered and explained to the recipient at 

the time of disclosure or earlier. 

The prohibition on redisclosure is clear and 

strict. Those who receive the notice are 

prohibited from rereleasing information except 

as permitted by the regulations. (Of course, a 

client may sign a consent form authorizing such 

a redisclosure.) 

Note on the effect of a signed 

consent form 

The fact that a client has signed a proper consent 

form authorizing the release of information does 

not require a program to make the proposed 

disclosure, unless the program has also received 

a subpoena or court order (§§ 2.3(b); 2.61(a)(b)). 

The program’s only obligation is to refuse to 

honor a consent that is expired, deficient, or 

otherwise known to be revoked, false, or 

invalid (§2.31(c)). 

In most cases, the decision whether or not to 

make a disclosure when a client has signed a 

consent form is within the discretion of the 

program, unless State law requires or prohibits 

disclosure once consent is given. In general, it is 

best to follow this rule: disclose only what is 

necessary, for only as long as is necessary, keeping in 

mind the purpose of the communication. 

Sharing Information: Strategies for 

Dealing With Common Situations 

Requiring Communications With 

Others 

This section discusses the kinds of questions that 

affect the operations of programs offering 

vocational services, either directly or through 

referral—bearing in mind the rules regarding 

consent discussed above. These questions 

include 

¢ How can alcohol and drug counselors 

obtain information from collateral sources 

about clients they are screening, assessing, 

or treating? 

¢ How should programs handle 

communications with vocational and 

training programs 

♦ When the vocational services are part of

the substance abuse treatment program?

♦ When the vocational services are offered

by an outside agency?

♦ When the vocational services are

offered by an outside agency onsite

at the program?

¢ How should programs handle 

communications with employers 

♦ Who have referred employees/clients

to treatment?

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Chapter 7 

♦ Who do not know their employees

are in treatment?

♦ When a client’s relapse may pose a

threat to fellow employees or others at

the workplace?

Seeking information from 

collateral sources 

When a client is referred to a program by an 

employer, a training program, or a physician, 

the program may, at some point in the intake 

and assessment process, need to ask the person 

or organization making the referral some 

questions. Or, a program may want to 

communicate with an outside person or 

organization to verify information about a client. 

Making inquiries of employers, schools, training 

programs, family members, doctors, and other 

health care entities might, at first glance, seem to 

pose no risk to a client’s right to confidentiality. 

But it does. 

When a program asks a family member, 

employer, training program, doctor, or mental 

health professional to supply information about 

a client or verify information it has obtained 

from a client, it is making a patient-identifying 

disclosure that the client has sought its services. 

In other words, when program staff seek 

information from other sources, they are letting 

those sources know that the client has asked for 

substance abuse treatment services. The Federal 

regulations generally prohibit this kind of 

disclosure unless the client consents, even if the 

person or organization already knows the client 

is in treatment. 

The easiest way to proceed in this situation is 

to get the client’s consent to contact the 

employer, training program, family member, 

school, health care facility, and so on. Or, the 

program could ask the client to sign a consent 

form that permits it to make a disclosure for 

purposes of seeking information from collateral 

sources to any one of a number of entities or 

persons listed on the consent form. Note that 

this combination form must still include “the 

name or title of the individual or the name of the 

organization” for each collateral source the 

program may contact. Whichever method the 

program chooses, it must use the consent form 

required by the regulations, not a general 

medical release form. 

Communicating with 

vocational/training programs 

As discussed in the first part of this chapter, the 

Rehabilitation Act and ADA generally protect 

individuals in substance abuse treatment when 

they seek vocational or training services from a 

provider covered by either Act. Nevertheless, 

communications with a vocational or training 

program must comply with the Federal 

confidentiality rules. For example, if a 

program refers a client to a vocational program 

by making an appointment for her, it would 

need to get the client to sign a consent form. 

Figure 7-4 sets out the different ways a referral 

can be handled. 

How the program communicates with a 

vocational or training program depends in part 

on whether the vocational or training services 

are part of the substance abuse treatment 

program or offered by a separate agency. 

When vocational or training services are 

part of the treatment program 

The Federal regulations permit some 

information to be disclosed to staff within the 

same program: 

The restrictions on disclosure in these 

regulations do not apply to communications of 

information between or among personnel 

having a need for the information in 

connection with their duties that arise out of 

the provision of diagnosis, treatment, or 

referral for treatment of alcohol or drug abuse 

if the communications are (i) within a program 

or (ii) between a program and an entity that 

has direct administrative control over that 

program (§2.12(c)(3)). 

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Legal Issues 

Figure 7-4 

Making a Referral to a Vocational or Training Program 

When a substance abuse treatment program refers a client to an outside agency providing vocational 

services, it has three choices: 

1. A counselor can give the client the agency’s name, address, and telephone number and urge her to

make an appointment.

2. A counselor can call the agency for the client and set up an appointment.

3. The program can invite the agency to interview clients and/or provide services on its premises.

The first option requires no communication between the program and the vocational or training 

agency; thus, no consent is required. However, the first option does require the client to take the 

initiative, something she may have difficulty doing. The second option requires the client to sign a 

consent form permitting the counselor to call the agency and set up an appointment. The third option 

provides the path of least resistance for the client—she need only present herself to the outside agency 

on the day it schedules services at the program. By appearing to request services from the outside 

agency, the client is making a disclosure about her participation in treatment and no consent form is 

required. However, if the program sets up appointments for clients beforehand, it will need a consent 

form signed by the client before it can present the list of applicants for services to the vocational or 

training program. And, as noted above, the substance abuse treatment program must have a proper, 

signed consent form if it and the vocational or training agency are to communicate in the future about 

any client they both serve. 

In other words, staff members who have access 

to information about clients because they work 

for or administratively direct the program— 

including full- or part-time employees and 

unpaid volunteers—may consult among 

themselves or otherwise share information if 

their substance abuse treatment work so 

requires (§2.12(c)(3)). 

This is the second most commonly invoked 

exception to the Federal confidentiality rules 

(after consent). While the exception may apply 

to an in-house vocational or training program, 

two cautions must be noted. First, the exception 

does not permit unfettered communications 

among staff within a substance abuse treatment 

program. Only staff members “having a need 

for the information in connection with their 

duties that arise out of the provision of 

[substance abuse treatment services]” may 

receive information about the client without 

consent. Second, once information about a client 

is communicated to an in-house vocational or 

training program, information about that client 

that is held by the vocational or training 

program becomes subject to the confidentiality 

rules. Thus, the vocational or training program 

staff would have to learn and agree to abide by 

the Federal confidentiality rules. 

When vocational or training services are 

offered by an outside agency 

In order for a substance abuse treatment 

program to communicate with a 

vocational/training program operated by an 

outside agency, it must have a valid consent 

form signed by the client. As noted above, the 

form must satisfy all the requirements of §2.31; it 

must include a statement of the need or purpose 

of the communication and the kind and amount 

of information to be disclosed. If the 

communication is to be ongoing, it is 143 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Chapter 7 

appropriate to have the consent form expire 

“when services by either agency end.” 

When an outside agency provides 

vocational or training services on 

program premises 

When a substance abuse treatment program 

invites an outside agency to provide vocational 

or training services on program premises, it may 

communicate information about a client to that 

agency and its staff only after the client signs a 

valid consent form. The fact that the staff of an 

agency operating on program premises 

presumably knows that the clients it is serving 

are in substance abuse treatment does not mean 

that the program can dispense with the consent 

requirements. Moreover, the substance abuse 

treatment program must take steps to protect the 

confidentiality of clients who are not using the 

onsite vocational or training services. 

Nonparticipating clients should receive notice 

about when such “outsiders” will be at the 

program and where they will be. The vocational 

or training program should occupy space at the 

program that can be avoided by clients not 

receiving those services so that they can protect 

their own identities. 

Communicating with employers 

As discussed in the first part of this chapter, the 

Rehabilitation Act and ADA offer limited 

protection against employment discrimination to 

individuals participating in substance abuse 

treatment. Whether and how the program 

should communicate with an employer depends 

on a variety of factors, including whether the 

employer referred the employee to treatment, 

whether the employer is likely to be 

understanding or hostile when he learns that an 

employee has sought substance abuse treatment, 

and what kind of job the employee holds. 

When the employer has 

referred the client 

When an employer refers a client to treatment as 

a condition of keeping his job, the employer may 

well require periodic reports from the substance 

abuse treatment program about the employee’s 

attendance and/or progress in treatment. 

Although the employer clearly knows in this 

situation that the employee is in treatment, a 

consent form is necessary for the program to 

communicate with the employer. As mentioned 

above, the program should limit the kind and 

amount of information it reports to the 

employer; with few exceptions, employers do 

not need detailed clinical information. 

When the employer does not know an 

employee needs or is in treatment 

When an employed client is self-referred or 

referred by someone other than her employer, 

there may be little or no reason for the program 

to communicate with the employer. However, 

circumstances may arise that appear to require 

communication. For example, suppose that a 

counselor believes that a client needs intensive 

treatment, available only in another county or at 

a residential facility? Someone must notify the 

client’s employer that she will be gone for a 

period of time. The counselor and the program 

should consult the client about how she wants to 

handle this situation. The client should gather 

preliminary information, such as the following: 

¢ What is the employer’s policy? Does the client 

know what the employer’s policy is with 

regard to medical leave? How much medical 

leave will the employer grant? Is there a 

procedure that must be followed to request a 

medical leave of absence? Is there a written 

personnel policy or a human resources 

department the client can consult? 

¢ Will the employer learn about the treatment 

through the insurance plan? How will the 

client pay for treatment? 

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Legal Issues 

If her job benefits include health insurance, 

does that insurance cover the type of 

substance abuse treatment the client needs? 

If she uses the insurance, is her employer 

likely to find out about her treatment? 

¢ Can the client ask for time off herself? If the 

client can simply tell the employer she needs 

time off for medical treatment, then that is 

probably the most prudent course to follow. 

(However, the client should ascertain 

whether, on her return, she would have to 

submit a medical report.) Or, perhaps the 

client can use her accumulated vacation time 

to pursue treatment. 

If the client does not need to involve a health 

care provider to get medical leave, the safest 

course might be for her to ask for medical leave 

herself or take vacation time. If a health care 

provider must certify that the client needs 

medical leave, what are the likely repercussions 

if the employer learns she is entering a program 

for treatment of a substance abuse disorder? 

¢ If the client believes the employer will be 

sympathetic, the program could inform the 

employer directly, so long as the client signs 

a proper consent form. 

¢ If the client believes there will be negative 

repercussions if her employer learns she has a 

substance abuse problem: 

♦ She could ask her medical doctor to write a

letter requesting a medical leave without

revealing the substance abuse problem.

♦ If the program is part of a larger health care

agency that is not identified as an agency

providing substance abuse treatment, it

could write a letter requesting medical

leave, using the umbrella agency’s

stationery. The letter would not mention

substance abuse disorders. This is not an

option that is practical for a free-standing

program (or a program that is part of a

larger agency that is identified as a

substance abuse treatment provider),

since writing to inform the employer that 

the client needs treatment will disclose 

the diagnosis to the employer. 

An astute counselor can help the employed 

client navigate the sometimes perilous path 

leading to treatment and back to employment. It 

is critical for the counselor and the program to 

listen to a client’s concerns about her employer’s 

attitude. Remember that protections for those 

recovering from a substance abuse disorder are 

limited, and enforcement of those protections is 

uncertain and can be expensive. If a program 

communicates with an employer without a 

client’s consent, and in doing so directly or 

indirectly reveals that the client has a substance 

abuse disorder, the program may find itself 

facing an unpleasant lawsuit if the client loses 

her job. 

Communicating with an employer or 

vocational program when a client’s 

relapse may pose a threat to others 

Does a program have a “duty to warn” an 

employer or training program when it knows 

that a client it is treating has relapsed? When 

would that “duty” arise? Even when no duty 

exists, should a substance abuse treatment 

program warn those who may be put at risk 

about a client’s relapse? How can others be 

warned without violating the Federal 

confidentiality regulations? 

Successful substance abuse treatment 

depends on the willingness of clients to expose 

powerful feelings and shameful things about 

themselves to program staff. The news that the 

program has, without a client’s consent, 

“warned” a training program or employer or 

someone else that a client has relapsed will 

spread quickly among the client population. It 

may have the effect of destroying clients’ trust in 

the program and its staff. Any counselor or 

program considering “warning” someone of a 

client’s relapse without the client’s consent 

should carefully analyze whether there is, in 

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Chapter 7 

fact, a “duty to warn” and whether it is possible 

to persuade the client to discharge this 

responsibility himself or consent to the 

program’s doing so. 

Is there a duty? The answer is a matter of 

State law. This question does not usually arise 

in the employment or vocational training 

context. The “duty to warn” issue usually arises 

when a client makes a verbal threat to cause 

physical harm to himself or another person. In 

such cases, in order for a “duty to warn” to exist, 

a counselor generally must be able to identify a 

particular potential victim. For example, if a 

client makes a statement that he intends to shoot 

his boss, and the counselor believes he means it, 

then the counselor would have a duty to warn 

either the potential victim or law enforcement.13 

There are obvious differences between the 

“verbal threat” and the threat that a relapse may 

present: because the client is not intending to 

hurt anyone in the training program or at work, 

it is not clear that his going to the training 

program or to work inebriated or “high” will 

actually result in physical harm to another. 

There are circumstances when individuals are in 

safety-sensitive positions, such as pilots, medical 

personnel, and child care workers, where harm 

to others may be an issue. However, there are 

always workers in such jobs whose performance 

seems unaffected by substance use. And, unlike 

the verbal threat scenario, the potential 

consequences are not so clear. 

There appears to be no consensus that 

substance abuse treatment programs have a 

duty to warn an employer or training program 

of a client’s relapse. The program has to make a 

judgment in a situation where it has conflicting 

moral obligations: On the one hand, no program 

would want to prompt a training program or 

employer to dismiss its client. On the other 

hand, it would be tragic if the client’s condition 

resulted in death or injury to someone. 

How should treatment providers address 

this dilemma? 

Reaching a decision: factors to consider 

The process of reaching a decision concerning 

whether to warn an employer or training 

program about a client’s relapse will be easier if 

programs develop a protocol about “duty to 

warn” cases in this context. A protocol gives 

staff guidelines to follow in making a decision. 

The protocol should require the client’s primary 

counselor to consult with her clinical supervisor 

(and perhaps the program director) and should 

include the following steps: 

1.	
 Evaluate the threat. 

2.	
 If the threat is serious, determine if there is a 

way to avoid disclosure about the client’s 

substance abuse disorder. 

3.	
 If the threat is serious and it is not possible 

to avoid a disclosure about the client’s 

substance abuse disorder, determine how 

the program should warn an employer 

without violating the Federal 

confidentiality rules. 

4. Document the incident. 

Evaluate the threat 

Safety sensitivity. The first question to consider is 

whether the client has the kind of job in which a 

relapse would be a problem. For example, if the 

client is a file clerk, being inebriated or “high” 

on the job would not pose a danger to others’ 

physical welfare. If, on the other hand, the client 

works as a truck driver or on a fast-paced 

assembly line, going to work inebriated or 

“high” might well pose a danger to others. 

The seriousness of the relapse. The program 

should determine whether the client’s relapse 

and resulting substance use pattern is a threat to 

himself or others on the job or at the training 

program. If the client binges on weekends, for 

example, he may not pose a threat to others at 

the workplace even if he holds a safetysensitive position. 

The client’s employment status. If the client has 

relapsed and is not keeping appointments at the 

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Legal Issues 

program, it may also be that the client has also 

stopped going to work. The program could try 

to find out whether the client is still employed, 

so long as it does not disclose that the client has 

a substance abuse disorder or is in treatment. 

Determine if there is a way to avoid 

disclosure about the client’s substance 

abuse disorder 

If the threat is serious, determine if there is a 

way to avoid disclosure about the client’s 

substance abuse disorder. 

Will the client take responsibility? The program 

should make an effort to convince the client to 

take steps to avoid putting others at risk. This 

may require the client to call in sick during a 

relapse or request medical leave or temporary 

reassignment to a job that is not safety-sensitive. 

Can the program give a warning without 

disclosing the client’s substance abuse disorder? For 

a program that is part of a larger non–substanceabuse treatment facility, this can be 

accomplished by giving a warning in the larger 

facility’s name. For example, a counselor 

employed by an alcohol treatment program that 

is part of a general hospital could phone the 

employer in question, identify herself as “a 

counselor at the New City General Hospital,” 

and state that John Smith (the client) is not fit to 

work. (The counselor may not mention that the 

employee has a substance abuse problem or that 

he is impaired by drugs or alcohol.) This kind of 

warning would convey the vital information 

without identifying the client as someone in 

substance abuse treatment. Counselors at freestanding alcohol or drug programs cannot give 

the name of the program but could give a 

warning to the employer without identifying 

themselves (often called an “anonymous” 

warning). (This “non-patient-identifying 

disclosure” exception is discussed more fully 

below.) 

Determine how the program should 

warn an employer without violating 

the Federal confidentiality rules 

If the threat is serious and it is not possible to 

avoid a disclosure about the client’s substance 

abuse disorder, determine how the program 

should warn an employer without violating the 

Federal confidentiality rules. Is there a consent 

form? For a client in a safety-sensitive position, 

the program should have on hand a consent 

form permitting it to inform the employer or 

training program about a relapse that poses a 

threat to others. This may be easier to obtain 

from a client who has been referred by an 

employer or whose vocational program knows 

he is in substance abuse treatment. Even then, 

the client can revoke his consent. 

If the client will not give consent, the program 

can seek a court order authorizing the disclosure. 

The program should try to educate the court 

about the “court order” requirements of the 

Federal confidentiality regulations (which are 

discussed below in detail). 

Document the incident 

A program that decides to warn an employer or 

training program should document the factors 

that impelled its decision. If the decision is later 

questioned, notes made at the time showing that 

the program made a good-faith effort to 

determine the need to make the disclosure, to 

persuade the client to take responsibility 

himself, and to determine an appropriate way to 

issue the warning could prove invaluable. 

The program’s “duty to warn” protocol 

should be supplemented with ongoing training 

and discussions to assist staff in sorting out what 

should be done in any particular situation. 

Programs should also keep abreast of 

developments in this area. The circumstances 

under which the law imposes a “duty to warn” 

or “duty to notify” are changing, as States adopt 

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Chapter 7 

new statutes and their courts apply statutes to 

new situations. Although a duty to warn in the 

vocational training and employment contexts 

does not fit neatly into the classic model, 

developments in other areas of liability law may 

foreshadow shifts that will result in imposition 

of liability in this area, too. In some States, for 

example, bar owners and even hosts at private 

parties have been held liable for serving alcohol 

to inebriated customers or guests who injured or 

killed other motorists on their way home. In 

these cases, the bar owner’s or host’s knowledge 

that a customer or guest was drunk and about to 

drive his car is viewed as imposing a duty to 

protect innocent third parties. On the other 

hand, in some cases, courts have refused to 

impose liability on alcohol treatment programs 

that failed to get clients to stop drinking or 

driving. How any individual case will be 

decided will depend on the particular facts of 

the case (how egregious it appears in hindsight 

that the program failed to warn someone), what 

kind of damage was caused by the relapsed 

client, and the legal precedents in the State in 

which the case is brought. 

Exceptions That Permit Disclosures 

The Federal confidentiality regulations’ general 

rule prohibiting disclosure of patient-identifying 

information has a number of exceptions. Some 

of these exceptions have already been 

mentioned: consent, disclosures that do not 

identify someone as a client in substance abuse 

treatment, communications within a program, 

and disclosures authorized by a special court. 

The rules governing these exceptions are 

described below. Other exceptions are listed at 

the end of this section, with references to other 

TIPs where they are explained more fully. 

Communications that do not 

disclose patient-identifying 

information 

The Federal regulations permit programs to 

disclose information about a client if the 

program reveals no patient-identifying 

information. A program may only disclose 

information about clients if it does not identify 

them as alcohol or drug abusers or support 

anyone else’s identification of them as such. 

Obviously, a program can report aggregate 

data about its population (summing up 

information that gives an overview of the clients 

served in the program) or some portion of its 

populations. Thus, for example, a program 

could tell the newspaper that in the last 6 

months it screened 43 clients, 10 female and 33 

male. Or, as mentioned above, a program can 

communicate information about a client in a 

way that does not reveal the client’s status as a 

substance abuse treatment patient (§2.12(a)(i)). 

For example, a program that provides services to 

clients with other problems or illnesses as well 

as a substance abuse disorder may disclose 

information about a particular client as long as 

the fact that the client has a substance abuse 

problem is not revealed. Or, a program that is 

part of a general hospital could have a counselor 

call a training program to inform them that the 

client may be unable to perform adequately. 

However, the counselor may not disclose that 

the client has a substance abuse problem or is a 

client of the substance abuse treatment program. 

Programs that provide only alcohol or drug 

services cannot disclose information that 

identifies a client under this exception, since 

letting someone know a counselor is calling from 

the “Capital City Drug Program” will 

automatically identify the client as someone who 

received services from the program. However, a 

free-standing program can sometimes make 

“anonymous” disclosures, that is, disclosures 

that do not mention the name of the program or 

otherwise reveal the client’s status as an alcohol 

or drug abuser. 

Disclosures authorized by 

court order 

A State or Federal court may issue an order that 

will permit a program to make a disclosure 

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Legal Issues 

about a client that would otherwise be 

forbidden. A court may issue one of these 

authorizing orders, however, only after it 

follows certain special procedures and makes 

particular determinations required by the 

regulations. A subpoena, search warrant, or arrest 

warrant, even when signed by a judge, is not 

sufficient, standing alone, to require or even to permit 

a program to disclose information (§2.61).14 

Before a court can issue a court order 

authorizing a disclosure about a client, the client 

about whom a disclosure will be made must be 

given notice of the application for the order and 

some opportunity to make an oral or written 

statement to the court. If the program is not the 

party requesting the order, then the program, 

too, must be given notice and an opportunity to 

be heard.15 Generally, the application and any 

court order must use fictitious names for any 

known client, and all court proceedings in 

connection with the application must remain 

confidential unless the client requests otherwise 

(§§2.64(a), (b), 2.65, 2.66). 

Before issuing an authorizing order, the court 

must find that there is “good cause” for the 

disclosure. A court can find “good cause” only 

if it determines that the public interest and the 

need for disclosure outweigh any negative effect 

that the disclosure will have on the patient, or 

the doctor–patient or counselor–patient 

relationship, and the effectiveness of the 

program’s treatment services. Before it may 

issue an order, the court must also find that 

other ways of obtaining the information are not 

available or would be ineffective (§2.64(d)).16 

The judge may examine the records before 

making a decision (§2.64(c)). 

There are also limits on the scope of the 

disclosure that a court may authorize, even 

when it finds good cause. The disclosure must 

be limited to information essential to fulfill the 

purpose of the order, and it must be restricted to 

those persons who need the information for that 

purpose. The court should also take any other 

steps that are necessary to protect the client’s 

confidentiality, including sealing court records 

from public scrutiny (§ 2.64(e)). 

The court may order disclosure of 

“confidential communications” by a client to the 

program only if the disclosure 

¢ Is necessary to protect against a threat to life 

or of serious bodily injury 

¢ Is necessary to investigate or prosecute an 

extremely serious crime (including 

child abuse) 

¢ Is in connection with a proceeding at which 

the client has already presented evidence 

concerning confidential communications (for 

example, “I told my counselor that...”) 

(§2.63) 

Other Exceptions 

Disclosures to an outside agency 

that provides services to the program 

If a program routinely needs to share certain 

information with an outside agency that 

provides services to the program, it can enter 

into what is known as a Qualified Service 

Organization Agreement (QSOA).17 

Medical emergencies 

A program may make disclosures to public or 

private medical personnel “who have a need for 

information about a patient for the purpose of 

treating a condition which poses an immediate 

threat to the health” of the patient or any other 

individual. The regulations define “medical 

emergency” as a situation that poses an 

immediate threat to health and requires 

immediate medical intervention (§2.51).18 

Research, audit, or evaluation 

The confidentiality regulations also permit 

programs to disclose patient-identifying 

information to researchers, auditors, and 

evaluators without patient consent, provided 

certain safeguards are met (§2.52,2.53).19 

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Chapter 7 

Crimes committed on program 


premises or against program 


personnel 


When a client has committed or threatens to 

commit a crime on program premises or against 

program personnel, the confidentiality 

regulations permit the program to report the 

crime to a law enforcement agency or to seek its 

assistance. The program can disclose the 

circumstances of the incident, including the 

suspect’s name, address, last known 

whereabouts, and status as a patient at the 

program (§2.12(c)(5)).20 

Child abuse and neglect 

The Federal confidentiality regulations permit 

programs to comply with State laws that require 

the reporting of child abuse and neglect. While 

many State statutes are similar, each has 

different rules about what kinds of conditions 

must be reported, who must report, and when 

and how reports must be made. This exception 

to the general rule prohibiting disclosure of any 

information about a client applies only to initial 

reports of child abuse or neglect. Programs may 

not respond to followup requests for 

information or subpoenas for additional 

information, even if the records are sought for 

use in civil or criminal proceedings resulting 

from the program’s initial report, unless the 

client consents or the appropriate court issues an 

order under subpart E of the regulations.21 

Other Rules Regarding 

Confidentiality 

Client notice 

The Federal confidentiality regulations require 

programs to notify clients of their right to 

confidentiality and to give them a written 

summary of the regulations’ requirements. The 

notice and summary should be handed to clients 

when they begin participating in the program or 

soon thereafter (§2.22(a)). The regulations 

contain a sample notice. 

Client access to records 

Programs can use their own judgment to decide 

when to permit clients to view or obtain copies 

of their records, unless State law grants patients 

the right of access to records. The Federal 

regulations do not require programs to obtain 

written consent from patients before permitting 

them to see their own records. 

Security of records 

The Federal regulations require programs to 

keep written records in a secure room, a locked 

file cabinet, a safe, or other similar container. 

The program should establish written 

procedures that regulate access to and use of 

clients’ records. Either the program director 

or a single staff person should be designated to 

process inquiries and requests for 

information (§2.16). 

The push toward computerization of medical 

and treatment records will complicate the 

problem of keeping sensitive information 

private. Currently, there is protection afforded 

by the cumbersome and inefficient way many, if 

not most, medical, mental health, and social 

service records are stored (on paper) and make 

their way from one provider to another. When 

records are stored in computers, retrieval can be 

far more efficient. Computerized records allow 

anyone with a disk and access to the computer 

in which the information is stored to instantly 

copy and carry away vast amounts of 

information without anyone’s knowledge. 

Modems that allow communication about 

patients among different components of a 

managed care network extend the possibility 

of unauthorized access to anyone with a 

modem, the password(s), and the necessary 

software. The ease with which computerized 

information can be accessed can lead to “casual 

gossip” about a client, particularly one of 

importance in a community, making privacy 

difficult to preserve.22 

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A Final Note 

The legal and ethical issues that affect clients 

and staff of programs providing VR services are 

complex and interrelated. Welfare reform has 

reduced the support system upon which many 

clients relied and given greater urgency to 

programs’ efforts to help clients enter the world 

of work. Federal and State laws offer some 

protection to those clients as they participate in 

training and seek employment. As programs 

help clients deal with the new welfare rules and 

find training and employment, they must keep 

in mind the Federal confidentiality rules, which 

affect every communication programs make 

about clients to welfare agencies, vocational 

training programs, employers, and others. 

Endnotes 

1.	
 For a discussion of how these laws apply to

persons living with HIV/AIDS, see the TIP,

Substance Abuse Treatment for Persons With

HIV/AIDS (CSAT, 2000b).

2. Rehabilitation Act and key implementing

regulations: 29 U.S.C. §793 and 29 CFR Part

1630; §794(a), (b)(1), (b)(3)(A), and 45 CFR

Part 84; Americans with Disabilities Act and

key implementing regulations: 42 U.S.C.

§§12111(2) and (5) and 12112 and 28 CFR

Part 35, Subpart C, and 29 CFR Part 1630.

3. Rehabilitation Act and key implementing

regulations: 29 U.S.C. §794 and 45 CFR Part

84; Americans with Disabilities Act and key

implementing regulations: 42 U.S.C.

§12182(b)(1)(A), 42 U.S.C. §12182(b)(2), and

28 CFR Part 35 and Part 36. 

4. 42 U.S.C. §12102(2), 29 U.S.C. §706(8)(A),

and, e.g., 28 CFR §§35.104 and 36.104.

5. Supplemental Information 28 CFR Part 35,

Section-by-Section Analysis, §35.105 and

Appendix B to 28 CFR Part 36, Section-bySection Analysis, §36.104.

Legal Issues 

6. The Act defines “offender” as “any adult or

juvenile (A) who or has been subject to any

stage of the criminal justice process, for

whom services under this Act may be

beneficial; or (B) who requires assistance in

overcoming artificial barriers to

employment resulting from a record of

arrest or conviction” (§101(27) of P.L.

105-220).

7. 29 U.S.C. §706(8)(C)(ii), 42 U.S.C. §12210(b),

28 CFR §36.209(c), and 28 CFR §35.131(c).

8.	
 For a more detailed description of these

changes, see the TIP, Substance Abuse

Treatment for Persons With Child Abuse and

Neglect Issues (CSAT, 2000a).

9.	
 For a discussion of these kinds of State

confidentiality laws, see TIP 24, A Guide to

Substance Abuse Services for Primary Care

Clinicians (CSAT, 1997a), Appendix B. For a

discussion of confidentiality issues for those

with HIV/AIDS, see the TIP, Substance Abuse

Treatment for Persons With HIV/AIDS

(CSAT, 2000b).

10. However, no information that is obtained

from a program (even if the client consents)

may be used in a criminal investigation or

prosecution of the client unless a court order

has been issued under the special

circumstances set forth in §2.65 (42 U.S.C.

§§290dd-2 and 42 CFR §2.12(a), (d)).

11. The regulations state that “acting in

reliance” includes the provision of services

while relying on the consent form to permit

disclosures to a third-party payor. (Thirdparty payors are health insurance

companies, Medicaid, or any party that pays

the bills other than the patient’s family or

the treatment agency.) Thus, a program can

bill the third party-payor for past services

provided before the consent was revoked.

12. Minors are those individuals, under a

certain age, who do not have all the rights

and privileges of adults. The specific age

151 
Chapter 7 

varies according to State law and also 

according to the “right” or “privilege” at 

issue—e.g., serving in the Army, drinking. 

13. For a discussion of “duty to warn” when a

client threatens violent harm to another

person, see TIP 19, Detoxification from Alcohol

and Other Drugs (CSAT, 1995[b]), Appendix

F, Legal and Ethical Issues for Detoxification

Programs, pp. 82, 84−85.

14. For an explanation about how to deal with

search and arrest warrants, see TIP 19,

Detoxification from Alcohol and Other Drugs

(CSAT, 1995[b]), Appendix F, Legal and

Ethical Issues for Detoxification Programs,

pp. 84−85. For advice about dealing with

subpoenas, lawyers, and law enforcement,

see TIP 24, A Guide to Substance Abuse

Services for Primary Care Physicians (CSAT,

1997[a]), Appendix B, Legal and Ethical

Issues, pp. 111–112.

15. If the information is being sought to

investigate or prosecute a patient for a

crime, only the program need be notified

(§ 2.65). If the information is sought to

investigate or prosecute the program, no

prior notice at all is required (§ 2.66).

16. If the purpose of seeking the court order is

to obtain authorization to disclose

information in order to investigate or

prosecute a patient for a crime, the court

must also find that (1) the crime involved is

extremely serious, such as an act causing or

threatening to cause death or serious injury;

(2) the records sought are likely to contain

information of significance to the

investigation or prosecution; (3) there is no

other practical way to obtain the

information; and (4) the public interest in

disclosure outweighs any actual or potential

harm to the patient, the doctor–patient

relationship, and the ability of the program

to provide services to other patients. When 

law enforcement personnel seek the order, 

the court must also find that the program 

had an opportunity to be represented by 

independent counsel. (If the program is a 

governmental entity, it must be represented 

by counsel. [§2.65(d)]. 

17. For a description of the rules governing

Qualified Service Organization Agreements,

see TIP 19, Detoxification from Alcohol and

Other Drugs (CSAT, 1995[b]), Appendix E,

Legal and Ethical Issues, pp. 87−88.

18. For a description of the rules governing

communications in medical emergencies, see

TIP 19, Detoxification from Alcohol and Other

Drugs (CSAT, 1995[b]), Appendix E, Legal

and Ethical Issues, p. 87.

19. For a more complete explanation of the

requirements of §§2.52 and 2.53, see TIP 14,

Developing State Outcomes Monitoring Systems

for Alcohol and Other Drug Abuse Treatment

(CSAT, 1995[a]), Chapter 6, Legal Issues in

Outcomes Monitoring, p. 58.

20. For a description of what and how programs

may report crimes on program premises or

against program personnel, see TIP 19,

Detoxification from Alcohol and Other Drugs

(CSAT, 1995[b]), Appendix E, Legal and

Ethical Issues, p. 85.

21. For a comprehensive discussion of how

programs should handle reporting child

abuse or neglect to State authorities, see the

TIP, Substance Abuse Treatment for Persons

With Child Abuse and Neglect Issues

(CSAT, 2000a).

22. For a brief discussion of the issues

computerization raises, see TIP 23, Treatment

Drug Courts: Integrating Substance Abuse

Treatment with Legal Case Processing (CSAT,

1996), pp. 52−53.

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8 Working With the Ex-Offender 

Over the past two decades, as law 

enforcement has become a front-line 

response to substance abuse, many 

people with substance abuse disorders have 

entered the criminal justice system. The increase 

in the number of people in the criminal justice 

system for drug-related crimes is startling. 

Between 1980 and 1997, drug arrests tripled to 

1,584,000; 80 percent were for possession (U.S. 

Department of Justice, 1999b). In 1980, 6 percent 

of the offenders in State prisons and 25 percent 

of the offenders in Federal prisons had been 

incarcerated for drug offenses. By 1996, there 

had been an elevenfold increase in the number 

of inmates in State prisons on drug offenses, and 

drug offenders constituted 23 percent of the 

State prison population. For Federal prisons, the 

increase over the 15-year period was twelvefold, 

with drug offenders constituting 60 percent of 

the prison population. 

This astronomical increase does not take into 

account the high number of individuals with 

substance abuse disorders who are arrested and 

incarcerated for drug-related crimes (e.g., 

property crimes, robbery, assault). In 1997, 57 

percent of State prison inmates had used drugs 

in the month prior to arrest, and one-sixth 

committed their offense to obtain money to buy 

drugs (Mumola, 1999). 

The “war on drugs” has had a 

disproportionate impact on African Americans 

as a result of three overlapping policy decisions: 

the concentration of drug law enforcement in 

inner cities, harsher sentencing policies, and the 

emphasis on law enforcement at the expense of 

prevention and treatment (The Sentencing 

Project, 1999a). Given the shortage of substance 

abuse treatment options in many inner cities, 

substance abuse in these communities is more 

likely to receive attention as a criminal justice 

problem than as a social problem (The 

Sentencing Project, 1999a). As a result, African 

Americans who use illicit substances are 

arrested, convicted, and imprisoned at greater 

rates than other groups. While Federal surveys 

show that 13 percent of those who reported 

using drugs within the previous month are 

African American, this group constitutes 35 

percent of those arrested for possession, 55 

percent of those convicted, and 74 percent of 

those sentenced to prison (Mauer and Huling, 

1995; SAMHSA, 1998a). According to current 

data, the Department of Justice estimates that 28 

percent of African American males will enter a 

Federal or State prison at least once during their 

lives; the rates are 16 percent for Hispano/ 

Latino males and 4.4 percent for White males 

(U.S. Department of Justice, 1999a). 

The exponential increase in the number of 

individuals arrested and convicted of drug 

offenses and the disproportionate representation 

of African Americans in that group means that 

many drug and alcohol counselors are working 

with ex-offenders and that a large proportion of 

these ex-offender clients are African American. 

A criminal record is an additional barrier to 

employment for anyone recovering from a 

substance abuse disorder. African Americans 

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Chapter 8 

and members of other minorities (including 

individuals without substance abuse and 

criminal histories) also experience employment 

discrimination, sometimes subtle, sometimes 

not. Counselors should be aware that the exoffenders among their clients will have more 

difficulty finding work and that clients’ 

experiences with discrimination may diverge 

along racial and ethnic lines. 

This chapter describes the barriers exoffenders seeking employment face and suggests 

ways for substance abuse treatment programs 

and counselors to help offenders overcome these 

barriers. These barriers tend to fall into two 

categories: internal (i.e., attitudes and 

characteristics ex-offenders bring to the process) 

and societal (i.e., the attitudes society has 

toward those with criminal records and the 

means it uses to exclude ex-offenders from the 

workplace). Both types of barriers can be 

difficult, although not impossible, to overcome. 

Barriers to Employment: 

What the Offender Brings 

To the Process 

Each ex-offender is a unique individual; yet as a 

group, ex-offenders tend to bring the following 

common characteristics or attitudes to the 

process of vocational rehabilitation: 

¢ Offenders face feelings of failure and hopelessness. 

Ex-offenders tend to have a long history of 

failure behind them and may feel that there is 

little they can do to change their lives. They 

may have failed at school, at relationships, 

and at crime, and may have little faith that 

they will find a job or that employment will 

make a difference in their lives. 

¢ Offenders often feel alienated from mainstream 

institutions. Offenders’ experiences with 

school, health care facilities, welfare and 

child welfare offices, lawyers, police, and 

courts have been primarily negative. Their 

roles while involved with these institutions 

tend to be those of supplicant or 

“wrongdoer.” Most often, they are told— 

rather than asked—what their needs are and 

how those needs will be met. With 

overwhelming caseloads, human service 

workers are often too pressed for time to 

listen to offenders or answer questions. 

Offenders may perceive this as a lack of 

respect. As they enter substance abuse 

treatment and vocational rehabilitation, exoffenders might expect to face more of the 

same: requirements laid down by 

overworked people who believe they know 

best and who do not care whether the “help” 

they are offering meets clients’ real needs or 

concerns. Offenders often expect to be 

treated with contempt and hostility; their 

sensitivity to the attitudes of others can make 

them seem “touchy” to counselors. 

¢ Offenders learn to be cynical and to manipulate 

the system. From the perspective of an exoffender, the most sensible way to deal with 

people assigned to provide “help” he may 

not want or believe he needs may be to find 

and exploit the system’s weaknesses. The 

objective is to avoid compliance with 

burdensome requirements but retain 

whatever benefits the system offers. Often, 

in the offender’s experience, passive 

resistance works because the system does not 

have the capacity to follow through and 

enforce rules with sanctions. 

¢ As a group, offenders tend to be less educated, less 

skilled, and less mature than the general 

population. Those who spent their youth 

abusing substances probably did poorly in 

school and may never have had the 

opportunity to learn work-related skills or 

to mature. 

¢ Some studies have shown that offenders tend to 

have higher rates of attention deficit/ 

hyperactivity disorder (AD/HD) and other 

learning disabilities than the general population 

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Working With the Ex-Offender 

(Eyestone and Howell, 1994; Mannuzza et al., 

1989; U.S. Department of Justice, 1998). 

Offenders may have had considerable 

difficulty in school because of problems with 

concentration, comprehension, ability to 

plan, and ability to sustain effort. When 

these problems are not addressed in school, 

they lead to further skill deficits. 

Offenders who have served time face 

additional barriers, and the more time someone 

has served, the more serious are the barriers to 

employment. The following points can help the 

substance abuse treatment counselor better 

understand the experience that ex-offenders 

may have had in prison. 

¢ Offenders’ educational, mental, and social 

problems are not addressed in prison. In many 

jurisdictions, these services were casualties 

of the explosive growth in prison population 

or never were available except at a 

minimal level. 

¢ Incarceration widens the educational and social 

gap. Incarceration leads to “disculturation”— 

that is, inmates lose or “fail to acquire some 

of the habits currently required in the wider 

society” (Goffman, 1961). The very nature of 

an all-encompassing institution like a prison 

is incompatible with the development of the 

social skills needed to succeed in society at 

large. The prison inmate undergoes a total 

loss of autonomy. Others determine every 

detail of his life—from where he will live and 

when he wakes up in the morning, to what 

he will eat and how he will spend his time. 

Successful adaptation to prison requires 

accepting this loss of autonomy. 

Successful adaptation to prison also 

requires the individual to accept that the 

everyday rules of cause and effect and 

reward and punishment have been 

suspended. Correction officers can (and do) 

punish groups of inmates because of the 

actions of individuals. They can (and do) 

arbitrarily single out and punish an offender 

for no reason other than personal dislike. 

Searches of cells frequently result in 

destruction of inmate property, including 

treasured possessions such as photographs 

and valuables such as typewriters and legal 

papers. Any privilege earned with good 

behavior can be revoked at a moment’s 

notice on a trumped-up charge. After years 

in one facility, an inmate can find herself on a 

bus to another without notice. 

Living in a place where the logic of cause 

and effect is suspended and justice occurs 

only by chance can create despair and anger. 

This, combined with the loss of autonomy, 

can cause an inmate to stop believing that he 

is responsible for his life or that anything he 

does can ever matter. He learns that it is 

useless to try to control his environment or 

what happens to him; attempts to plan for 

the future are almost always futile and 

frustrating. Yet taking responsibility, making 

decisions, planning for the future, and 

following through are precisely the social 

skills that the released offender needs in 

order to successfully function in the 

community, especially in the world of work. 

¢ Survival in prison and survival outside prison 

require two vastly different sets of skills. To 

survive in prison, the offender must get 

along with other inmates, many of whom are 

angry and hostile and some of whom are 

dangerous. Because inmates have no 

privacy, battle over “turf” is common. 

Because inmates have no autonomy, power 

struggles are frequent. Survival in this 

environment calls on some of the behavior 

that the offender may have learned before he 

entered prison (and that may have 

contributed to being in prison). In some 

ways, the prison experience reinforces some 

of the offender’s more undesirable social and 

personal attitudes. 

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Chapter 8 

¢ After release, offenders may experience emotional 

shock. Life in prison can be brutal. From the 

prisoner’s perspective, the world outside can 

take on a rosy glow. The disappointments 

and difficulties the offender experienced 

prior to incarceration are often forgotten. As 

she counts the days to release, her 

expectations may be high that life on the 

other side of the wall will be good, if 

not carefree. 

However, reality rarely lives up to such 

expectations. After release, many exoffenders are overwhelmed by personal and 

financial troubles. Some have difficulty 

adjusting to relationships with spouses and 

families who have changed and learned to 

live with greater independence while the exoffenders were away. Others may return to 

old relationships that were built on the exoffender’s (or mutual) drug use. Still others, 

who are struggling to comply with substance 

abuse treatment and vocational 

requirements, may face hostility from family 

and friends who may not like the “new” 

person the ex-offender is being asked to (or 

has) become. The ex-offender can experience 

crushing disappointment at how difficult life 

is and how much adjustment is required. 

Having learned early in his life to deal with 

stress by drinking alcohol and using illicit 

substances, the ex-offender may be tempted 

by the pull of the streets and old friends or 

relatives who still abuse substances. 

¢ Release from prison can bring culture shock. 

Offenders leaving prison may find 

themselves in an unfamiliar world. Simple 

things such as ordering from a menu can 

seem alien and anxiety-provoking. For those 

who have served long terms, the shock can 

be intensified by the pace of technological 

change during their incarceration. Offenders 

may be ashamed of their lack of familiarity 

with things other people take for granted. 

Overcoming Barriers Resulting 

From Offender Alienation 

Overcoming the formidable barriers offenders 

bring to vocational rehabilitation (VR) requires 

engaging offenders in services. Substance abuse 

treatment programs that engage ex-offenders 

should offer the following: 

¢ Respect. Drug and alcohol counselors should 

strive to treat each person as an individual 

with a unique set of positive and negative 

qualities. Treatment staff should respect exoffenders’ autonomy, asking what they view 

as their primary needs and offering help in 

meeting those needs. When an ex-offender 

resists meeting program requirements, staff 

should not assume that the cause is willful 

disobedience. Resistance may arise from a 

variety of sources, including fear, anxiety, 

ignorance, lack of social skills, or the 

“lessons” learned in prison. Respecting the 

client means working with her to locate the 

reason for her resistance and then helping 

her overcome it. 

Counselors can also demonstrate respect 

by holding conversations with clients 

privately, looking at clients directly and 

asking, “How are you?” before launching 

into “business.” An attractive and clean 

waiting area also conveys respect for clients. 

Program staff can demonstrate respect and 

cultural competence by explaining why 

certain questions need to be asked. For 

example, when asking about school and work 

experiences during which the client may have 

repeated failures, program staff should 

introduce the questions by stating, “In order 

for us to work together to find the best career 

path for you, I need to ask you some 

questions about school and work that may 

seem upsetting to you. Please let me know if 

there is a better way to ask you about this 

information, because that will help both 

of us.” 

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Working With the Ex-Offender 

¢ Hope. Offenders accustomed to failure and 

feelings of hopelessness need contact with 

positive role models—people who have come 

through prison and substance abuse 

treatment and found a job. Employing 

program graduates as counselors is one way 

to offer role models; moreover, program 

graduates are often effective in breaking 

through clients’ denial and cutting through 

manipulation. Bringing graduates in to 

speak to groups of participants and 

compiling a book of letters from graduates 

who benefited from vocational services are 

other ways of providing role models. 

¢ Positive incentives. Offenders need to 

experience achievement rather than failure. 

Programs should emphasize and build upon 

clients’ small successes. This principle is in 

operation in many “drug courts,” where 

judges take the time to praise the 

accomplishments of offenders, however 

small these accomplishments may seem. 

Some programs mark advancement through 

program phases with ceremonies or small 

tokens of achievement. 

¢ Clear information. Offenders need to know 

what they can expect from substance abuse 

treatment and vocational counseling and 

what will be expected of them. Counselors 

should orient clients to the process they are 

beginning: what the steps or stages are, how 

long each lasts, what happens during each 

stage, and what the program rules are, as 

well as the consequences of violating them. 

¢ Consistency. When ex-offenders fail to 

comply with program requirements, 

consequences under the program’s control 

must be enforced swiftly and consistently. 

Offenders quickly learn whether the 

“system” is taking itself seriously. If there 

are inconsistent or delayed responses to rule 

violations, the rules might simply 

be disobeyed. 

¢ Compassion. Counselors should be aware that 

the ex-offender may be juggling many 

demands. Requirements laid down by the 

substance abuse treatment counselor may be 

competing with criminal justice reporting 

requirements (e.g., to a parole officer) or 

family obligations. From the ex-offender’s 

perspective, it may seem that everyone trying 

to “help” her is piling on competing 

demands that are impossible for her to meet 

and that make failure inevitable. Counselors 

should ask the client what other 

requirements she faces and offer to help her 

master the skills to manage everything. 

¢ Information about the career ladder. Many exoffenders believe that if they do obtain 

employment, it will be in a low-paying, 

“dead end” job. It is important for program 

staff to introduce and reinforce the concept of 

a career ladder. Clients need to develop a 

vision of increasing job skills and increasing 

job complexity, leading to increased pay 

and responsibility. 

¢ Assistance in transfer of skills. Often 

counselors overlook some of their clients’ 

“special talents” that may have served to 

bring about negative outcomes in the past 

but that can be used in a new way when the 

ex-offender is clean and sober. For example, 

an ex-offender who was a leader of gang 

activity and showed management abilities 

(under negative circumstances) can be 

assisted to see that those same skills could be 

used to lead a work crew. 

Program strategies for overcoming 

barriers 

There are many strategies that substance abuse 

treatment programs can institute on a program 

157 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Chapter 8 

level to help clients who are ex-offenders 

overcome barriers to employment. Following 

are some suggested strategies. 

¢ Programs can encourage and assist clients to 

acquire a General Equivalency Diploma 

(GED) by providing GED classes at the 

treatment site. In this way, clients can feel 

that education and GED classes are an 

important part of treatment. If this is not 

feasible, then program staff should attempt 

to enroll a group of ex-offender clients 

together at an outside GED classroom site 

and work with the instructor on an ongoing 

basis to sensitize her to the multiple needs of 

the clients. 

¢ VR staff should be invited to spend some 

time at the substance abuse treatment 

program site. In this way, clients see VR staff 

as part of the “treatment family,” and staff 

have the opportunity to see the clients in 

another setting. In addition, this provides 

the substance abuse treatment program with 

an opportunity to cross-train staff. 

¢ Treatment programs can include job and 

skills training by providing clients with 

opportunities to perform jobs at the 

treatment site. When clients are expected to 

perform (and assisted in performing) 

important job functions at the treatment site, 

they (1) learn time management, 

problemsolving, and many of the unwritten 

rules of employment, such as not being 

distracted by friends; (2) are allowed the 

gradual development of work skills within a 

known, safe environment; and (3) can try 

different types of jobs (e.g., receptionist, 

carpenter, child care aide, gardener, 

transportation coordinator). 

¢ Programs should provide clients with 

guidance on budgeting. Many ex-offenders 

have not learned how to budget money. 

Programs should consider providing a skillsbuilding group on budgeting and money 

management. Counselors can also work with 

clients to establish bank accounts and review 

and plan for monthly expenses. 

¢ Counselors should assist clients who are exoffenders in following through on referrals 

and assembling necessary documents, 

such as social security cards and 

school transcripts. 

¢ The program can match clients to mentors or 

peers who can assist clients with all 

components of the vocational training or job 

placement tracks. Peers and mentors who 

are ex-offenders and have been employed 

successfully can assist in facilitating skillsbuilding groups and job clubs (see Figure 4-2 

in Chapter 4), providing support to 

appointments, facilitating support groups 

postemployment, and providing ongoing 

support. Workplace conflict is to be 

expected, and peers and mentors can 

assist the ex-offender in coping with 

these situations. 

¢ If the offender’s emotional readiness to 

return to work is poor, substance abuse 

treatment programs can offer empowerment 

workshops to help clients increase their 

readiness. Peer-run or peer-cofacilitated 

workshops based on stages of change and 

motivational interviewing strategies can be 

effective in increasing clients’ readiness and 

help them to feel that they have some control 

over their vocational choices (see TIP 35, 

Enhancing Motivation for Change in Substance 

Abuse Treatment [CSAT, 1999c] for more 

information on this topic). 

¢ Participation in 12-Step programs provides 

clients with peer support for remaining 

abstinent, handling daily problems, and 

developing a healthy social network. 

Substance abuse treatment programs can 

form linkages with local 12-Step programs to 

provide clients with information about 

joining these programs. 

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Working With the Ex-Offender 

Women’s Issues 

Between 1986 and 1991, the number of women 

in State prisons for drug offenses increased by 

433 percent, compared with a 283 percent 

increase for men in the same time period 

(LeBlanc, 1996). The number of African 

American women incarcerated for drug offenses 

in State prisons increased by 828 percent from 

1986 to 1991 (Mauer and Huling, 1995). 

Women in prison differ from their male 

counterparts in several significant ways: (1) they 

are less likely to have committed a violent 

offense; (2) they are more likely to have a dual 

diagnosis (substance abuse disorder and a 

psychiatric disorder); (3) they are more likely to 

have experienced multiple incidents of physical 

and sexual abuse; and (4) they are more likely to 

be responsible for their children’s support 

(Morash et al., 1998; Teplin et al., 1996). 

In a study of women in California prisons 

(Bloom et al., 1994), 31 percent reported 

experiencing sexual abuse as a child and 23 

percent as adults, and 29 percent reported 

physical abuse as a child and 60 percent as 

adults, usually by partners. Domestic violence 

may continue to be a risk for women when they 

return to the community. 

Economic self-sufficiency is a challenge for 

ex-offenders who have not developed 

employment skills, particularly for women faced 

with supporting themselves and their children. 

Women who were involved in drug dealing 

generally had low-ranking roles, and many 

women have been forced by economic need to 

participate in sex work or prostitution. In 

addition, educational opportunities and job 

training in prison may have been different for 

men than for women. A 1980 General 

Accounting Office study found that women 

within the Bureau of Prisons had access to only 

13 prison industry jobs, while men had access to 

84 (Miller, 1990). 

Women with substance abuse problems who 

were incarcerated are more likely to be 

unemployed or underemployed than their male 

counterparts (Wellisch et al., 1993). In a large 

survey of incarcerated female prisoners 

conducted by the American Correctional 

Association, only 18 percent of the women 

indicated that they were qualified to obtain 

satisfactory employment following release from 

incarceration (American Correctional 

Association, 1990). 

Female ex-offenders are extremely 

vulnerable to recidivism and relapse if they 

cannot sustain themselves economically through 

lawful employment. This has become even 

more critical since passage of the Federal 

Welfare-To-Work legislation (see Chapter 1 for 

more information). 

Program strategies for female clients 

Substance abuse treatment programs can 

institute strategies on a program level to help 

address the special needs and considerations of 

female clients who are ex-offenders. Following 

are examples of such strategies (see also Figure 

8-1 for an example of a program that addresses 

women’s issues). 

 Programs should incorporate the teaching of 

parenting skills and skills in finding child 

care. Program staff need to help mothers 

improve their parenting skills and assist 

them in finding affordable, safe child care 

when they do find employment. Many 

women are so concerned about losing their 

children or reuniting with them after 

incarceration that they have difficulty 

focusing on job preparedness. Staff should 

help clients see that preparing for work will 

help them care for their children adequately. 

 Once released from incarceration, women 

with substance abuse disorders should 

contact substance abuse treatment centers. 

The treatment program may need to provide 

transportation to the treatment site as well as 

make arrangements for child care. Ideally, 

the substance abuse treatment program 

159 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Chapter 8 

Figure 8-1 

A Program That Addresses Women’s Issues 

California has been a pioneering State in allowing women inmates with children under the age of 6 to 

live in community-based facilities. The California Department of Corrections Community Prisoner 

Mother Program (CPMP) is an innovative program that allows women inmates to strengthen bonds 

with their children and to reintegrate back into the community as productive and self-reliant 

individuals. As part of the community re-entry programming, women receive vocational training, job 

preparedness training, job placement services, referrals, and aftercare services. 

should form a linkage to the correctional 

facility so that substance abuse treatment 

counselors have the opportunity to “reach 

in” to women while they are still 

incarcerated. This prerelease connection 

helps to establish relationships with 

these women. 

 Address safety issues—women who have 

been in abusive situations may be returning 

to an abuser. Counselors should assess 

safety issues when women return to 

potentially violent environments, and a 

safety plan should be developed and 

implemented (see TIP 25, Substance Abuse 

Treatment and Domestic Violence [CSAT, 1997] 

for information on how to do this). Many 

women may be prevented from 

implementing vocational plans by an abusive 

partner, and this possibility should be 

addressed. In addition, it is important for the 

counselor to assess the safety of the client’s 

working environment or potential 

working environment. 

 Poor retention of women clients in 

community treatment programs is a widely 

reported problem. To increase retention, it is 

important to find or develop a gendersensitive program that offers a continuum of 

care, including aftercare. 

Barriers to Employment: 

What Society Brings to 

The Process 

Employers who are reluctant to hire people with 

histories of substance abuse can be even less 

enthusiastic about substance abusers with 

criminal records. Ex-offenders may be viewed 

as unreliable and morally deficient and feared as 

volatile and dangerous. When this attitude is 

combined with the lack of marketable skills and 

scant work experience common to many exoffenders, there seems to be little to recommend 

ex-offenders as employees. 

There is no Federal statute like the 

Americans with Disabilities Act (see Chapter 2) 

to protect ex-offenders against employment 

discrimination. Although there are rulings that 

prohibit employers from asking applicants about 

arrests,1 employers are free to ask about 

convictions. In fact, some employers have access 

to offender criminal records. For example, 

applicants’ criminal records may be screened by 

employers at any level in the public sector, by 

licensing agencies (and employment in a great 

number of occupations requires obtaining a 

license), by child care agencies, by educational 

institutions, by health care institutions, and by 

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Working With the Ex-Offender 

financial institutions. In fact, some employers 

may be required to ask about criminal history 

and to verify the information the offender 

supplies by checking official records. Which 

employers can (or must) obtain the criminal 

records of job applicants varies by State. 

Counselors and their clients should learn such 

information about prospective employers ahead 

of time so they can formulate strategies for 

addressing employers’ concerns (see Chapter 3 

for more information). 

There are ways employers can obtain 

information about applicants’ criminal records 

other than by obtaining official records. 

Employers can develop relationships with law 

enforcement officials and receive information 

“under the table.” Employers can also pay 

consumer reporting (or “credit” reporting) 

agencies for information about applicants’ 

criminal records and work histories. The 

Federal Fair Credit Reporting Act prohibits such 

agencies from reporting negative information 

that is more than 7 years old when an applicant 

has applied for a job paying less than $20,000 a 

year. Some States have Fair Credit Reporting 

laws that provide additional protections. 

Some States, such as New York, offer exoffenders explicit statutory protection against 

employment discrimination.2 New York’s 

statute (Article 23A of the Correction Law) 

makes it illegal to deny an ex-offender 

employment because of his criminal history 

unless the offender’s convictions are directly 

related to the job he seeks or his employment 

would create an unreasonable risk to the safety 

of people or property. The statute requires the 

employer to consider each ex-offender as an 

individual, weighing factors such as the specific 

duties and responsibilities of the job and the 

bearing, if any, that the offender’s criminal 

history has on his fitness to fulfill the duties and 

responsibilities of the job; the seriousness of the 

offense(s) committed; how long ago the 

offense(s) occurred and the individual’s age at 

the time; and any evidence of rehabilitation. 

While the statute is well drafted, in practice 

employers have wide latitude to reject exoffenders on the ground that their convictions 

are directly related to the jobs they seek or that 

their employment would pose an unreasonable 

risk to people or property. 

Unfortunately, once an ex-offender has been 

rejected by an employer, there is seldom legal 

recourse, even when statutory protections exist. 

It will be the rare ex-offender who can 

demonstrate that she was clearly the superior 

applicant for a particular job. Therefore, for the 

ex-offender, as for the person recovering from 

substance abuse disorders, the best strategy is 

similar to the “Ounce of Prevention” strategy 

outlined in Chapter 7. Counselors should help 

clients who are ex-offenders to 

 Focus on occupations and employers who do not 

bar ex-offenders. A job-seeker with two strikes 

against him (inexperience and a substance 

abuse history) should not make his search 

more difficult by targeting a job for which his 

criminal history will be a barrier. Counselors 

should be alert to the kinds of jobs that will 

be particularly difficult for clients to obtain. 

A client with a felony record who insists on 

seeking a job in law enforcement, for 

example, probably needs help recognizing 

that his quest is unattainable. He may also 

benefit from counseling that will help him 

understand that his focus is self-defeating. 

 Develop realistic goals. Clients with limited 

work experience often have unrealistic 

expectations about the kinds of jobs they can 

obtain. Often, they need exposure to the long 

view—the notion that people can start at a 

level commensurate with their current skills 

and experience history and work their way 

up to greater pay and responsibility as their 

skills increase and their work 

history accumulates. 

 Clean up official criminal histories (“rap sheets”). 

If an employer will have access to the ex161
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Chapter 8 

offender’s criminal record, it is a good idea 

for counselor and client to take a look at it 

before the prospective employer does. 

Offenders’ records frequently include 

mistakes that make their criminal histories 

look far more serious than they are. For 

example, the number of the statute the 

offender violated may be incorrect; a single 

digit can turn an assault into a conviction for 

bombing a building. A single offense may 

also be entered multiple times—when the 

offender was first arrested, when she was 

convicted, and when she was sentenced and 

incarcerated. Multiple entries for the same 

offense will appear to the employer to be 

entries for a series of crimes. Multiple entries 

can sometimes be combined, “shortening” 

the offender’s record. Finally, in some States, 

offenders can “seal” parts of their criminal 

records, so that some employers with access 

will not see the offenses. For example, 

arrests that did not result in a conviction can 

sometimes be expunged from a criminal 

record. The process for obtaining an 

offender’s criminal history, correcting errors, 

and “sealing” portions of the record varies 

by State. This process of cleaning up the exoffender’s record can also help the counselor 

engage her in developing a positive attitude 

toward counseling, as the process not only 

demonstrates the counselor’s interest in the 

client’s improved job prospects but also can 

yield immediate and tangible results. 

 Develop “smarts” about when to disclose a 

criminal record. Clients looking for a job 

should not volunteer negative information 

unless the employer has some other way to 

get it. For example, if a job applicant will be 

fingerprinted, it is usually a good idea for 

him to disclose his criminal record before the 

employer obtains it. 

 Learn and practice a statement that acknowledges 

a substance abuse and criminal history and offers 

evidence of rehabilitation. The statement that 

the client develops should address three 

important parts: 

1.	
 An acknowledgment that the client has a 

criminal record. The simple statement, 

“Yes, I have been convicted of drug 

possession,” is sufficient unless the 

employer asks for more. If the employer 

asks for more, the client should offer a 

brief but accurate summary of the facts. 

An employer does not usually need to 

know the full details. 

2.	
 The details of the criminal offense(s) (should 

the employer request them) without “letting 

it all hang out” and losing the employment 

opportunity. Counselors and clients alike 

should keep in mind that there is a 

difference between describing a criminal 

history to a 12-Step group and 

describing it to a prospective employer. 

3.	
 A brief explanation (should the client be 

asked) of her record that does not try to 

excuse it. A client should not profess 

innocence or claim she was unjustly 

convicted. Such statements are red flags 

for an employer, signaling that the client 

is not honest with herself or others. On 

the other hand, if the criminal record 

dates to the offender’s youth, she can 

mention that or other circumstances that 

might “explain” (but not excuse) the 

criminal behavior. 

The statement should then offer evidence 

that the ex-offender has overcome his problems 

and changed his life. The client should be 

prepared to provide facts to support the claim 

that he has mended his ways. For example, a 

client with a criminal record for drug possession 

could point out that he has been sober for a year, 

that his criminal activities were limited to the 

period he was abusing drugs, that he has 

successfully completed a rehabilitation program, 

and that his drug use history and criminal 

activities are behind him. A client who served 

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time for robbery could point to the efforts she 

made while in prison to prepare for a different 

future, such as taking academic or vocational 

courses, earning a degree, or participating in 

substance abuse treatment. Or, a client can tell 

the employer that since his release he has 

become active in his church choir or that he 

shovels snow for the elderly man next door. 

Evidence of change could also include written 

recommendations from community members, 

such as a minister, parole officer, or counselor. 

(Note that if the counselor at a substance abuse 

treatment program is asked to provide a 

reference, the client must sign a proper consent 

form, as discussed in Chapter 7.) 

¢ Develop a “statement of interest.” Job seekers 

who are competing with others who do not 

have criminal records should be prepared to 

tell an employer why they are particularly 

interested in a job and why they are qualified 

for it. For example, a client who is 

interviewing for a job as a stock-room clerk 

might say that she is interested in the 

employer’s business (be it hardware or toys), 

that she likes working in an environment 

where she is responsible for keeping track of 

inventory, and that she hopes, in time, to 

move up in the organization. Or, a client 

applying for a job as a car mechanic might 

mention that he has always been fascinated 

with cars and helped at a neighborhood 

repair shop when he was a teenager. The 

client making this kind of statement should 

avoid clichés and pat answers. To make the 

statement believable, the client must believe 

in the statement. A counselor can be 

particularly helpful to clients struggling to 

formulate goals and develop statements 

of interest. 

¢ Develop statements about other positive aspects of 

a client’s background. Counselors can help 

clients sift through their histories to uncover 

interests, skills, and experience to offer a 

particular employer. 

Working With the Ex-Offender 

Perhaps a client applying for a food-handling 

job has worked in a program’s kitchen 

during treatment. Another client seeking 

work with a landscaper might have earned 

money gardening during school vacations. A 

client who can offer enthusiasm, talent, or 

some related background is more likely to get 

a job than someone who simply presents 

herself as needing one. 

¢ See the problem from the employer’s point of view 

and learn to address the employer’s concerns. An 

employer may never have knowingly hired 

an ex-offender. The employer may feel that 

someone with a substance abuse and 

criminal history is, by definition, a “bad” 

person, someone who cannot be relied on to 

show up regularly, who cannot be trusted 

with money, who probably still uses drugs or 

alcohol, or who will inevitably relapse into 

drug use and criminal activity. 

During an interview, a client may have the 

opportunity to acknowledge that he is asking 

the employer to “take a chance” on him and 

to address the employer’s concerns directly. 

For example, an ex-offender could say, “I 

know this job carries a lot of responsibility 

and that you are probably concerned about 

whether I can handle it or whether I will start 

using drugs again. Well, I went into 

treatment and have been drug free for 2 

years. Once I entered treatment, I stopped 

getting into trouble.” Perhaps the client can 

offer a concrete example that shows that once 

she became sober her attitudes and actions 

changed; for example, she volunteered to 

work in a soup kitchen. Such steady work is 

evidence that she will reliably show up for 

work and pitch in. A reference letter from 

the organization running the soup kitchen 

could reduce a potential employer’s negative 

view of the ex-offender. 

¢ Deal with illegal questions such as “Have you 

ever been arrested?” Counselors can tell a 

client whose record includes both arrests and 

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Chapter 8 

convictions to respond by answering, “Yes,” 

and listing his convictions. A client who has 

been arrested but never convicted can 

respond in one of these ways: 

♦ “I have never been convicted of a crime.”

♦ “No,” but this is a lie and, for reasons

mentioned in Chapter 7, not a

good idea.

♦ “That’s an illegal question.” This is

bound to antagonize the employer

and raise the suspicion that the answer

is “yes.”

Program Strategies for Overcoming 

Barriers With Employers 

The following are strategies that substance abuse 

treatment programs can implement to help 

clients who are ex-offenders overcome barriers 

to employment. 

¢ Educate employers. Some treatment providers 

are implementing education programs for 

employer groups to help them understand 

some of the positive aspects of hiring exoffenders. Some providers have established 

Business Advisory Committees. 

¢ Provide job coaching on an employer’s site. If 

possible, substance abuse treatment 

programs should consider providing staff as 

job coaches to assist new employees in 

adapting to a new work culture (see Chapters 

2 and 3 for more information about 

job coaching). 

¢ Help clients to evaluate work environments. 

When an ex-offender is offered a job, 

counselors should help the client to assess 

whether the job provides a supportive 

environment for recovery from substance 

abuse disorders. 

Program Examples 

A report (Finn, 1999) described four programs 

across the country that prepare inmates and 

parolees for employment by providing intensive 

educational and life skills services, social 

support, and postemployment followup, in 

addition to traditional job preparation and 

placement assistance. These programs are (1) 

the Safer Foundation in Chicago, (2) the Center 

for Employment Opportunities (CEO) in New 

York City, (3) Project RIO (Reintegration of 

Offenders) in Texas, and (4) the Corrections 

Clearinghouse (CCH) in Washington State. 

Although each program is unique, they share 

program components that can be replicated by 

others. Basic services include life skills training, 

job preparation skills, job placement, social 

support, and followup assistance. With regard 

to providing support services and followup, all 

four programs devote resources to helping exoffenders address substance abuse, affordable 

housing, child care, emotional difficulties, and 

other barriers to securing and maintaining 

employment. These programs also follow up 

with clients after placement. See Figure 8-2 for a 

summary of the four programs. 

Endnotes 

1.	
 Title VII of the Civil Rights Act (29 U.S.C.

§2000e–2000e-17), which prohibits

employment discrimination based on race, 

has been interpreted to outlaw questions 

about an applicant’s arrests. This ruling is 

based on two premises: (1) Members of 

minority racial groups are arrested more 

often than whites, which means that this 

question tends to disqualify a 

disproportionate number of minority 

applicants, and (2) an arrest that has not 

resulted in conviction of a crime has little 

value as a test of character. A few States, 

such as New York, have adopted legislation 

that offers limited protection to ex-offenders 

from employment discrimination. Unlike 

the Federal laws protecting individuals with 

disabilities, however, the law permits 

employers to weigh an individual’s 

164 
Working With the Ex-Offender 

convictions against a set of factors in 

determining whether to hire him. 

Employers can weigh the disability in 

terms of whether or not the employer 

believes it means that the applicant cannot 

fulfill the “essential functions” of the job 

(and perhaps also that changes to the job 

situation would fundamentally alter 

management prerogatives). 

2. To learn more about State law—the

protections it offers and the available

remedies—providers can call the State or

local “human rights,” “civil rights,” or

“equal opportunity” agency. Local legal

services offices, law school faculties, or bar

associations may also have information

available or may be willing to provide a

lawyer to make a presentation to staff.

165 
Figure 8-2 

Summary of Program Examples 

Safer Foundation 

(Chicago) 

Center for Employment 

Opportunities (CEO) 

(New York) 

Project RIO 

(Texas) 

Corre

Orig inalObj ectives

To provide vocational training to inmates and to assist them in entering into unions and private industry after release 

To develop work crews that could offer day labor employment in neighborhoods where offenders were living 

To provide specialized employment services to ex-offenders to reduce recidivism 

To coordadult ofprison 

Prog ramCom ponents

(1) 200-bed work release centers where residents attend nine 90minute minicourses and basic reading and math skills courses using a small-group, peerlearning approach. (2) The PACE (Programmed Activities for Correctional Education) Institute, a private school that provides basic education and life skills courses (3) A coordinator closely supervises 200 trained volunteers who provide literacy tutoring and 65 who facilitate groups. 

(1) CEO assigns ex-offenders to day labor work crews. (2) Orientation includes four allday job readiness classes and a 90minute orientation to the work crews. 

(1) Funds for a prison school district for life skills courses, job readiness counseling, and help assembling needed documents (e.g., birth certificates, social security cards, school transcripts) (2) A 30-minute orientation to the RIO hotline number and the program that inmates attend on their release day (3) Assessment, placement, and followup services (4) Arrangements for employers to spend a day in prison talking to inmates about job opportunities 

(1) Sevecourses assessm(2) At th

Women

trades in

(3) CCH agencies center to to adult includinservices 

(4) A coin recovproblem

-

-

Dat a/Results (1) Improved GED scores by an 

average of 12.5 percent (2) Ninety-one percent of inmates improved basic skills test scores (3) Fifty-nine percent of those who found jobs remained on the job for at least 30 days 

(1) Average placement rate of 70 percent (2) Half of those who remained on the job for 1 month were still on the same job at 6 months (3) In 1996, the average hourly wage of placed participants was nearly 50 percent higher than minimum wage 

(1) In 1995, almost 74 percent of clients were employed at an average of 21 percent above minimum wage. (2) At 1 year after release, 69 percent were employed, compared with 36 percent of non-RIO parolees. (3) Of minority clients, 66 percent found employment compared with 30 percent of African Americans and 36 percent of Hispanos/Latinos who were not enrolled. (4) Forty-eight percent of RIO clients were rearrested during the year after release, compared with 57 percent of non-RIO parolees. 

(1) In 19complet(2) Ex-O offenderwork anstill emp(3) Recidafter 1 ywith 10 years, refor Ex-O percent 

166 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Appendix A 

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employment programs. In: Wehman, P., and 

Moon, M.S., eds. Vocational Rehabilitation and 

Supported Employment. Baltimore, MD: 

Brookes, 1988. pp. 235–250. 

Shaw, L.R.; MaGillis, P.W.; and Dvorchik, K.M. 

Alcoholism and the Americans With 

Disabilities Act: Obligations and 

accommodations. Rehabilitation Counseling 

Bulletin 38(2):108–113, 1994. 

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Appendix A 

Sherman, L.W.; Gottfredson, D.; MacKenzie, D.; 

Eck, J.; Reuter; P.; and Bushway, S. 

Preventing Crime: What Works, What Doesn't, 

What's Promising. Washington, DC: The 

National Institute of Justice, 1998. 

Strawn, J. Substance abuse and welfare reform 

policy. Welfare Information Network Issue Notes 

1(1), 1997. 

Substance Abuse and Mental Health Services 

Administration (SAMHSA). Preliminary 

Results From the 1997 National Household 

Survey on Drug Abuse. Fact Sheet. Rockville, 

MD: SAMHSA, 1998a. 

Substance Abuse and Mental Health Services 

Administration (SAMHSA), Office of 

Applied Studies. National Household Survey 

on Drug Abuse. HHS Pub. No. (SMA) 97-

3149. Rockville, MD: SAMHSA, 1998b. 

Suffet, F., and Brotman, R. Employment and 

social disability among opiate addicts. 

American Journal of Drug and Alcohol Abuse 

3:387–395, 1976. 

Syzmanski, E.; Ryan, C.; Merz, M.; Trevino, B.; 

and Johnston-Rodriguez, S. Psychosocial and 

economic aspects of work: Implications for 

people with disabilities. In: Syzmanski, E.M., 

and Parker, R.M., eds. Work and Disability: 

Issues and Strategies in Career Development and 

Job Placement. Austin, TX: Pro-Ed, 1996. 

Teplin, L.A.; Abram, K.M.; and McClelland, 

G.M. Prevalence of psychiatric disorders 

among incarcerated women. I. Pretrial jail 

detainees. Archives of General Psychiatry 

53(6):505−512, 1996. 

Terkel, S. Working. New York: Ballentine, 1985. 

U.S. Department of Health and Human Services 

(HHS), Administration for Children and 

Families, Substance Abuse and Mental 

Health Services Administration, Office of the 

Assistant Secretary for Planning and 

Evaluation (ASPE). Blending Perspectives and 

Building Common Ground: A Report to Congress 

on Substance Abuse and Child Protection. 

Washington, DC: U.S. Government Printing 

Office, 1999a. 

U.S. Department of Health and Human Services, 

Administration for Children and Families. 

Change in Welfare Caseloads as of September 

1998. Washington, DC: U.S. Department of 

Health and Human Services, 1999. 

U.S. Department of Health and Human Services 

(HHS), Office of the Assistant Secretary for 

Planning and Evaluation (ASPE); National 

Institute on Drug Abuse. Substance Abuse 

Among Women and Parents. Washington, DC: 

HHS/ASPE, 1994a. 

U.S. Department of Health and Human Services 

(HHS), Office of the Assistant Secretary for 

Planning and Evaluation (ASPE); National 

Institute on Drug Abuse. Patterns of 

Substance Use and Program Participation. 

Washington, DC: HHS/ASPE, 1994b. 

17
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Health/National Institute on Drug Abuse; and 

the Substance Abuse and Mental Health 

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Participants in the Aid to Families With 

Dependent Children Program (AFDC). 

Washington, DC: HHS/ASPE, 1994c. 

U.S. Department of Justice (DOJ), Office of 

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Appendix A 

Vobejda, B., and Havemann, J. States’ welfare 

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Wellisch, J.; Anglin, M.D.; and Prendergast, M.L. 

Numbers and characteristics of drug-using 

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Wickizer, T.; Joesch, J.; Longhi, D.; Krupski, A.; 

and Stark, K. Employment Outcomes of 

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Substance Abuse and Mental Health Services 

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Wolkstein, E., and Bausch, R.B. “Method of 

employment counseling.” Unpublished 

document, 1998. 

Wolkstein, E., and Hastings-Black, D. 

Vocational rehabilitation. In: Dupont, R.L.; 

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eds. Handbook on Drug Abuse. Rockville, MD: 

National Institute on Drug Abuse, 1979. pp. 

159–164. 

Wolkstein, E., and Spiller, H. Providing 

vocational services to clients in substance 

abuse rehabilitation. Directions in 

Rehabilitation Counseling 9:65–78, 1998. 

Woolis, D.D. Family works: Substance abuse 

treatment and welfare reform. Public Welfare 

56(1):24–32, 1998. 

Wright, G.N. Total Rehabilitation. Boston: Little, 

Brown, 1995. 

Young, N.K. Invest in Treatment for Alcohol and 

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DC: National Association of State Alcohol 

and Drug Abuse Directors, 1994. 

Young, N.K. Alcohol and Other Drug Treatment: 

Policy Choices in Welfare Reform. Rockville, 

MD: Center for Substance Abuse Treatment, 

1996. 

Young, N.K., and Gardner, S.L. Implementing 

Welfare Reform: Solutions to the Substance Abuse 

Problem. Irvine, CA: Children and Family 

Futures; and Washington, DC: Drug 

Strategies, 1997. 

Young, N.K.; Gardner, S.L.; and Dennis, K. 

Responding to Alcohol and Other Drug Problems 

in Child Welfare: Weaving Together Practice and 

Policy. Washington, DC: Child Welfare 

League of America, 1998. 

Zadny, J.J., and James, L.F. Job placement of the 

vocationally handicapped: A survey of 

technique. Studies in Placement. Monograph 

No. 2, Job Development for the 

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Rehabilitation Research Institute, School of 

Social Work, Portland State University, 1977. 

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Appendix B 

Resources: Tools and Instruments 

Title: Addiction Severity Index Package 

Purpose: To evaluate client functioning in seven life areas: employment, medical, alcohol 

use, drug use, legal, family/social, and psychiatric; often used as an outcome 

measure before and after treatment. 

Target Population: Substance abuse disorder and mental health clients (adult version) 

Administration: Both clinician-administered and client self-administered forms; paper and pencil 

and software versions are available. 

Test/Scoring Time: Approximately 60 minutes 

Price: $63 (kit includes 240-page manual and 2-hour VHS video) 

Some ASI materials may be distributed without cost. See Appendix D for one version of 

this instrument. 

Available From: National Technical Information Service (NTIS) Order Desk 

5285 Port Royal Road 

Springfield, VA 22161 

(888) 584-8332 Fax: (703) 605-6900 

www.ntis.gov. 

E-mail: info@ntis.fedworld.gov 

Also available from: Delta Metrics 

2005 Market Street, Suite 1120 

Philadelphia PA 19103 

(215) 665-2880, (215) 665-2892 

For SOFTWARE versions of ASI (Adult and Adolescent versions, and Treatment Plans), 

contact: 

Accurate Assessments 

183 Harney, Ste. 101 

Omaha, NE 68102 

(800) 324-7960 

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Appendix B 

Title: (ABLE) 

Authors: Bjorn Karlsen, Eric F. Gardner 

Purpose: Measures adult learning in a variety of adult education programs, including Tech 

Prep programs, GED programs, and adult literacy programs. 

Target Population: Adults 

Administration: Designed for classroom use. Consists of 3 levels: level 1 for adults who have 

completed 1–4 years of formal education; level 2 for adults with 5–8 years of 

schooling; level 3 for adults with at least 8 years of schooling and who may or 

may not have graduated from high school. A Spanish version of level 2 is 

available as well. Related products are available. 

Test/Scoring Time: Untimed; each level averages 2 hours, 40 minutes. ABLE Screening Battery 

averages about 1 hour. 

Price: $55.75 (kit includes level 1, 2, 3 test booklets, directions for administering, group 

record, hand-scorable answer sheet, READY SCORE answer sheet, and Selectable 

READY SCORE answer sheet) 

Available From: The Psychological Corporation 

555 Academic Court 

San Antonio, TX 78204 

Attn: Clinical Sales 

(800) 211-8378 Fax: (800) 232-1223 

www.psychcorp.com 

Title: Career Attitudes and StrategiesTM (CASI): An Inventory for Understanding 

Adult Careers (1994) 

Authors: John L. Holland, Ph.D.; Gary D. Gottfredson, Ph.D. 

Purpose: Assesses attitudes related to career, identifies career problems and obstacles in 

employed and unemployed adults. 

Target Population: Adults 

Administration: Self-administered; individual 

Test/Scoring Time: 35 minutes 

Price: $75 (introductory kit includes manual, 25 inventory booklets, 25 hand-scorable 

answer sheets, and 25 interpretive summary booklets) 

Available From: Psychological Assessment Resources, Inc. 

P.O. Box 998 

Odessa, FL 33556 

(800) 331-TEST 

www.parinc.com 

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Resources 

Title: Career Thoughts InventoryTM (CTI) (1996) 

Authors: James P. Sampson, Jr., Ph.D.; Gary W. Peterson, Ph.D.; Janet G. Lenz, Ph.D.; 

Robert C. Reardon, Ph.D.; Denise E. Saunders, M.S. 

Purpose: Assists in career problemsolving and decisionmaking; assesses for and alters 

negative career thinking. 

Target Population: Adults, college students, and high school students 

Administration: Individual or group 

Test/Scoring Time: 7–15 minutes 

Price: $89 (kit includes CTI professional manual, 5 workbooks, 25 test booklets) 

Available From: Psychological Assessment Resources, Inc. 

P.O. Box 998 

Odessa, FL 33556 

(800) 331-TEST 

www.parinc.com 

Title: Crawford Small Parts Dexterity Test (CSPDT) 

Author: John Crawford 

Purpose: Tests manual dexterity. 

Administration: The two-part, pegboard-type test uses a wooden board with separate wells for 

pins, collars, and screws. 

Test/Scoring Time: 3 minutes for part 1; 5 minutes for part 2. 

Price: Kit: $564.10 (Canadian) 

Manual: $22.44 (Canadian) 

Available From: M.D. Angus & Associates Ltd. 

2639 Kingsway Avenue, 2nd floor 

Port Coquitlam, BC V3C 1T5 

Canada 

(604) 464-7919 Fax: (604) 941-1705 

www.psychtest.com 

Title: Geist Picture Interest Inventory 

Author: Harold Geist, Ph.D. 

Purpose: Identifies vocational and avocational interests, especially with culturally different 

and educationally deprived persons. 

Target Population: Grade 8 through adult 

Administration: Individually or to groups 

Test/Scoring Time: Scoring takes a few minutes. 

Price: $78.50 (kit includes test booklets for males and females, and manual) 

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Appendix B 

Available From: 

Title: 

Purpose:



Target Population: 

Administration: 

Test/Scoring Time: 

Price: 

Available From: 

Title: 

Author: 

Purpose:



Target Population: 

Price: 

Available From: 

Western Psychological Services 

12031 Wilshire Blvd. 

Los Angeles, CA 90025 

(800) 648-8857 Fax: (310) 478-7838 

General Aptitude Test Battery (GATB) 

Measures 9 aptitudes with 12 separate tests. The last five tests involve 

pegboards. 

Grade 9 to adult 

Comprises two test booklets with four separately sold answer sheets and two 

pegboards (small parts and gross motor). May be administered to small groups, 

except for the small parts and gross motor test. The pegboards are expensive and 

relatively difficult to administer. Their use may be warranted if residual 

neurological impairment is suspected (e.g., in recovering alcoholics). 

1 hour 

Test booklets: $71.50 each 

Prices of answer sheets and pegboards may be viewed in online catalog.

M.D. Angus & Associates Ltd. 

2639 Kingsway Avenue, 2nd floor 

Port Coquitlam, BC V3C 1T5 

Canada 

(604) 464-7919 Fax: (604) 941-1705 

www.psychtest.com 

Kuder Occupational Interest Survey (KOIS) 

Frederic Kuder 

Assesses interest of students and adults in areas related to higher education and 

occupations. 

Grade 10 through adult 

$135.10 (package includes 20 books with items and response section, complete 

scoring, individual narrative reports, counselor’s narrative reports, instructions; 

manual sold separately) 

CTB/McGraw-Hill 

20 Ryan Ranch Road 

Monterey, CA 93940 

(800) 538-9547 Fax: (800) 282-0266 

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Resources 

Title: System 2000 (formerly Microcomputer Evaluation Screening and 

Assessment [MESA] System) 

Purpose: A modular software system for IBM-compatible personal computers, including a 

career planner, census database, computerized assessment, competencies 

database, dictionary of occupational titles (DOT), and more. Modules can be 

purchased separately. 

Price: Varies by module (e.g., system manager, $300; computerized assessment, $3,875; 

DOT database, $1,015) 

Available From: Valpar International Corporation 

P.O. Box 5767 

Tucson, AZ 85703-5767 

(800) 528-7070 Fax: (520) 292-9755 

www.valparint.com 

Title: Minnesota Clerical Test (MCT) (1979) 

Authors: Dorothy Andrew, et al. 

Purpose: Measures aptitude for office work such as bookkeeping, filing. 

Price: Examination kit: $41.67 (Canadian) 

Booklets (25): $102.56 (Canadian) 

Manual: $35.26 (Canadian) 

Scoring key: $32.05 (Canadian) 

Available From: M.D. Angus & Associates Ltd. 

2639 Kingsway Avenue, 2nd floor 

Port Coquitlam, BC V3C 1T5 

Canada 

(604) 464-7919 Fax: (604) 941-1705 

www.psychtest.com 

Title: My Vocational Situation (MVS) 

Authors: John L. Holland, Ph.D.; Denise Daiger; Paul G. Power 

Purpose: Helps determine lack of vocational identity, lack of information or training, or 

emotional or personal barriers. 

Target Population: Adults 

Administration: Self-administered 

Test/Scoring Time: Less than 10 minutes; can be tabulated “at a glance” 

Price: $25 (kit includes manual and 50 questionnaires) 

Available From: Psychological Assessment Resources, Inc. 

P.O. Box 998 

Odessa, FL 33556 

(800) 331-TEST 

www.parinc.com 

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Appendix B 

Title: Peabody Picture Vocabulary Test (PPVT-III) 

Purpose: Measures listening comprehension for spoken words in standard English, 

provides a screening test of verbal ability. 

Target Population: 2.5–90+ years 

Administration: Individually administered 

Test/Scoring Time: 11–12 minutes 

Price: $149.50 for basic kit; other related products available at various prices. 

Available From: AGS/American Guidance Service 

4201 Woodland Road 

Circle Pines, MN 55014-1796 

(800) 328-2560 or (612) 786-4343 Fax: (800) 471-8457 or (612) 786-9077 

E-mail: agsmail@agsnet.com 

Title: Psychological Screening Inventory 

Author: Richard I. Lanyon, Ph.D. 

Purpose: Provides brief, nonthreatening mental health screening. Identifies people who 

might benefit from more extensive examination. 

Target Population: Adults and adolescents 

Administration: Individual or group 

Test/Scoring Time: 15 minutes 

Price: $49 (includes manual, question and answer sheets, scoring templates, and profile 

sheets) 

Available From: Sigma Assessment Systems, Inc. 

511 Fort Street, Suite 435 

P.O. Box 610984 

Port Huron, MI 48061-0984 

(800) 265-1285 Fax: (800) 381-9411 

Title: Reading-Free Vocational Interest Inventory (R-FVII) 

Author: Ralph L. Becker, Ph.D. 

Purpose: Measures vocational interests, likes, and dislikes of special populations. 

Target Population: Learning disabled, mentally retarded, and disadvantaged individuals ages 13 

and older 

Administration: Individual or group 

Test/Scoring Time: 20 minutes 

Price: $84 (introductory kit includes manual, occupational title lists, and 20 test 

booklets) 

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Resources 

Available From: Psychological Assessment Resources, Inc. 

P.O. Box 998 

Odessa, FL 33556 

(800) 331-TEST 

www.parinc.com 

Title: Revised Beta Examination (Beta II) 

Authors: C.E. Kellogg, N.W. Morton 

Price: $153.85 (Canadian) (kit includes booklets, key, manual) 

Available From: M.D. Angus & Associates Ltd. 

2639 Kingsway Avenue, 2nd floor 

Port Coquitlam, BC V3C 1T5 

Canada 

(604) 464-7919 Fax: (604) 941-1705 

www.psychtest.com 

Title: Self-Directed Search® (SDS®) (several versions available) 

Author: John L. Holland, Ph.D. 

Purpose: Assesses vocational interests and long-term career planning. 

Target Population: Individuals on the career-development track 

Administration: Self-administered; individual or group 

Test/Scoring Time: 15–25 minutes 

Price: $133 (for Form CP: Career Planning) (introductory kit includes professional 

user’s guide, technical manual, 25 form CP assessment booklets, 25 career options 

finders, and 25 exploring career options booklets) 

Available From: Psychological Assessment Resources, Inc. 

P.O. Box 998 

Odessa, FL 33556 

(800) 331-TEST 

www.parinc.com 

Title: Slosson Intelligence Test-Revised (SIT-R) 

Authors: Richard L. Slosson, Ph.D. Revised by Charles L. Nicholson, Ph.D., Terry L. 

Hibpshman, Ph.D. 

Purpose: Provides a quick, reliable measure of intelligence to determine if further, in-depth 

evaluation is needed. Slosson Full-Range Intelligence Test (S-FRIT) (1993) is 

also available from source listed below ($119/kit). 

Target Population: Ages 4 years and older 

Administration: Individual 

Test/Scoring Time: 10–30 minutes 

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Appendix B 

Price: 

Available From: 

Title: 

Purpose: 

Target Population: 

Administration: 

Test/Scoring Time: 

Price: 

Available From: 

Title: 

Authors: 

Purpose: 

Target Population: 

Administration:



Test/Scoring Time: 

Price: 

Available From: 

Title: 

Author: 

Purpose:



Target Population:



Administration: 

$91 (introductory kit includes manual, norm tables, and 50 score sheets) 

Psychological Assessment Resources, Inc. 

P.O. Box 998 

Odessa, FL 33556 

(800) 331-TEST 

www.parinc.com 

Strong Interest Inventory 

Measures interest in a broad range of occupations, work activities, leisure 

activities, and school subjects. 

Clients interested in career development or job change, as well as students 

exploring careers 

Licensed therapist or other professional trained in testing administration 

30–40 minutes (317 items) 

Several versions available ranging from $69 to $135. Applications and technical 

guide: $57.75 

Consulting Psychologists Press, Inc. (CPP) 

3803 East Bayshore Road 

Palo Alto, CA 94303 

(800) 624-1765 Fax: (650) 969-8608 

Tennessee Self-Concept Scale (TSCS:2) 

William H. Fitts, Ph.D.; W.L. Warren, Ph.D. 

Measures self-concept in adolescents, adults, and children. 

Adolescents, adults, children 

Individual or group 

10–20 minutes 

$130 (kit includes manual, answer forms, and 4 prepaid mail-in answer sheets) 

Western Psychological Services 

12031 Wilshire Boulevard 

Los Angeles, CA 90025 

(800) 648-8857 Fax: (310) 478-7838 

Vocational Preference InventoryTM (VPI) (1985) 

John L. Holland, Ph.D. 

Assesses career interests through a brief personality/interest inventory based on 

the RIASEC personality theory. 

Adults and older adolescents 

Self-administered



186
 

 

 

 

 

 

 

 

 

 

 

 

Resources 

Test/Scoring Time: 15–30 minutes 

Price: $44 (introductory kit includes manual and 25 test booklet/answer sheet/profile 

combinations) 

Available From: Western Psychological Services 

12031 Wilshire Boulevard 

Los Angeles, CA 90025 

(800) 648-8857 Fax: (310) 478-7838 

Title: Wechsler Adult Intelligence Scale (WAIS-III) 

Author: David Wechsler 

Purpose: The most widely used ability assessment instrument; results reflect age and 

abilities of today’s population. 

Target Population: Ages 16–89 

Administration: Individual 

Price: $625 (complete set includes administration and norms manual, technical manual, 

stimulus booklet, record forms, response booklets, object assembly subtest, block 

design subtest, picture arrangement subtest, and scoring templates) 

Available From: The Psychological Corporation 

555 Academic Court 

San Antonio, TX 78204 

Attn: Clinical Sales 

(800) 211-8378 Fax: (800) 232-1223 

www.psychcorp.com 

Title: Wide Range Achievement Test 3 (WRAT3) 

Author: Gary S. Wilkinson, Ph.D. 

Purpose: Measures development of reading, spelling, and arithmetic skills. New 

standardization of this widely used test yields all new grade ratings. 

Target Population: Ages 5–75 

Administration: Individual or group 

Test/Scoring Time: 15–30 minutes 

Price: $142 (introductory kit includes manual, 25 blue test forms, 25 tan test forms, 25 

profile/analysis forms, plastic word list cards, and soft canvas carrying case) 

Available From: Psychological Assessment Resources, Inc. 

P.O. Box 998 

Odessa, FL 33556 

(800) 331-TEST 

www.parinc.com 

187
 

 

 

 

 

 

 

 

 

 

 

 

Appendix B 

Title: 

Author: 

Purpose: 

Target Population: 

Administration: 

Price: 

Available From: 

Title: 

Purpose: 

Target Population: 

Administration: 

Test/Scoring Time: 

Price: 

Available From: 

Title: 

Purpose: 

Target Population: 

Administration: 

Test/Scoring Time: 

Price: 

Wide Range Interest-Opinion Test (WRIOT) (1979) 

Joseph F. Jastak, Ph.D.; Sarah Jastak, Ph.D. 

Culturally and sexually unbiased pictorial interest test for vocational career 

planning and counseling. No reading or language understanding required. 

Ages 5 through adult 

Individually or in groups (individual administration is necessary for those too 

limited by age, mental ability, or physical limitations to complete the answer 

sheet). Self-loading IBM scoring package available. 

$150 (starter set includes manual profile/report, picture book, answer sheets, 

scoring stencils, attaché case) 

Wide Range, Inc. 

15 Ashley Place, Suite 1A 

Wilmington, DE 19804-1314 

(800) 221-9728 Fax: (302) 652-1644 

Wonderlic Basic Skills TestTM (WBST) 

Measures job-related math and language skills to identify basic skill levels of job 

applicants and employees. 

Teenagers and adults 

Individual 

20 minutes 

$115 (introductory kit includes user’s manual, 25 verbal tests, 25 quantitative 

tests, and scoring diskette with 25 uses for each test) 

Psychological Assessment Resources, Inc. 

P.O. Box 998 

Odessa, FL 33556 

(800) 331-TEST 

www.parinc.com 

Work Potential Profile (WPP) 

Identifies current characteristics and dispositions of older adolescents and adults 

seeking employment. Provides a criterion-referenced profile for the initial 

assessment of long-term unemployed persons and persons who have difficulty 

finding employment. 

Adolescents and adults 

Individual or group; self-administered 

Untimed 

$150 (introductory kit includes manual, 10 WPP questionnaires, 10 WPP answer 

sheets, 10 WPP group summary forms, 10 individual summary forms, and 8 

score keys) 

188
 

 

Resources 

Available From: Psychological Assessment Resources, Inc. 

P.O. Box 998 

Odessa, FL 33556 

(800) 331-TEST 

www.parinc.com 

189

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Appendix C 

Published Resource Materials 

Bolles, R.N. The 1999 What Color Is Your 

Parachute: A Practical Manual for Job-Hunters 

and Career-Changers. Berkeley, CA: Ten 

Speed Press, 1998. 

Brown, C.; McDaniel, R.; Couch, R.; and 

McClenahan, M. Vocational Evaluation 

Systems and Software: A Consumer’s Guide. 

Menomonie, WI: University of WisconsinStout, 1994. 

Farley, R.C. Developing and Enhancing Interview 

Skills: A Supplemental Manual for the 

Interviewing Skills Training Workshop. Hot 

Springs, AR: Arkansas Research and Training 

Center on Vocational Rehabilitation, 1983. 

Hinman, S.; Means, B.; Parkerson, S.; and 

Odendahl, B. Manual for the Job-Seeking Skills 

Assessment. Hot Springs, AR: Arkansas 

Research and Training Center on Vocational 

Rehabilitation, 1988. 

Holland, J.L. Self-Directed Search (SDS) Form R, 

4th ed. Tampa, FL: Psychological 

Assessment Resources, Inc. 1997. 

Kapes, J.T.; Mastie, M.M.; and Whitfield, E.A. 

Counselor’s Guide to Career Assessment 

Instruments, 3rd ed. Alexandria, VA: 

American Counseling Association, 1994. 

Matrix Research Institute. (many publications) 

6008 Wayne Avenue, Philadelphia, PA 19144. 

Tel: (215) 438-8200; Fax: (215) 438-8337; TDD: 

(215) 438-1506.

National Institute on Drug Abuse. Assessing 

Client Needs Using the ASI: A Handbook for 

Program Administrators. Washington, DC: 

U.S. Government Printing Office, 1995. 

Power, P.W. A Guide to Vocational Assessment, 

2nd ed. Austin, TX: PRO-ED, 1991. 

U.S. Department of Labor. Manual for the General 

Aptitude Test Battery, Section III: Development. 

Washington, DC: U.S. Government Printing 

Office, 1970. 

U.S. Department of Labor. Guide for Occupational 

Exploration. Washington, DC: U.S. 

Government Printing Office, 1979. 

U.S. Department of Labor. Instructions for 

Administering and Using the Interest Check List. 

Washington, DC: U.S. Government Printing 

Office, 1979. 

U.S. Department of Labor. Manual for the USES 

Interest Inventory. Minneapolis, MN: Intran 

Corporation, 1982. 

191
 

 

 

Appendix C 

Software 

Open Options for Windows. Order from Career 

Planning Specialists Software, Inc., 362 S. 

Harvey St., Plymouth, MI 48170. Voice:

(313) 459-7348. Fax: (313) 459-9833. 

Center for Substance Abuse Prevention (CSAP) 

Prevention Works! Software.

192
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Appendix D 

Addiction Severity Index 

GENERAL INFORMATION 

G1. Client ID: 

G2. Social Security Number: 

G3. Provider Number: 

G4. Date of Admission: 

G5. Date of Interview: 

G6. 

G51. 

G52. 

Time Begun: 

Who referred you for an evaluation? 

1 Attorney 

3 Presentence Investigator 

5 Judge or Court 

The referral source’s name: 

2 

4 

6 

Probation/Parole Officer 

Self 

Other 

G53. Address: 

Phone number: 

G54. Why are you receiving this assessment? (1−6) 

1 OWI or DWI 4 Other criminal arrest 

2 Court ordered 5 Self interest 

3 Attorney recommended 6 Other 

G55. BAC: 

G56. By whom was it ordered (1-4)? 

1 Judge 3 Presentence 

2 Probation 4 Parole 

Specify other: 

G8. Class: 

1 Intake 2 Followup 

G9. Contact code: 

1 In person 2 Phone 

3 Mail 

G57. Interviewer’s initials: 

193
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Appendix D 

G10. Gender: 

G12. Special: 

1 Terminated 2 Refused 

3 Unable to respond X Not applicable 

Client first name: 

Client middle name: 

Client last name: 

Client’s address: 

Address: 

Address: 

Phone number: 

G15. Is this address owned by you or your family? (Y/N): 

G16. Date of birth: 

G17. Of what race do you consider yourself? 

1 White (Not of Hispanic Origin) 2 Black (Not of Hispanic Origin) 

3 American Indian 4 Alaskan Native 

5 Asian or Pacific Islander 6 Hispanic – Mexican 

7 Hispanic – Puerto Rican 8 Hispanic – Cuban 

9 Other Hispanic 

G18.	
 Religious preference: 

1 Protestant 2 Catholic 

3 Jewish 4 Islamic 

5 Other 6 None 

G58.	
 Specify other religion: 

G19.	
 Have you been in a controlled environment in the past 30 days? 

1 No 2 Jail 

3 Alcohol or drug treatment 4 Medical treatment 

5 Psychiatric treatment 6 Other 

G20. How many days? 

MEDICAL STATUS 

M1. How many times in your life have you been hospitalized for medical problems? 

Include ODs, DTs, exclude detox. 

M2. How long ago was your last hospitalization for a physical problem? _____ years _____ months 

M51. What was it for? 

M3. Do you have any chronic medical problems that continue to interfere with your life? (Y/N) 

Specify: 

M4. Are you taking any prescribed medication on a regular basis for a physical problem? (Y/N) 

M52. What is it? 

M53. What is it for? 

M5. Do you receive financial compensation (pension, disability, etc.) for a physical disability? (Y/N) 

Specify: 

M6. How many days have you experienced medical problems in the past 30 days? 

194
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Addiction Severity Index 

M7. How troubled or bothered have you been by these medical problems in the past 30 days? 

0 – Not at all 1 – Slightly 2 – Moderately 3 – Considerably 4 – Extremely 

M8. How important to you now is treatment for these medical problems? 

0 – Not at all 1 – Slightly 2 – Moderately 3 – Considerably 4 – Extremely 

The questions below are to be answered by the interviewer only. 

M9.	
 How would you rate the patient’s need for medical treatment? 

0 – None necessary, to 9 – Treatment needed to intervene in life-threatening situation 

Is the medical status information significantly distorted by: 

M10. Patient’s misrepresentation (Y/N)? 

M11. Patient’s inability to understand (Y/N)? 

EMPLOYMENT/SUPPORT STATUS 

E1. Education completed (GED = 12 years): _______ years, _______ months



E2. Training or technical education completed: _______ months



E3. Do you have a profession, trade, or skill? (Y/N):



E4. Do you have a valid driver’s license? (Y/N):



E5. Do you have an automobile available? (Y/N): 

Answer “No” if no valid driver’s license. 

E6. How long was your longest full-time job? _______ years, _______ months 

E7. Usual (or last) occupation: 

1 1. a. Higher Executives 

2 1. b. Large Proprietors (Value over $180,000) 

3 1. c. Major Professionals 

4 2. a. Business Managers 

5 2.	
 b. Proprietors of Medium-Sized Businesses 

6 3. a. Administrative Personnel 

7 3. b. Proprietors of Small Businesses (less than $55,000) 

8 3. c. Minor Professionals 

9 3. d. Farmers (Owners $41,000 to $60,000) 

10 4. a. Clerical and Sales Workers 

11 4. b. Technicians 

12 4. c. Proprietors of Little Business (less than $10,000) 

13 4. d. Farmers (Owners $21,000 to $40,000) 

14 5.	
 a. Skilled Manual Employees and Small Farmers 

15 5. b. Small Farmers (Owners less than $20,000) 

16 6.	
 a. Machine Operators and Semi-Skilled Employees 

17 6. b. Small Farm Tenants 

18 7. Unskilled Employees 

Specify: 

E8. Does someone contribute to your support in any way? (Y/N) 

Specify: 

195
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Appendix D 

E9. Does this constitute the majority of your support? (Y/N): 

E10. Employment status: 

1 full time (35 hrs/week) 2 part time (reg. hrs) 

3 part time (irreg., daywork) 4 student 

5 service 6 retired/disability 

7 unemployed 8 in controlled environment 

E11. How many days were you paid for working in the last 30 days? _______ days 

How much money did you receive from the following sources in the past 30 days? 

E12. Employment (net income) 

E13. Unemployment compensation 

E14. Welfare 

E15. Pension, benefits, or social security 

E16. Mate, family, or friends 

E17. Illegal 

E51. What was your gross income last year? 

E18. How many people depend on your for the majority of their food, shelter, etc.? 

E19. How many days have you experienced employment problems in the past 30 days? 

E20. How troubled or bothered have you been by these employment problems in the past 30 days? 

0 – Not at all 1 – Slightly 2 – Moderately 3 – Considerably 4 – Extremely 

E21. How important to you now is counseling for these employment problems? 

0 – Not at all 1 – Slightly 2 – Moderately 3 – Considerably 4 – Extremely 

The questions below are to be answered by the interviewer only. 

E22.	
 How would you rate the patient’s need for employment counseling? 

0 – None necessary, to 9 – Treatment needed to intervene in life-threatening situation 

Is the employment/support status information significantly distorted by: 

E23. Patient’s misrepresentation (Y/N)? 

E24. Patient’s inability to understand (Y/N)? 

DRUG/ALCOHOL USE 

D51. At what age did you first try alcohol or drugs? 

D52. What was it? 

Past 30 Lifetime Route of 

Days Yrs. Administration 

D1. Alcohol—any use at all 

D2. Alcohol—to intoxication Route of 

D3. Heroin Administration: 

D4. Methadone 1 – Oral 

D5. Other opiates and analgesics 2 – Nasal 

D6. Barbiturates 3 – Smoking 

D7. Other sed/hyp/tranq 4 – Non IV injection 

196
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Addiction Severity Index 

D8. Cocaine 5 – IV injection 

D9. Amphetamines 

D10. Cannabis 

D11. Hallucinogens 

D12. Inhalants 

D13. More than one per day 

(including alcohol) 

D53. Have you ever used a needle to administer any of these drugs? (Y/N) 

D54. Are you an I.V. drug user? (Y/N) 

D14. According to the interviewer, which substance(s) are the major problem (0−16)? 

00—No problem 08—Cocaine 

01—Alcohol any use 09—Amphetamines 

02—Alcohol to intox 10—Cannabis 

03—Heroin 11—Hallucinogens 

04—Methadone 12—Inhalants 

05—Opiates/analgesics 13—Alcohol and one or more drugs 

06—Barbiturates 14—More than one drug 

07—Other sed/hyp/tranq 

D15. How long was your last period of voluntary abstinence from this major substance (substance 

identified in D14)? _______ months, 00—never abstinent 

D16. How many months ago did this abstinence end? _______ months, 00—still abstinent 

How many times have you: 

D17. Had alcohol DTs? 

D18. Overdosed on drugs? 

How many times in your life have you been treated for: 

D19. Alcohol abuse? 

D20. Drug abuse? 

How many of these were for detox only? 

D21. Alcohol? 

D22. Drug? 

D55. How long ago were you last in treatment? _______ years, _______ months 

D56. Name of center: 

D57. Address: 

D58. Type of treatment: 1—Inpatient, 2—Outpatient 

D59. How long did it last? days 

D60. Did you complete it successfully? (Y/N) 

D61. Have you been evaluated for alcohol or drugs before today? (Y/N) 

D62. Where? 

When? 

How much money would you say you spent during the past 30 days on: 

D23. Alcohol? 

Drugs? 

D25.	
 How many days have you been treated in an outpatient setting for alcohol or drugs in the 

past 30 days (include NA, AA)? days 

197
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Appendix D 

D26. Alcohol problems? 

D27. Drug problem? 

How troubled or bothered have you been in the past 30 days by these: 

0 – Not at all 1 – Slightly 2 – Moderately 3 – Considerably 4 – Extremely 

D28. Alcohol problems? 

D29. Drug problems? 

How important to you now is treatment for these: 

0 – Not at all 1 – Slightly 2 – Moderately 3 – Considerably 4 – Extremely 

D30. Alcohol problems? 

D31. Drug problems? 

The questions below are to be answered by the interviewer only. 

How would you rate the patient’s need for treatment for 

0 – None necessary, to 9 – Treatment needed to intervene in life-threatening situation 

D32. Alcohol problems? 

D33. Drug problems? 

Is the drug/alcohol status information significantly distorted by: 

D34. Patient’s misrepresentation (Y/N)? 

D35. Patient’s inability to understand (Y/N)? 

LEGAL STATUS 

L1. Was this admission prompted or suggested by the criminal justice system (judge, 

probation/parole officer, etc.)? (Y/N) 

L2. Are you on probation or parole? _______ 0 – Neither 1 – Probation 2 – Parole 

How many times in your life have you been arrested and charged with the following: 

Under the influence 

at the time (Y/N) 

L3. Shoplifting/vandalism/theft? 

L4. Parole/Probation violations? 

L5. Drug charges? 

L6. Forgery? 

L7. Weapons offense? 

L8. Burglary, larceny, B&E? 

L9. Robbery? 

L10. Assault? 

L11. Arson? 

L12. Rape/sex-related crimes? 

L13. Homicide, manslaughter? 

L14. Prostitution? 

L15. Contempt of court? 

L16. Other? 

L17. How many of these charges resulted in convictions? 

198
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Addiction Severity Index 

How many times in your life have you been charged with the following: 

L18. Disorderly conduct? 

Vagrancy? 

Public intoxication? 

L19. Driving while intoxicated? 

L20. Major driving violations? 

L51. MIP (minor in possession)? 

L21. How many months were you incarcerated in your life? _______ months 

L22. How long was your last incarceration? _______ months 

L23. What was it for? 

03 – Shoplifting/vandalism/theft 12 − Rape/sex-related crimes 

04 − Parole/probation violation 13 − Homicide/manslaughter 

05 − Drug charges 14 − Prostitution 

06 − Forgery 15 − Contempt of court 

07 − Weapons offense 16 − Other 

08 − Burglary, larceny, B&E 18 − Disorderly conduct, vagrancy 

09 − Robbery 19 − Driving while intoxicated 

10 − Assault 20 − Major driving violations 

11 − Arson 

L24. Are you presently awaiting charges, trial, or sentencing? (Y/N) 

L25. For what? 

L26. How many days in the past 30 days were you detained or incarcerated? _______ days 

L27. How many days in the past 30 days have you engaged in illegal activities for profit? _____ days 

L28. How serious do you feel your present legal problems are (exclude civil problems)? 

0 – Not at all 1 – Slightly 2 – Moderately 3 – Considerably 4 – Extremely 

L29. How important to you now is counseling or referral for these legal problems? 

0 – Not at all 1 – Slightly 2 – Moderately 3 – Considerably 4 – Extremely 

The questions below are to be answered by the interviewer only. 

L30.	
 How would you rate the patient’s need for legal services or counseling? 

0 – None necessary, to 9 – Treatment needed to intervene in life-threatening situation 

Is the legal status information significantly distorted by: 

L31. Patient’s misrepresentation (Y/N)? 

L32. Patient’s inability to understand (Y/N)? 

FAMILY HISTORY 

Have any of your relatives had what you would call a significant drinking, drug use, or psychological 

problem—one that did or should have led to treatment? 

Y − Yes N − No X − Not applicable Z − Not answered 

Mother’s side: Alcohol Drug Psych 

H1. Grandmother 

H2. Grandfather 

H3. Mother 

199
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Appendix D 

H4. Aunt 

H5. Uncle 

Father’s side: Alcohol Drug Psych 

H6. Grandmother 

H7. Grandfather 

H8. Mother 

H9. Aunt 

H10. Uncle 

How many siblings do you have? 

H53. Brothers: 

H54. Sisters: 

Have any of your siblings had what you would call a significant drinking, drug use, or psychological 

problem—one that did or should have led to treatment? 

Y − Yes N − No X − Not applicable Z − Not answered 

Alcohol Drug Psych 

H11. Brother #1 

H51. Brother #2 

H12. Sister #1 

H52. Sister #2 

FAMILY/SOCIAL RELATIONSHIPS 

F1. Marital Status: 

1 Married 2 Remarried 

3 Widowed 4 Separated 

5 Divorced 6 Never married 

F2. How long have you been in this marital status (If never married, then since age 18)? 

_______ years, _______ months 

F3. Are you satisfied with this situation (0−2)? 0 − No 1 − Indifferent 2 − Yes 

F51. How many children do you have? 

F4. Usual living arrangements for the past three years: 

1 With sexual partner and children 2 With sexual partner alone 

3 With children alone 4 With parents 

5 With family 6 With friends 

7 Alone 8 Controlled environment 

9 No stable arrangements 

F5. How long have you lived in these arrangements (If with family or parents, since age 18)? 

_______ years, _______ months 

F6. Are you satisfied with these arrangements (0−2)? 0 − No 1 − Indifferent 2 − Yes 

Do you live with anyone who: 

F7. Has a current alcohol problem (Y/N)? 

200
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Addiction Severity Index 

F8. Uses nonprescribed drugs (Y/N)? 

F9. With whom do you spend most of your free time? 

1 − Family 2 − Friends 3 − Alone 

F10. Are you satisfied spending your free time this way? _______ 0 − No 1 − Indifferent 2 − Yes 

F11.	
 How many close friends do you have? 

Would you say you have had close, reciprocal relationships with any of the following people in 

your life? Y − Yes N − No X − Not applicable Z − Not answered 

F12. Mother 

F13. Father 

F14. Brothers/Sisters 

F15. Sexual Partner/Spouse 

F16.	
 Children 

F17.	
 Friends 

Have you had significant periods in which you have experienced serious problems getting 

along with: Y − Yes N − No X − Not applicable Z − Not answered 

Past 30 In Your Affected by Alcohol 

Days Life or Drugs 

Mother 

F19. 

F18. 

Father 

F20. Brothers/Sisters 

F21. Sexual Partner/Spouse 

F22. Children 

F23. *Other significant family 

F24. Close friends 

F25. Neighbors 

F26. Coworkers 

F23. *Specify other relative: 

Did any of these people abuse you: 

00 − None 21 − Sexual partner 25 − Neighbors 

18 − Mother 22 − Children 26 − Coworkers 

19 − Father 23 − Other family 27 − Yes-does not know who or chooses 

10 − Brother/sister 24 − Close friends not to identify person 

Past 30 days In your life 

F27. Emotionally (make you feel bad through harsh words)? 

F28. Physically (cause you physical harm)?



F29. Sexually (force sexual advances or sexual acts)?



How many days in the past 30 days have you had serious conflicts: 

F30. With your family? _______ days 

F31. With other people (excluding family)? _______ days 

How troubled or bothered have you been in the past 30 days by these conflicts: 

0 – Not at all 1 – Slightly 2 – Moderately 3 – Considerably 4 – Extremely 

F32. Family problems? 

F33. Social problems? 

201
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Appendix D 

How important to you now is treatment or counseling for these problems? 

0 – Not at all 1 – Slightly 2 – Moderately 3 – Considerably 4 – Extremely 

F34. Family problems? 

F35. Social problems? 

The questions below are to be answered by the interviewer only. 

L30.	
 How would you rate the patient’s need for family and/or social counseling? 

0 – None necessary, to 9 – Treatment needed to intervene in life-threatening situation 

Is the family/social relationships information significantly distorted by: 

L31. Patient’s misrepresentation (Y/N)? 

L32. Patient’s inability to understand (Y/N)? 

PSYCHIATRIC STATUS 

How many times have you been treated for any psychological or emotional problems: 

P1. In a hospital or inpatient setting? 

P1. As an outpatient or private patient? 

P2. Do you receive financial compensation for a psychiatric or emotional disability (include 

pension, SSI, SSDI, etc.) (Y/N)? 

Have you had a significant period (that was not a direct result of drug/alcohol use) in which 

you have: Y − Yes N − No X − Not applicable Z − Not answered 

Past 30 days In your life 

P3. Experienced serious depression—sadness, hopelessness, 

loss of interest, difficulty with daily functioning? 

P4. Experienced serious anxiety/tension—uptight, 

unreasonably worried, unable to feel relaxed? 

P5. Experienced hallucinations—saw things or heard voices 

that others did not see or hear? 

P6. Experienced trouble understanding, concentrating, or 

remembering? 

P7. Experienced trouble controlling violent behavior 

including episodes of rage or violence? 

P8. Experienced serious thoughts of suicide? 

P9. Attempted suicide? 

P10. Been prescribed medication for any psychological 

or emotional problems?



Note: for questions P7 through P9, include incidents that occurred when the person



was under the influence of substances. 

P11. How many days in the past 30 days have you experienced these psychological or 

emotional problems? _______ days 

P12. How much have you been troubled or bothered by these psychological or emotional 

problems in the past 30 days? 

0 – Not at all 1 – Slightly 2 – Moderately 3 – Considerably 4 – Extremely 

202
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Addiction Severity Index 

P13. How important is it to you now is treatment for these psychological or emotional problems? 

0 – Not at all 1 – Slightly 2 – Moderately 3 – Considerably 4 – Extremely 

The questions below are to be answered by the interviewer only. 

At the time of the interview, is the patient: Y − Yes, N − No 

P14. 

P15. 

P16. 

P17. 

P18. 

P19. 

P20. 

P21. 

P22. 

Obviously depressed/withdrawn? 

Obviously hostile? 

Obviously anxious/nervous? 

Having trouble with reality testing, thought disorders, paranoid thinking? 

Having trouble comprehending, concentrating, remembering? 

Having suicidal thought? 

How would you rate the patient’s need for psychiatric/psychological treatment? 

0 – None necessary, to 9 – Treatment needed to intervene in life-threatening situation 

Is the psychiatric status information significantly distorted by: 

Patient’s misrepresentation (Y/N)? 

Patient’s inability to understand (Y/N)? 

P22. 

P22. 

Time begun: 

Time ended: 

INTERVIEWER’S ASSESSMENT 

DIAGNOSTIC IMPRESSION 

Interviewer’s Assessment Comments __________ SASSI-3 

RAP? 

FVA? 

FVOD? 

SYM? 

OAT? 

SAT? 

DEF? 

SAM? 

FAM? 

COR? 

DSM-IV 

AXIS I: 

Description: 

AXIS II: 

Description: 

203
 

 

 

 

 

Appendix D 

AXIS III: 

AXIS IV: 

AXIS V: 

RECOMMENDATIONS FOR TREATMENT 

Recommendation for Treatment: 

Level of Care Recommendation: 

204
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Appendix E

State Employment Agencies 

ALABAMA

Alabama State Employment Service 

649 Monroe St, Room 266 

Montgomery, AL 36131 

Phone: (334) 242-8003; Fax: (334) 242-8012 

ALASKA

Alaska Career Information System 

Alaska Department of Education 

801 West 10th Street, Suite 20 

Juneau, AK 99801-1894 

Phone: (907) 465-2980; Fax: (907) 465-2982 

ARIZONA

Employment and Rehabilitation Services 

Arizona Department of Economic Security 

1831 W. Jefferson 

Phoenix, AZ 85007 

Phone: (602) 542-4941 or (602) 542-5216 

ARKANSAS

Arkansas Employment Security Department 

#2 Capital Mall, Room 506 

ESD Building 

Little Rock, AR 72201 

Phone: (501) 682-2121; Fax: (501) 682-2273 

CALIFORNIA

The California State Job Training Coordinating 

Council 

800 Capitol Mall, MIC 67 

Sacramento, CA 95814 

Phone: (916) 654-6836; Fax: (916) 654-8987 

COLORADO

Colorado Department of Labor and 

Employment 

Attn: Public Relations 

1515 Arapahoe Street, Tower 2, Suite 500 

Denver, CO 80202-2117 

Phone: (303) 620-4718 

CONNECTICUT

Employment Training/Connecticut Works 

Connecticut Department of Labor 

200 Folly Brook Boulevard 

Wethersfield, CT 06109 

Phone: (888) 289-6757 [(888) CTWORKS] 

DELAWARE

Delaware Department of Labor 

Division of Employment and Training 

First Floor 

4425 North Market Street 

Wilmington, DE 19806 

205
 

 

 

 

Appendix E 

DISTRICT OF COLUMBIA 

Department of Employment Services
 

Training, Referral and Assessment Office
 

500 C Street, NW, Room 300
 

Washington, DC 20001
 

Phone: (202) 724-2300
 

FLORIDA 

Florida Department of Labor & Employment 

Security
 

Division of Vocational Rehabilitation – Bldg A
 

2002 Old Augustine Road
 

Tallahassee, FL 32399
 

Phone: (850) 488-6210 or (850) 488-4398 (general
 

information)
 

GEORGIA 

Georgia Department of Labor
 

Suite 642
 

148 International Boulevard N.E. 

Atlanta, GA 30303-1751
 

Phone: (404) 656-3032
 

HAWAII 

Department of Labor and Industrial Relations
 

Workforce Development Division
 

830 Punchbowl Street
 

Honolulu, HI 96813
 

Phone: (808) 586-8842; Fax: (808) 586-9099
 

IDAHO 

Idaho Department of Labor
 

317 Main Street
 

Boise, ID 83735-0600
 

Phone: (208) 334-6252; Fax: (208) 334-6300
 

ILLINOIS 

Illinois Department of Employment Security
 

Field Operations
 

401 S. State Street, 7th North
 

Chicago, IL 60605
 

Phone: (312) 793-2713; in Springfield: (217) 785-

5069
 

INDIANA 

Department of Workforce Development
 

10 N. Senate Avenue
 

Indianopolis, IN 46204
 

Phone: (317) 232-7670; Fax: (319) 233-4793
 

IOWA 

Iowa Workforce Development
 

1000 East Grand Avenue
 

Des Moines, IA 50319-0209
 

Phone: (515) 281-5387, 800-JOB-IOWA
 

KANSAS 

Kansas Department of Human Resources
 

1430 SW Topeka Boulevard
 

Topeka, KS 66612-1897
 

Phone: (785) 296-1715; Fax: (785) 296-1984
 

KENTUCKY 

Workforce Development Cabinet
 

Department for Employment Services
 

275 East Main Street
 

Frankfort, KY 40621
 

Phone: (502) 564-5331
 

LOUISIANA 

Louisiana Department of Labor
 

735 St. Charles Avenue
 

New Orleans, LA 70130-3713
 

Phone: (504) 568-7111; Fax: (504) 568-7195
 

206
State Employment Agencies 

MAINE 

Department of Labor 

Job Service 

Bureau of Employment Services 

55 State House Station 

Augusta, ME 04333-0055 

Phone: (207) 624-6390; Fax: (207) 624-6499 

MARYLAND 

Maryland Job Service 

Division of Employment and Training 

Phone: (800) 765-8692 

MASSACHUSETTS 

Massachusetts Division of Employment and 

Training 

19 Staniford Street 

Boston, MA 02114 

Phone: (617) 727-6560 

MICHIGAN 

Michigan Department of Career Development 

[formerly Michigan Jobs Commission] 

201 N. Washington Square 

Victor Office Center, 4th Floor 

Lansing, MI 48913 

Phone: (517) 373-9808 

MINNESOTA 

Minnesota Department of Economic Security 

390 N. Robert Street 

St. Paul, MN 55101 

Phone: (888) 438-5627 

MISSISSIPPI 

Mississippi Employment Security Commission 

P.O. Box 1699 

Jackson, MS 39215-1699 

Phone: (601) 354-8711; Fax: (601) 961-7405 

MISSOURI 

Workforce Development Transition Team 

P.O. Box 1928 

Jefferson City, MO 65102-1928 

Phone: (573) 751-7039; Fax: (573) 751-0147 

MONTANA 

Montana Department of Labor and Industry 

Job Service Division 

NEBRASKA 

Nebraska Department of Labor 

550 South 16th Street 

Lincoln, NE 68509-4600 

Phone: (402) 471-2600; Fax: (402) 471-9867 

NEVADA 

Nevada Department of Employment, Training 

and Rehabilitation 

Information Development and Processing 

Division 

Research & Analysis Bureau 

500 E. Third Street 

Carson City, NV 89713 

Phone: (702) 687-4550 

NEW HAMPSHIRE 

New Hampshire Employment Security 

Web site: www.nhworks.state.nh.us 

NEW JERSEY 

New Jersey State Employment & Training 

Commission 

P.O. Box 940 

Trenton, NJ 08625-0940 

NEW MEXICO 

New Mexico Department of Labor 

Employment Security Division 

401 Broadway NE 

Albuquerque, NM 87102 

207
 

Appendix E 

NEW YORK 

Workforce Development and Training
 

New York State Department of Labor
 

State Campus, Building 12
 

Albany, NY 12240
 

Phone: (518) 457-0380; Fax: (518) 457-9526
 

NORTH CAROLINA 

North Carolina Division of Employment & 

Training
 

441 N. Harrington Street
 

Raleigh, NC 27603
 

Phone: (919) 733-6383
 

NORTH DAKOTA 

Job Service North Dakota 

P.O. Box 5507
 

Bismarck, ND 58506-5507
 

Phone: (800) 732-9787 or (701) 328-2868;
 

Fax: (701) 328-4193
 

OHIO 

Ohio Bureau of Employment Services
 

145 S. Front Street
 

Columbus, OH 43215
 

OKLAHOMA 

Oklahoma Employment Security Commission 

Will Rogers Office Building 

2401 North Lincoln Blvd. 

P. O. Box 52003
 

Oklahoma City, OK 73152-2003
 

Phone: (405) 557-0200
 

OREGON 

Oregon Employment Department
 

875 Union Street, N.E.
 

Salem, OR 97311
 

PENNSYLVANIA 

Career Development Marketplace Unit
 

c/o Department of Labor and Industry
 

412 Labor and Industry Building
 

7th & Forster Streets
 

Harrisburg, PA 17120
 

RHODE ISLAND 

Rhode Island Department of Labor and Training
 

101 Friendship Street
 

Providence, RI 02903
 

Phone: (401) 222-3625
 

SOUTH CAROLINA 

South Carolina Employment Security 

Commission
 

1550 Gadsden Street
 

Columbia, SC 29202
 

SOUTH DAKOTA 

South Dakota Department of Labor
 

700 Governors Drive
 

Pierre, SD 57501-2291
 

Phone: (605) 773-3101; Fax: (605) 773-4211
 

TENNESSEE 

Tennessee Department of Employment Security
 

Davy Crockett Tower - 11th Floor
 

500 James Robertson Parkway
 

Nashville, TN 37245-1200
 

Phone: (615) 741-213
 

TEXAS 

Texas Workforce Commission
 

101 E. 15th Street
 

Austin, TX 78778-8001
 

208
 

UTAH 

Utah Department of Workforce Services 

P.O. Box 45249
 

Salt Lake City, UT 84145-0249
 

Phone: (801) 526-WORK (9675);
 

Fax: (801) 536-7420
 

VERMONT 

Vermont Department of Employment and 

Training 

5 Green Mountain Drive 

P.O. Box 488
 

Montpelier, VT 05601-0488
 

Phone: (802) 828-4000; Fax: (802) 828-4022
 

VIRGINIA 

Virginia Employment Commission
 

5520 Cherokee Avenue, Suite 100
 

Alexandria, VA 22312- 2319
 

Phone: (703) 813-1300; Fax: (703) 813-1380
 

WASHINGTON 

Washington State Employment Security 

Department 

Commissioner’s Office 

212 Maple Park Drive 

P.O. Box 9046
 

Olympia, WA 98507-9046
 

Phone: (360) 902-9301; Fax: (360) 902-9383
 

State Employment Agencies 

WEST VIRGINIA 

West Virginia Bureau of Employment Programs
 

112 California Avenue
 

Charleston, WV 25305-0112
 

Phone: (304) 558-2630
 

WISCONSIN 

Wisconsin Department of Workforce 

Development 

201 E. Washington Avenue 

P.O. Box 7946
 

Madison, WI 53707-7946
 

WYOMING 

Wyoming Department of Employment
 

122 West 25th Street
 

Cheyenne, WY 82002
 

Phone: (307) 777-7672
 

209

 

 

 

 

 

 

 

 

 

 

Appendix F 

Federal Funding Sources 

The information about Federal and State funding sources in Figures F-1 and F-2 is intended to illustrate 

the range of potential Federal funding sources available and should not be regarded as comprehensive. 

Although every effort was made to ensure that the information was as up-to-date as possible, some 

information may no longer be current. The information is arranged in the same order as it was presented 

in the section “Federal and State Funding Sources” in Chapter 6. 

Each of the funding sources listed in Figure F-1 has its own eligibility and reporting requirements and 

funding cycle. Some programs are competitive, whereas others award funding by formula. Although 

substance abuse treatment programs may not be able to compete directly for some of these funds, they 

may be able to subcontract with a funded agency. They can also have a crucial advocacy role in deciding 

funding priorities. 

The following acronyms are used in Figure F-1. 

¢ CHIP = Child Health Insurance Plan 

¢ HHS = Department of Health and Human Services 

¢ DOE = Department of Education 

¢ DOJ = Department of Justice 

¢ DOL = Department of Labor 

¢ DOT = Department of Transportation 

¢ EZ/EC = Enterprise Zone/Empowerment Community 

¢ HCFA = Health Care Financing Administration 

¢ JTPA = Job Training Partnership Act 

¢ SAPT Block Grant = Substance Abuse Prevention and Treatment Block Grant 

¢ SSA = Single State Agency (i.e., the primary State agency responsible for publicly funded substance 

abuse treatment services) 

¢ TANF = Temporary Assistance to Needy Families 

¢ USDA = United States Department of Agriculture 

¢ VR = Vocational Rehabilitation 

211
Figure F-1 Federal Funding Sources 

Services Provided Federal 

Agency 

Enabling Rule Target Populations Eligibility 

Requirements for Target 

Populations 

Grant

Alcohol abuse prevention and 

treatment 

Substance abuse prevention and 

treatment 

Primary prevention activities Administrative costs 

HHS SAPT Block 

Grant 

formula 

(42 U.S.C. 

§300)

People with alcohol 

and substance abuse disorders 

Special populations 

(e.g., women) 

Substance abuse 

disorders 

Pregnant/postpartum 

women 

SSA 

Funding for substance abuse HHS/ Title XIX of the Medicaid-eligible Medicaid State departm

treatment of Medicaid-eligible HCFA Social Security individuals Income health and individuals. This is an optional Medicaid Act Age services benefit at the State’s discretion. (42 U.S.C. 

§§1396− 1396v) 

Participation in other 

Federal programs 

Pregnancy status 

Some substance abuse treatment 

services if State sets funds aside 

Job training Transportation Child care 

HHS Personal 

Responsibility and Work Opportunity Reconciliation Act of 1996 

(P.L. 104-193) 

TANF recipients TANF receipt Three-quarte

formula fuStates; one-of formula to local communiti

Support services for “hardest to DOL Welfare-to-Work Hardest to employ TANF receipt State driven 

employ” TANF recipients grant TANF recipients 

Transportation assistance provisions of 

Title IV, Part A of the Social Security Act (P.S. 105-33) 

Basic and remedial education Job skills assessment On-the-job training Job search assistance Work experience programs Internships School-to-work transition programs 

Transportation and relocation 

assistance 

DOL JTP (29 U.S.C. 

§201− 206)

(Note: JTPA is superseded by the Workforce Investment Act of 1998 and will be repealed on 7/1/00.) 

Unemployed adults Youth Disabled persons Dislocated workers Native Americans Migrant and seasonal 

farm workers 

Veterans 

Disadvantaged and 

disabled individuals 

Funds are ch

to States, woversee the planning aoperation oprograms 

212
Figure F-1 (continued) 

Federal Funding Sources 

Services Provided Federal 

Agency 

Enabling Rule Target Populations Eligibility 

Requirements for Target 

Populations 

Grant

States receive block grants for adult 

employment, training for 

disadvantaged youths and 

families, and literacy 

Grant establishes a system of “onestop” centers for job seekers 

DOL Workforce 

Investment 

Act of 1998 

(P.L. 105-220)

 consolidates 

more than 60 Federal programs into 3 block grants to States for employment, training, and literacy 

Disadvantaged adults 

and youth 

Disadvantaged adults 

and youth 

85% of funds 

local areas; 

remainder Statewide a

Substance abuse prevention, 

intervention, referral, and treatment 

Job training (to assist prevention 

efforts) 

Security improvements in public 

housing complexes 

HUD Drug 

elimination, 

“back to work” efforts 

Public Housing 

Drug Elimination Program (42 U.S.C. §11901)

Public housing 

residents 

Public housing residence Local public 

authoritiescontract wiservice pro

Substance abuse disorder 

assessment and treatment 

Prescription medications Equipment and accommodation for 

disabled 

Transportation Training and secondary education 

Vocational testing and evaluation 

DOE Vocational 

Rehabilitation Act (29 U.S.C. §720− 728a,

730, 731) 

Workforce 

Investment Act of 1998 

(P.L. 105-220, 

§106)

People with disabilities People receiving 

Supplemental 

Security Income 

People with disabilities; 

Supplemental Security Income 

VR agency 

designated 

 213
Figure F-1 (continued) Federal Funding Sources 

Services Provided Federal 

Agency 

Enabling Rule Target Populations Eligibility 

Requirements for Target 

Populations 

Grant

Foster care 

Services to prevent child abuse and 

neglect 

Substance abuse treatment (often 

court-ordered) 

Child care 

HHS Title IV of the 

SSA (42 U.S.C. 

§1862)

Parents in child 

welfare system 

(often TANF) 

TANF-eligible and those 

in the child welfare 

system 

State or coun

welfare ser

State determines benefits package; 

in some States, adolescents and teen mothers are included 

HHS Title XXI of the 

Social Security Act 

(P.L. 105-33 

§4901a)

CHIP 

Uninsured children (as 

defined by State) 

Uninsured children; 

sometimes more narrowly defined 

Varies by Sta

Child care 

Transportation Detoxification 

Substance abuse treatment services Social services 

HHS Title XX of the 

Social Security Act 

(42 U.S.C. 

§§1397−1397f) 

State determined State determined State HHS or 

subcontrac

Substance abuse treatment services 

Tear down housing 

Move drugs out, services in 

DOJ “Weed and 

Seed” 

Residents in 

designated 

neighborhoods 

Law enforcement 

agencies with local 

community coalitions 

Law enforcem

agencies w

as part of a community coalition 

Substance abuse treatment at every 

point of entry in the criminal 

justice system 

Substance abuse treatment services 

for adjudicated and non adjudicated individuals 

DOJ, Office of 

Justice 

Programs, Drug Courts Program Office 

Violent Crime 

Control and 

Law 

Enforcement Act of 1994 (28 CFR §93) 

Adjudicated and 

non adjudicated 

individuals 

Adjudicated and 

non adjudicated 

individuals 

Local crimina

system 

214
Figure F-1 (continued) 

Federal Funding Sources 

Services Provided Federal 

Agency 

Enabling Rule Target Populations Eligibility 

Requirements for Target 

Populations 

Grante

Counseling 

Medical and psychological 

services 

Job training 

DOE, 

Office of 

Special 

Education and Rehabilitative Services, Rehabilitation Services Administration 

Rehabilitation 

Act of 1973 (29 U.S.C. §701ff)

Individuals with 

physical or mental disabilities (priority given to severely disabled) 

Individuals with physical 

or mental disabilities (priority given to severely disabled) 

State VR agen

Help States and local communities 

develop flexible transportation services that connect welfare recipients and other lowincome persons to jobs and other employment-related services 

DOT Transportation 

Equity Act of 1998 (49 U.S.C. §5309)

Welfare recipients, 

low-income persons 

Welfare recipients, lowincome persons States, local communitie

Loans and grants to create jobs, 

expand business opportunities 

Support activities for job hunting, such as job training, child care, transportation 

HUD, USDA 

Empowerment 

Zone and 

Enterprise Community Initiative (26 U.S.C. §1391)

Designated EZs or 

ECs 

Within area with local 

discretion 

EZ/EC local 

coalitions 

Aid in the elimination of slums 

and blight 

Meet other urgent community 

development needs 

Neighborhood revitalization Economic development Improvement of community 

facilities and public services 

HUD Housing and 

Community Development Act of 1974 (42 U.S.C. §5301)

Low- and moderateincome people Low- and moderate- income people Entitled comm

(metropolitand urban c

215
 

 

 

 

 

 

 

 

 

 

 

 

Figure F-2 

Federal Sources of Discretionary, Time-Limited Project Grants 

Appendix F 

Note: This list is not intended to be comprehensive. 

Department of Education 

National Institute on Disability and Rehabilitation Research 

Office of Special Education and Rehabilitative Services, Rehabilitation Services Administration 

Department of Health and Human Services 

Administration for Children and Families 

Health Care Financing Administration 

Health Resources and Services Administration 

National Institutes of Health 

National Institute on Alcohol Abuse and Alcoholism



National Institute on Drug Abuse 

National Institute of Mental Health



Substance Abuse and Mental Health Services Administration



Center for Substance Abuse Prevention



Center for Substance Abuse Treatment 

Center for Mental Health Services



Department of Housing and Urban Development 

Department of Justice 

Executive Office for Weed and Seed 

National Institute of Justice 

Office of Justice Programs



Office of Juvenile Justice and Delinquency Prevention



Department of Labor 

Department of Transportation 

Federal Transit Administration 

216
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Appendix G 

Sample Individualized Written 

Rehabilitation Program 

Sample Individualized Written Rehabilitation Program (IWRP) 

Notice: This form is voluntary. You are not required to give us personal information as part of the joint 

development of your IWRP and there is no penalty if you do not provide the information requested. 

However, if you choose not to provide this information, we may not be able to provide goods or services 

we had discussed as part of your rehabilitation program. The IWRP is a plan of services jointly developed by 

my counselor and myself to assist me in reaching my employment outcome and/or long-term rehabilitation goal. The 

services will be provided in the most integrated environment. 

Name ID Number 

Jane Doe 7321 

This IWRP is for services in the program checked below 

VR employment outcome 

(X) Independent living ( ) Extended evaluations for VR Services 

( ) Other (specify) ( ) Rehabilitation Teaching 

Employment objective and/or long-term rehabilitation goal: 

Obtain and maintain employment in the clerical field. 

(X) Full time ( ) Part time Weekly hours of work (SE only) 

Rehabilitation technology services: ( ) needed (X) Not needed at this time 

Personal assistance services: ( ) needed (X) Not needed at this time 

Postemployment services: (X) anticipated ( ) Not anticipated at this time 

IWRP Intermediate Objective 

Maintain recovery. Meet responsibilities of drug treatment center, establish VR goals. 

217
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Appendix G 

Services Providers Start End Funded By 

Individual Counseling* Substance abuse counselor 

tx center

1/98 1/99 Drug treatment 

NA and/or AA Meetings* Local meeting sites 1/98 1/99 “ 

Vocational Rehabilitation* VR Counselor, tx center 1/98 1/99 “ 

Group Counseling* Relapse prevention counselor 1/98 1/99 “ 

Vocational Rehabilitation* State VR counselor 1/98 1/99 State VR 

*Began before inception of this plan. Had been in substance abuse treatment since 3/97 

Progress toward meeting this intermediate objective will be measured by and reviewed: 

( ) Annually ( ) Every 90 days (X) Monthly 

( ) Weekly ( ) School term ( ) Other Specify: 

Intermediate Objective 

Attain skill through training 

Services Providers Start End Funded By 

Training/education Outside provider 4/98 10/98 DVR 

On-going counseling VR counselor, tx center 4/98 10/98 Tx center 

On-going counseling DVR counselor 4/98 10/98 DVR 

Books and supplies Training program 4/98 10/98 DVR 

Transportation Client 4/98 10/98 DVR 

Progress toward meeting this intermediate objective will be measured by and reviewed: 

Attendance at school/program. Participation in counseling sessions. 

And reviewed: 

( ) Annually ( ) Every 90 days (X) Monthly 

( ) Weekly ( ) Every school term ( ) Other: 

Intermediate Objective: 

Secure a job. 

218
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Individualized Written Rehabilitation Program 

Services Providers Start End Funded By 

VR Counseling Tx center VR counselor 10/98 5/99 Tx center 

Placement State VR counselor 10/98 5/99 DVR

 Training program 10/98 5/99 DVR 

Progress toward meeting this intermediate objective will be measured and reviewed: 

Attendance at all services. Involvement in counseling and placement. 

And reviewed: 

( ) Annually ( ) Every 90 days (X) Monthly 

( ) Weekly ( ) Every school term ( ) Other Specify: 

This is how I was involved in determining my employment objective or long-term rehabilitation goal. 

I was unsure about my career goals, but had interests in clerical work. My counselor gave 

me an assessment to see if I had the aptitude for this career and if my interests were 

similar to people in the field. Volunteering was a good way to determine whether the goal I 

want to pursue was realistic. 

This is how I was informed about and involved in choosing the intermediate objectives, the service 

providers, and the schedule of frequency for progress measures. I was an active participant in my 

career planning. I was present at team meetings and I felt my opinion counted as a member 

of the team. 

....................................................................................................................................... 

Signature (client or representative) Date: 

DVR Approval Signatures-Original Approval 

........................................................................................................................................ 

Counselor/Teacher Signature Date 

......................................................................................................................................... 

Dist Dir/Asst Dir Signature Date 

......................................................................................................................................... 

Reg Adm Signature Date if required 

A copy of this IWRP was sent or given to you on: (date and initials)............... 

219

   

   

                           

             

   

     

         

       

   

   

     

             

     

   

     

     

           

   

   

   

   

   

       

   

   

     

     

       

             

       

           

   

           

     

   

       

   

     

         

   

     

   

   

     

         

             

   

     

     

         

           

     

   

   

   

         

Appendix H

Resource Panel

Note: The information given indicates each participantʹs affiliation during the time the panel was

convened and may no longerreflect the individual's current affiliation.

Candace Baker

Clinical Affairs Manager

National Association of Alcohol and Drug

Abuse Counselors
 

Arlington, Virginia
 

Elena Carr

Substance Abuse Program Coordinator

Office of the Assistant Secretary for Policy

Department of Labor

Washington, D.C.

Janie Dargan, M.S.N.

Senior Policy Analyst

Office of National Drug Control Policy/

E.O.P.
 

Washington, D.C.
 

Marsha Dubose

Supervisory Vocational Rehabilitation

Specialist

District Government

Department of Human Services

Rehabilitation Services Administration

Washington, D.C.

Laura Feig, M.P.P.

Social Science Analyst

Division of Children and Youth Policy

Office of the Assistant Secretary for Planning

and Evaluation

Department of Health and Human Services

Washington, D.C.

Sharon L. Gottoui, M.A., L.P.C., C.S.A.C.

Second Genesis, Inc.

Bethesda, Maryland

Jeff A. Hoffman, Ph.D.

President

Danya International, Inc.

Silver Spring, Maryland

Randy T. Hoover, C.A.S., C.A.C.

Vocational Counselor

Second Genesis, Inc.

Crownsville, Maryland

Janice Jordan

Substance Abuse Consultant

Department of Mental Health, Mental

Retardation and Substance Abuse Services

Richmond, Virginia

Cathy Keiter, M.A.

Media, Pennsylvania

Dennis Moore, Ed.D.

Director

Rehabilitation Research and Training Center

on Drugs and Disability
 

Wright State University
 

Dayton, Ohio
 

Thomas O’Connell

Division of Self‐Sufficiency

Administration on Children and Families

Washington, D.C.

221
 

 

 

Appendix H 

Gwen Rubinstein, M.P.H. 

Deputy Director of National Policy 

Legal Action Center 

Washington, D.C. 

Daniel Simpson 

HIV/AIDS Coordinator/Alcohol 

Alcoholism and Substance Abuse Program 

Branch



Indian Health Service 

Rockville, Maryland



Barbara J. Spoor, M.P.A. 

Project Director 

American Public Welfare Association 

Washington, D.C. 

Dora Teimouri, M.Ed. 

Rehabilitation Program Specialist 

Rehabilitation Services Administration 

Office of Special Education and 

Rehabilitative Services 

U.S. Department of Education



Washington, D.C. 

222
   

   

                           

                   

     

   

           

       

   

       

   

     

   

     

   

       

   

           

   

       

         

   

       

   

       

           

   

   

   

             

       

   

     

           

       

     

   

       

       

       

       

         

             

         

   

       

       

     

         

         

           

   

Appendix I

Field Reviewers

Note: The information given indicates each participantʹs affiliation during the time the review was

conducted and may no longer reflect the individualʹs current affiliation.

William J. Allen

Deputy Director

Mental Health and Substance Abuse Services

Department of Community Health

Lansing, Michigan

Richard C. Baron, M.A.

Philadelphia, Pennsylvania

Adrienne Bitoy‐Jackson

Grants Developer

Grants Administration

Chicago Housing Authority

Chicago, Illinois

Karen Busha, Ed.M.

Treatment Director

Lexington County Residential and

Outpatient

Lexington Richland Alcohol and Drug Abuse

Council

West Columbia, South Carolina

Susanne Caviness, Ph.D., C.A.P.T., U.S.P.H.S.

Quality Improvement Advisor

Office of Pharmacological and Alternative

Therapies

Center for Substance Abuse Treatment

Substance Abuse and Mental Health Services

Administration
 

Rockville, Maryland
 

Barbara Cimaglio

Director

Office of Alcohol and Drug Abuse Programs

Oregon Department of Human Resources

Salem, Oregon

Michael Couty, M.S.

Director

Division of Alcohol and Drug Abuse

Missouri Department of Mental Health

Jefferson City, Missouri

John Darin

President

The National Association on Drug Abuse

Problems, Inc.
 

New York, New York
 

Lynn F. Duby, M.S.W.

Director

Department of Mental Health, Mental

Retardation & Substance Abuse Services

Maine Office of Substance Abuse

Augusta, Maine

Laura Faulconer, M.S.W., M.P.A.

Director, Continuity of Care

Commonwealth of Virginia

Northern Virginia Mental Health Institute

Department of Mental Health, Mental

Retardation and Substance Abuse
 

Falls Church, Virginia
 

223
 

 

 

 

 

 

 

 

 

Appendix I 

Judy Fried, M.A. 

Executive Director 

Women and Children’s Program 

Northern Illinois Council on Alcoholism and 

Substance Abuse 

Round Lake, Illinois 

Nick Gantes, M.P.A. 

Director 

James R. Thompson Center 

Illinois Department of Alcoholism and 

Substance Abuse 

Chicago, Illinois 

Matthew Gissen 

President 

The Village 

Miami, Florida



Sharon L. Gottoui, M.A., L.P.C., C.S.A.C. 

Second Genesis 

Bethesda, Maryland 

James Herrera, M.A., L.P.C.C. 

Center on Alcoholism, Substance Abuse and 

Addictions



University of New Mexico



Albuquerque, New Mexico



James Robert Holden, M.A. 

Program Director 

Partners in Drug Abuse Rehabilitation 

Counseling 

Washington, D.C. 

Brandon Hunt, Ph.D., N.C.C., C.R.C. 

Assistant Professor 

Counselor Education, Counseling 

Psychology, and Rehabilitation Services 

The Pennsylvania State University 

University Park, Pennsylvania 

Linda S. Janes, C.C.D.C. III 

Recovery Services Administrator 

Division of Parole and Community Services 

Ohio Department of Rehabilitation and 

Corrections



Columbus, Ohio 

Linda Kaplan 

Executive Director 

National Association of Alcoholism and Drug 

Abuse Counselors 

Arlington, Virginia



Cathy Keiter, M.A. 

Media, Pennsylvania 

Michael W. Kirby, Jr., Ph.D. 

Chief Executive Officer 

Arapahoe House, Inc. 

Thornton, Colorado 

Russell P. MacPherson, Ph.D., C.A.P., C.A.P.P., 

C.C.P., D.A.C., D.V.C. 

President 

RPM Addiction Prevention Training 

Deland, Florida 

Marcello Maviglia, M.D. 

Albuquerque, New Mexico 

Dennis Moore, Ed.D. 

Director 

Rehabilitation Research and Training Center 

on Drugs and Disability 

Wright State University 

Dayton, Ohio 

Ethel Mull 

Vice President 

Treatment Alternatives for Special Clients 

Chicago, Illinois 

Fanny G. Nicholson, C.C.S.W., A.C.S.W., 

N.C.A.C.I., C.S.A.E. 

Alcohol and Drug Specialist 

Oconaluftee Job Corps 

Cherokee, North Carolina 

Larry D. Raper, M.B.A., M.A., C.A.D.C. 

Director 

Office of Program Compliance and Outcomes 

Monitoring 

Bureau of Alcohol and Drug Abuse 

Prevention



Arkansas Department of Health 

Little Rock, Arkansas



224
 

 

 

 

 

 

 

 

 

 

Steve D. Redfield 

Executive Director 

Strive/Chicago Employment Service 

Chicago, Illinois 

Gwen Rubinstein, M.P.H. 

Deputy Director of National Policy 

Legal Action Center 

Washington, D.C. 

Nancy Siegrist, M.P.A. 

Executive Director 

Lansing Regional Agency 

National Council on Alcoholism 

Lansing, Michigan 

Tom W. Smith 

Health Program Manager 

Office of Consumer Affairs 

Behavioral Health Services Division 

New Mexico Department of Health 

Santa Fe, New Mexico 

Ruth Delores Smith, C.S.W., M.A., C.A.S.A.C. 

Director of Residential Services and Training 

VIP Community Services 

Bronx, New York 

Richard T. Suchinsky, M.D. 

Associate Director for Addictive Disorders 

and Psychiatric Rehabilitation 

Mental Health and Behavioral Sciences 

Services



Department of Veterans Affairs 

Washington, D.C. 

Field Reviewers 

Sushma Taylor, Ph.D. 

Executive Director 

Center Point, Inc. 

San Rafael, California 

Anthony Tusler 

Santa Rosa, California 

Eileen Wolkstein, Ph.D. 

Research Scientist 

School of Education 

Department of Health Studies 

Rehabilitation Counseling Program 

New York University 

New York, New York 

Stephen A. Young 

Director 

Planning and Development 

First Inc. 

Winston Salem, North Carolina 

Dennis Zimmerman 

New York State Office of Alcohol and 

Substance Abuse Services 

Albany, New York 

Janet Zwick 

Director 

Division of Substance Abuse and Health 

Promotion 

Iowa Department of Public Health 

Des Moines, Iowa 

225

   

             

                             

                       

                                   

                           

                         

                 

               

                   

                           

                             

                     

                   

               

                   

                     

                           

                   

                   

              

                               

               

                   

                     

                       

             

                 

                 

                         

                 

                       

                       

                         

                     

                             

                   

                   

                 

              

      

                   

   

       

           

   

             

The TIPs Series

TIP 5 Improving Treatment for Drug‐Exposed Infants

TIP 14 Developing State Outcomes Monitoring Systems for Alcohol and Other Drug Abuse Treatment

TIP 16 Alcohol and Other Drug Screening of Hospitalized Trauma Patients

TIP 21 Combining Alcohol and Other Drug Abuse Treatment With Diversion for Juveniles in the Justice System

TIP 23 Treatment Drug Courts: Integrating Substance Abuse Treatment With Legal Case Processing

TIP 24 A Guide to Substance Abuse Services for Primary Care Clinicians

TIP 25 Substance Abuse Treatment and Domestic Violence

TIP 26 Substance Abuse Among Older Adults

TIP 27 Comprehensive Case Management for Substance Abuse Treatment

TIP 29 Substance Use Disorder Treatment for People With Physical and Cognitive Disabilities

TIP 30 Continuity of Offender Treatment for Substance Use Disorders From Institution to Community

TIP 31 Screening and Assessing Adolescents for Substance Use Disorders

TIP 32 Treatment of Adolescents With Substance Use Disorders

TIP 33 Treatment for Stimulant Use Disorders

TIP 34 Brief Interventions and Brief Therapies for Substance Abuse

TIP 35 Enhancing Motivation for Change in Substance Abuse Treatment

TIP 36 Substance Abuse Treatment for Persons With Child Abuse and Neglect Issues

TIP 37 Substance Abuse Treatment for Persons With HIV/AIDS

TIP 38 Integrating Substance Abuse Treatment and Vocational Services

TIP 39 Substance Abuse Treatment and Family Therapy

TIP 40 Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction

TIP 41 Substance Abuse Treatment: Group Therapy

TIP 42 Substance Abuse Treatment for Persons With Co‐Occurring Disorders

TIP 43 Medication‐Assisted Treatment for Opioid Addiction in Opioid Treatment Programs

TIP 44 Substance Abuse Treatment for Adults in the Criminal Justice System

TIP 45 Detoxification and Substance Abuse Treatment

TIP 46 Substance Abuse: Administrative Issues in Outpatient Treatment

TIP 47 Substance Abuse: Clinical Issues in Outpatient Treatment

TIP 48 Managing Depressive Symptoms in Substance Abuse Clients During Early Recovery

TIP 49 Incorporating Alcohol Pharmacotherapies Into Medical Practice

TIP 50 Addressing Suicidal Thoughts and Behaviors in Substance Abuse Treatment

TIP 51 Substance Abuse Treatment: Addressing the Specific Needs of Women

TIP 52 Supervision and the Professional Development of the Substance Abuse Counselor

TIP 53 Addressing Viral Hepatitis in People With Substance Use Disorders

TIP 54 Managing Chronic Pain in Adults With or in Recovery From Substance Use Disorders

TIP 55 Behavioral Health Services for People Who Are Homeless

TIP 56 Addressing the Specific Behavioral Health Needs of Men

TIP 57 Trauma‐Informed Care in Behavioral Health Services

TIP 58 Addressing Fetal Alcohol Spectrum Disorders (FASD)

TIP 59 Improving Cultural Competence

Other TIPs may be ordered by calling 1‐877‐SAMHSA‐7 (1‐877‐726‐4727) (English and Español)

or visiting http://store.samhsa.gov.

HHS Publication No. (SMA) 12‐4216

Substance Abuse and Mental Health Services Administration

First Printed 2000

Revised 2002, 2003, 2006, 2010, 2012, and 2014