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.

The definitive guide to identify, assess, and create individualized treatment plans for high-risk clients who suffer from challenging co-occurring disorders "Treat the person and not the diagnosis. Respect that all behaviors are purposeful. Remain mindful that nobody changes behaviors without motivation. These essential guiding principles are the framework of this book. They will be repeated quite often as we examine the challenging population of men and women with co-occurring disorders." —From Integrated Treatment for Co-Occurring Disorders Annual studies reveal that 70 percent of men and women who died by suicide were diagnosed with a mental illness or personality disorder and used drugs to gain temporary relief from the symptoms. Until now, very little has been written about how to identify, assess, and treat this population. Integrated Treatment for Co-Occurring Disorders: Treating People, Not Behaviors addresses that need. Respectful of the client and filled with practical advice, this book: Examines the guiding principles for treating clients with co-occurring disorders Details the methods of formulating an evidence-based individualized treatment plan for the self-medicating mentally ill Explores how to assess this population for suicide risk and vulnerability Focuses on the person and not a behaviorally defined diagnostic category Reflects state-of-the-art knowledge for the treatment of co-occurring disorders Illustrates how Motivational Enhancement Therapy can be an effective treatment strategy With numerous clinical case studies to illustrate key points and reinforce learning, Integrated Treatment for Co-Occurring Disorders encourages a flexible, person-centered treatment approach that focuses on the individual rather than the diagnosis.

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.