Policy Issues in Vocational Rehabilitation Related to Consumers with Substance Use Disorders

Abstract

State vocational rehabilitation (VR) agencies demonstrate wide reporting variability regarding the prevalence of substance use disorders among consumers of their services. The differences do not appear to correspond with state-level data derived from the general population in national substance use/abuse studies. This study reports findings from national surveys of VR program directors and counselors in regard to policy, practice, and professional perceptions. Results indicate that there are differences in the perceptions of profossionals regarding order of selection, sobriety waiting policies, and estimates of substance abuse but no relationship between state VR policies and the variability found in SUD rates.

Benefits of Substance Use Disorder Screening on Employment Outcomes in State–Federal Vocational Rehabilitation Programs

“…A larger metropolitan area in this state had a particularly high percentage of screening refusals; it may be that counselors marked "refused" on the screeners to avoid conflicts with providing immediate VR services versus placing someone on a sobriety waiting list. In our parallel study of SUD policy, we learned that the sobriety waiting period in West Virginia apparently was created in an effort to avoid paying for methadone maintenance as SUD treatment providers routinely referred their consumers to VR once they entered treatment (Moore et al, 2008). As in other states, far less methadone maintenance is provided to West Virginia residents now; however, the VR sobriety policy continues, as do the financial strains on its VR system.…”

“…Counselors face several challenges in addressing consumers' SUD. Approximately half of state-based VR programs have formal or informal sobriety waiting periods for consumers identified with an SUD (Moore, McAweeney, Keferl, Glenn, & Ford, 2008). A sobriety waiting period requires consumers to demonstrate abstinence to qualify for VR services; typically new consumers must wait 90 or more days before receiving services.…”

“…The waiting period can be problematic for persons who do not have gainful employment. There is more state-to-state variation in official SUD diagnosis rates in VR than for any other condition, with the rates ranging from 0.2% to 32% of the state VR population (Moore et al, 2008). For example, using data from 2005, Idaho reported a 1% rate for those with deafness or hearing impairment, which was the lowest reported in all states.…”

“…No widely used standard practice or screening instrument exists for identifying SUD in VR consumers (Heinemann, Lazowski, Moore, Miller, & McAweeney, 2008;Moore et al, 2008). Moreover, counselors often do not routinely ask about substance use or history (Brown & Saura, 1996;Moore & Li, 1998).…”

Preparing Addiction Specialists to Include Case Management and Vocational Rehabilitation Services in the Treatment Model for Problem Gamblers

“…Numerous programs and interventions have been developed to assist in that process, including vocational evaluation, career counseling, medical and psychological services, and supported job placement, to name a few. The effects of specific interventions have also been receiving attention from researchers (Moore, McAweeney, Keferl, Glenn, & Ford, 2008). Because comparable literature on problem gambling is limited, our question becomes this: What are the vocational rehabilitation and case management issues germane to clients who are problem gamblers?…”