Employment after beginning treatment for substance use disorders: The impact of race/ethnicity and client community of residence

Abstract

Employment is an important substance use treatment outcome, frequently used to assess individual progress during and after treatment. This study examined whether racial/ethnic disparities exist in employment after beginning treatment. It also examined the extent to which characteristics of clients' communities account for such disparities. Analyses are based on data that linked individual treatment information from Washington State's Behavioral Health Administration with employment data from the state's Employment Security Department. Analyses subsequently incorporated community-level data from the U.S. Census Bureau. The sample includes 10,636 adult clients (Whites, 68%; American Indians, 13%, Latinos, 10%; and Blacks, 8%) who had a new outpatient treatment admission to state-funded specialty treatment. Heckman models were used to test whether racial/ethnic disparities existed in the likelihood of post-admission employment, as well as employment duration and wages earned. Results indicated that there were no racial/ethnic disparities in the likelihood of employment in the year following treatment admission. However, compared to White clients, American Indian and Black clients had significantly shorter lengths of employment and Black clients had significantly lower wages. With few exceptions, residential community characteristics were associated with being employed after initiating treatment, but not with maintaining employment or with wages. After accounting for community-level variables, disparities in length of employment and earned wages persisted. These findings highlight the importance of considering the race/ethnicity of a client when examining post-treatment employment alongside community characteristics, and suggest that the effect of race/ethnicity and community characteristics on post-treatment employment may differ based on the stage of the employment process.

Access to and Engagement in Substance Use Disorder Treatment Over Time

“…The decline in initiation and engagement in treatment for commercial plans and a lack of improvement for Medicaid plans is concerning, given the availability of effective treatment for substance use disorders and the growing evidence that initiation and engagement in treatment are associated with lower mortality (3)(4)(5)(6)(7)(8). It is also concerning that the narrowing of the gap in performance in initiation and engagement rates between low-and high-performing plans was mostly due to a decline in performance among highperforming plans, which suggests that even high-performing plans struggled to improve substance use disorder treatment rates.…”

“…Initiation and engagement have been endorsed by the National Quality Forum as reliable and valid quality measures. Research has shown that initiation and engagement in substance use disorder treatment is associated with lower criminal justice involvement, unemployment, and mortality (3)(4)(5)(6)(7)(8).…”

Disparities in Criminal Justice Outcomes After Beginning Treatment for Substance Use Disorders: The Influence of Race/Ethnicity and Place

“…Living in communities with a higher proportion of Black residents has also been associated with lower likelihood of receiving timely services in the early stages of treatment (Acevedo et al, 2018b), which has been associated with worse criminal justice outcomes . Communities with a higher proportion of Black residents are also associated with a lower likelihood of employment after beginning SUD treatment (Acevedo et al, 2018a), and unemployment might lead to more substance use and/or criminal justice involvement. Segregated neighborhoods also tend to have a higher concentration of alcohol outlets (LaVe ist & Wallace Jr., 2000) and fewer employment opportunities (VonLockette, 2010;Weinberg, 2000), both of which may increase the likelihood of relapse.…”