While employment has been linked to positive clinical outcomes with drug abusers, research suggests that many treatment programs do not emphasize vocational services and under-utilize vocational resources. This article summarizes potential client-, program-, and societal-level obstacles to vocational rehabilitation service delivery identified in past studies with both substance abusers and other related client groups. Obstacles identified for related groups are integrated with issues relevant to drug treatment clients. This analysis is based on literature published over the last 20 years.

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The research literature indicates that vocational rehabilitation services are underutilized in many drug treatment programs. This study explored the perceptions of drug treatmentclients concerning use of vocational/educational (V/E) services. Clients from four methadone maintenance treatment clinics were Interviewed regarding: (a) types of VIE services received and desired by clients, (b) perceived obstacles to the use of clinic V/E services, and (c) client/clinic characteristics that may affect service utilization. Although Individuals generally reported receiving vocational counseling, many desired more job placement, vocational training, or educational assistance. Vocational counseling was seldom cited as a desired service; however, results indicated a need for such counseling with certain clients. Client- and clinic-level obstacles to service utilization are reported and ways to enhance service delivery are discussed.

Much literature points to the existence of common organizational and staff factors that can serve as obstacles to effective utilization of vocational and educational (V/E) services in clinical settings. This paper reports findings from systematic organizational analyses off our methadone maintenance clinics in New York City, which were used to help identify formal and informal arrangements that facilitate or hinder effective utilization of vocational rehabilitation services in this treatment system. The study included 43 face-to-face staff interviews, 50 anonymous staff surveys, and 16 case file reviews. The major structural obstacles found were: (a) client V/E needs are typically given a low priority compared with other service needs, (b) monitoring and supervision in relation to V/E service utilization is generally lacking, (c) the prevalence of critical deficits in counsellors' vocational rehabilitation skills (e.g., targeting, assessment, and caseload management) relate to inadequate and/or inappropriate referral to community-based V/E agencies, and (d) fiscal disincentives (particularly Medicaid dependence) exist for both program and client.

This paper provides results of secondary analyses of a national study of clients in drug treatment, in which client expressed need and reported receipt of vocational/educational (V/E) services are compared in relation to important SES indicators. It then describes the vocational and educational functioning of clients in four methadone maintenance treatment programs, taking into account various “competing factors” (such as health problems) common to this client population. The paper presents a method for categorizing client V/E status which is then discussed in terms of targeting, as well as integrating VIE services with other treatment planning concerns.