The significance of having a job for individuals with substance use disorders (SUD)
Background: Employment is associated with better outcome of substance use treatment, and employment protects against relapse after treatment completion. A reason for this may be that having a job counters the loneliness and meaninglessness reported by many newly recovered substance users. However, for persons in SUD-treatment, unemployment rates are extremely high, Norwegian estimates ranging from 81 % to 89 %. In this study, which is a part of the larger Hooked on work study, we explore the significance and what having a job represents for individuals with SUD.
Methods: This was a qualitative study based on 17 semi-structured in-depth interviews with participants who were outpatients and inpatients receiving specialized SUD treatment at Oslo University Hospital. As participants in the Hooked on Work project, all had received an enhanced employment support service, following the Individual Placement and Support method (IPS), integrated with their ordinary treatment. We used a criterion based purposive sampling strategy, seeking both participants who had experienced transition to employment and those who had not. Interview transcripts were analyzed with thematic analysis, by a group consisting of researchers, health care providers and user representatives. We identified codes with close proximity to the content in the text, and organized these codes into fewer and more overarching themes. Interviews were conducted in 2021 and 2023, and analyses conducted in 2022 and 2023.
Results: We identified three main themes describing the significance of having a job. The first theme was that employment enabled societal reconnection. The participants described an initial state of being on the outside, having little content though the day, and feeling stigmatized as a drug addict or a social benefits client. Having a job provided an arena for socialization, activity and growth, and they felt that they could contribute to society, enabling a transition to a more de-stigmatized personal identity. The second theme was about how they felt about themselves, that having a job strengthened self-confidence, enhanced control over substance use and mental health challenges. The third theme was about the duality of having a job; that though it was highly wanted, it also represented destabilization, stress and risk for relapse.
Conclusions: For individuals with SUD who want to work, having a job represents connectedness with society, increased self-confidence, transformed personal identity and better control over substance use and mental health problems. However, having a job can also be stressful, and increase the risk for relapse.
