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...

Presents a fundamental rethinking of the importance of integrating vocational services into substance abuse treatment planning. Shows how employment can play a key role in recovery from substance abuse disorders. In the wake of legislative reforms and limited resources, this report discusses establishing a referral relationship with other agencies to better meet client needs. Not only will clients receive services in areas outside the alcohol and drug counselor's area of expertise, but active referrals may help the client stay in treatment, and agencies can also share resources and funding to provide services more efficiently. Policy and funding issues also are discussed, as are legal issues.

Motivation is key to substance use behavior change. Counselors can support clients' movement toward positive changes in their substance use by identifying and enhancing motivation that already exists. Motivational approaches are based on the principles of person-centered counseling. Counselors' use of empathy, not authority and power, is key to enhancing clients' motivation to change. Clients are experts in their own recovery from SUDs. Counselors should engage them in collaborative partnerships. Ambivalence about change is normal. Resistance to change is an expression of ambivalence about change, not a client trait or characteristic. Confrontational approaches increase client resistance and discord in the counseling relationship. Motivational approaches explore ambivalence in a nonjudgmental and compassionate way.

Basic knowledge about the nature and treatment of stimulant use disorders. Reviews what is currently known about treating the med., psychiatric, and substance abuse-dependence problems assoc. with the use of 2 high-profile stimulants: cocaine and methamphetamine (MA). The info. is understandable and relevant for clinicians and other "front line" substance use disorder treat. providers. Offers recomm. on treat. approaches, recomm. to maximize treat. engagement, strategies for planning and initiating treat., and strategies for initiating and maintaining abstinence. Includes recomm. for the med. mgmt. of stimulant users and recomm. regarding special groups and settings.

Many health problems that healthcare practitioners encounter derive from or are complicated by alcohol use disorders (AUD). Four approved medications that treat AUD make treatment in primary care a viable adjunct or alternative to specialty care, with many potential advantages. Screening for and providing brief interventions to treat AUD in general medical settings promote healthy life choices and increase the likelihood of recovery, especially for patients who have not yet progressed to chronic alcohol dependence, those with comorbid medical disorders being treated in these settings, and those who otherwise would not seek or receive treatment for their AUD. This report provides a resource to assist the health-care provider in this effort. Illus.