Vocational Rehabilitation and Job Accommodations for ...€¦ · Vocational Rehabilitation services in 1996, 2000, and 2004 who had a primary disabilify of alcohol abuse or dependence

Journal of Rehabilitation, Volume 75, Number 4 35

Journal of Rehabilitation2009, Volume 75, No, 4, 35-44

Vocational Rehabilitation and Job Accommodationsfor Individuals with Substance Abuse Disorders

Richard T. WallsWest Virginia University

Lucas C. MooreWest Virginia University

Linda C. BatisteWest Virginia University

Beth LoyWest Virginia University

In the present investigation, employment variables and workplace accommodation issuesare examined for individuals with substance abuse disorders. In 1996, 2000, and 2004,there were 29,063 clients, 36,529 clients, and 35,473 clients, respectively, with substanceabuse disorders served by the Vocational Rehabilitation (State-Federal) program. Therewere about 38,000 individuals with alcoholism and about 63,000 with drug addiction.During this same period (1996 to 2005), the Job Accommodation Network (JAN) handledcases for 475 employees, 806 employers, and 87 rehabilitation professionals, all involv-ing alcoholism (715 cases), drug addiction (333 cases), or both (320 cases). Overall, theanalyses compared and contrasted data for (a) disability, (b) gender, (c) education, (d)referral source, (e) accommodation inquiry source, (f) types of services, (g) job accom-modations, (h) case service costs, (i) rehabilitation closure status, (j) occupational out-comes, (k) industries, (I) ADA, and (m) primary issues. The literature reviewed and thepresent findings affirm the value of a strong employment orientation in successful sub-stance abuse treatment.

According to 2007 statistics reported by the SubstanceAbuse and Mental Health Services Administration(SAMHSA, 2008), there were an estimated 22,3 million

individuals in the U.S. aged 12 or older (9% of the population)who met the DSM-IV diagnostic criteria for either substanceabuse or dependence. Of those 22.3 million, 15,5 million wereclassified with alcohol abuse or dependence, 3.7 million wereclassified with drug abuse or dependence, and approximately 3.2million had abuse or dependence on both alcohol and drugs.

The present study examines employment outcomes andworkplace accommodation issues for individuals with substanceabuse disorders. Rehabilitation Services Administration (RSA)client service records show the types of employment successfullyrehabilitated individuals have attained. Workplace accommoda-tion information, however, is not included in the RSA case-clo-sure record (RSA-911 form). Given the importance of workplaceaccommodations, data from the Job Accommodation Network(JAN) have been incorporated to provide a more complete pictureof the services needed for individuals with substance abuse disor-ders to retain employment. Thus, the focus of the current articleis on approaches to serving individuals with substance abuse dis-orders, drawn from two databases. Analyses are conducted toexamine the rates of successful employment outcomes (case clo-

Richard T, Walls, Ph,D., Professor of Educational Psychology andDisability Information, 806 Allen Hall, West Virginia UniversityMorgantown, WV 26506-6122Email: [email protected],edu

sures) of clients with either alcoholism or drug addictions whowere served by the State/Federal Vocational RehabilitationSystem across three years (1996, 2000, 2004), A primary reasonfor selecting 1996 as the first year for the RSA data was that theavailable JAN database spanned 1996 to 2005.

Counselors in the Rehabilitation Services Administration(RSA) provide counseling and employment-related services toindividuals with disabilities to obtain employment and live moreindependently (Rehabilitation Services Administration, 2006),Analyses are conducted to examine the prevalence of accommo-dation inquiries made to the Job Accommodation Network (JAN)for clients with substance abuse (alcoholism or drug addiction),JAN is a free resource for information regarding job accommoda-tions and Title I of the ADA, The service is available free ofcharge to anyone, but the majority of inquiries (68%) are fromemployers and individuals with disabilities, JAN averages about32,000 telephone inquiries (cases) per year and provides one-on-one consultation (and follow-up materials and communications,as necessary) to each person about all aspects of job accommoda-tion, including the accommodation process, effective accommo-dation options, funding sources for accommodations, productinformation, disability awareness, and legal rights and responsi-bilities under the employment provisions of the ADA,

The following research questions are investigated:1, What are the demographic characteristics for individuals

with substance abuse disorders (Alcoholism vs Drug

36 Journal of Rehabilitation, Volume 75, Number 4

Addiction) who received Vocational Rehabilitation serv-ices?

2. Are there differences between clients (consumers) withAlcoholism vs Drug Addiction, in terms of VocationalRehabilitation services received and outcome (rehabili-tated vs not rehabilitated)?

3. What occupations were involved for those VocationalRehabilitation consumers whose outcomes were success-ful (rehabilitated)?

4. In the JAN case data for substance abuse calls from 1996to 2005, what are the relative proportions of (a)Causative Factor, (b) Caller Industry, (c) Job Function,and (d) Issue Discussed?

5. What commonalities link the findings from the RSAcases to the findings from the JAN cases on substanceabuse disorders?

In the workplace, individuals with substance abuse disordersoften exhibit difficulties with attendance, concentration, stayingorganized, meeting deadlines, handling stress, and maintainingstamina during the workday (Batiste, 2005a; 2005b). The obliga-tion to provide accommodations for people with substance abuseunder the ADA can be confusing to employers because the obli-gation differs somewhat from the obligation to accommodateemployees with other types of disabilities. The difference mainlyarises from the general rule that employers do not have to provideaccommodations to enable an employee to continue abusing sub-stances. For example, the ADA requires employers to considerproviding flexible work schedules for employees with disabilitieswho are experiencing problems related to their disabilities (e.g.,an employee with multiple sclerosis who cannot work latebecause of fatigue, or an employee with Crohn's disease whoneeds frequent restroom breaks). However, if the current abuse ofsubstances is causing the problems, under the ADA, the employ-er does not have to provide accommodations to address thoseproblems. In addition, employers are not required under the ADAto accommodate employees with substance abuse by allowingthem to violate conduct rules (e.g., working under the influence ofillegal drugs). On the other hand, employers may need to consid-er accommodations related to treatment of the addiction, such asleave time for rehabilitation or a flexible schedule to attend AAmeetings.

In a systematic review, Adamson, Sellman, and Frampton(2009) found that, for patients with alcohol use disorders, one ofthe "key predictors" of drinking-related outcome was previousemployment (during the baseline period). There is evidence lend-ing support to vocational services being incorporated into sub-stance-abuse treatment (Deren & Randell, 1990; Durkin, 2002;Leshner, 2001; SAMHSA, 2000). Employment has been shownto be beneficial for retention in treatment programs and moderat-ing relapse occurrence (Platt, 1995; Wolkstein & Spiller, 1998).Wolkstein, Bausch, & Weber, 2000 suggested that relevant topicsto be included in treatment for substance abuse are the importanceof work (independence, income, respect), pre-treatment factors(employment history, education, social milieu), treatment goals(realistic employment, drugs/alcohol), services (basic employ-ment training, problem-solving skills, job placement), integrated

rehabilitation model (vocational, economic, social, psychological,legal, spiritual), and post-employment services (job coaching,ongoing counseling for employment retention and sobriety).Unemployment and vocational instabilify constitute a themeemphasized by rehabilitation professionals and researchers (e.g..Brown & Saura, 1996; Gorske, Daley, Yenerall, & Morrow, 2006;Magura, 2003; Rehabilitation Research and Training Center onSubstance Abuse and Disabilify, 1996; Renwick & Krywonis,1992).

In addiction-treatment evaluation research, employment hasbeen viewed as both a desired outcome and an element of treat-ment (e.g., income, self-esteem, integration into mainstream soci-ety). Barriers that may work against the vocational rehabilitationclient with substance use disorders include: job-related barriers(e.g., lack of education or training), attitudinal barriers (e.g.,employer bias), program-level barriers (e.g., poor vocational serv-ices), medical and emotional barriers (e.g., continued alcohol ordrug use), and family and societal barriers (e.g., disincentivesfrom public financial support) (Platt, 1995). Misconceptionsabout the nature of substance abuse as a disabilify may createadditional barriers, not only for the client, but also for the coun-selors working with these individuals. These misconceptions maybe decreased by providing additional training to vocational reha-bilitation counselors in the area of substance abuse (Greer &Walls, 1997; West & Miller, 1999). The present research consid-ers the address of barriers through rehabilitation services and jobaccommodations for consumers with alcoholism or drug addic-tion.

MethodParticipants

Individual case data were investigated from two disabilify-related databases (RSA and JAN). Archived data were examinedto gather information on vocational rehabilitation outcomes andjob accommodations for individuals with substance abuse disor-ders. The data consisted of cases where individuals were dealingwith drug addiction or alcoholism.

The RSA records included all applicants for State/FederalVocational Rehabilitation services in 1996, 2000, and 2004 whohad a primary disabilify of alcohol abuse or dependence or drugabuse or dependence, termed alcoholism and drug addiction forpurposes of this research. Since all client records in those yearswere used, all states and territories of the United States wereincluded. The Vocational Rehabilitation cases in the RSA-911form database contain information on such data elements as: (1)demographics of the client (e.g., age, gender, education), (2) dis-abling condition of the client (e.g., drug abuse or dependence), (3)services received by the client (e.g., technical-school training,job-search assistance), (4) case outcome for the client (e.g., reha-bilitated to competitive employment, not-rehabilitated case out-come), and (5) occupational outcome (e.g., construction, motorfreight). The Vocational Rehabilitation cases in the RSA-911database for clients with alcoholism or drug addiction totaled29,063 in 1996, totaled 36,529 in 2000, and totaled 35,473 in2004.


The second database contained JAN ease records. The caserecords of JAN for the time period of 1996-2005 (all years)included a total of 1,365 cases concerning accommodations forindividuals with substance abuse issues (not necessarily the pri-mary disability). Descriptive data were collected on each "case"(inquiry) handled (primarily via telephone, but often involvingfollow-up e-mail or information sent by the JAN consultant to theinquirer by U,S, mail). The data elements collected by skilledJAN consultants from the Employee (or potential employee), theEmployer, or the Rehabilitation Professional included: (1) callerindustry, (2) job functions, and (3) tasks to be accommodated, (4)limitations, (5) causative factors, and (6) issues/concerns.

ResultsResearch Question 1

What are the demographic characteristics for individuals withsubstance abuse disorders (Alcoholism vs Drug Addiction) whoreceived Vocational Rehabilitation services? Descriptive statis-tics (e.g., frequencies and percentages) are used, rather than infer-ential statistics (e.g., chi-square), in addressing the research ques-tion because even slight differences with such large samples con-sistently yield statistically significant differences. For example,an analysis of Referral Source by Case Closure Outcome (for the35,473 drug and alcohol vocational rehabilitation cases in 2004)yields Chi-Square {i,N= 35,473) = 95,3, p < ,0001, a highly sig-nificant result. The numbers of alcohol versus drug cases are pre-sented in Table 1 for Gender, Age, and Education. Consistentlyacross the categories listed in Table 1, there were more drugaddiction cases than alcoholism related cases (about 60% drugaddiction to 40% alcoholism). Across the three time periods(1996,2000, and 2004), 26% of alcoholism cases involved femaleclients, and 74% involved male clients. For the drug-relatedcases, 31% involved female clients and 69% involved male

clients. In total, 57% of female clients were rehabilitated, and55% of male clients were rehabilitated (Table 1).

The age of these clients tended to be less than 46 years (near-ly 80%) (Table 1), Client ages were partitioned into six ageranges, which included (a) less than 26, (b) 26 to 35, (c) 36 to 45,(d) 46 to 55, (e) 56 to 65, and (f) greater than 65, Across all threetime periods more of the clients were in the 36 to 45 age range(40%) than in any other age range. The clients with drug addic-tion tended to be younger than those clients with alcoholism. Forexample, in the less than 26 age category across the three timeperiods, the percentages were 11%, 12%, and 13% for drug addic-tion cases compared to 8%, 7%, and 6% for alcoholism cases.

Across 1996 and 2000 and 2004, there were 31% who had notachieved a high school diploma, 47% who had graduated highschool, and 21% who had some post-secondary training. Thealcoholism cases (48% high school graduates) and drug addictioncases (47% high school graduates) were similar in educationalachievement. The frequencies associated with these percentagesare presented in Table 1,

Research Question 2Are there differences between clients (consumers) with

Alcoholism vs Drug Addiction in terms of VocationalRehabilitation services received an outcome (rehabilitated vs notrehabilitated)? Of the 29,063 individuals with a substance abusedisorder served in 1996, 54% achieved a successful rehabilitationoutcome. In 2000, 57% of the 36,529 clients were rehabilitated.In 2004, 51% of the 35,473 persons were rehabilitated. In Table2, these percentages are partitioned by the primary disability(alcoholism versus drug addiction). The two types of disablingconditions show remarkable consistency in each year (54% versus53% in 1996, and 57% versus 57% in 2000, and 52% versus 51%in 2004) (Table 2), Of the clients who were rehabilitated, approx-

Table 1Demographic Characteristics (Gender, Age, Education) by Disability in 1996, 2000, and 2004 for Vocational RehabilitationConsumers

GenderMaleFemale

Age<46>45

Education<H,S,

H,S,>H,S,

1996Alcohol

8,546(74%)3,066(26%)

9,410(81%)2,202(19%)

3,417(29%)5,667(49%)2,528(22%)

Drug

11,728(67%)5,723(33%)

15,868(91%)1,583(9%)

5,575(32%)8,316(48%)3,560(20%)

2000Alcohol

10,112(73%)3,657(27%)

10,141(74%)3,628(26%)

4,075(30%)6,653(48%)3,041(22%)

Drug

15,724(69%)7,036(31%)

19,062(84%)3,698(16%)

8,039(35%)10,516(46%)4,205(19%)

2004Alcohol

9,211(75%)3,079(25%)

8,064(66%)4,226(34%)

3,151(26%)5,805(47%)3,334(27%)

Drug

15,992(69%)7,191(31%)

17,863(77%)5,320(23%)

7,036(30%)11,168(48%)4,979(22%)

Total 11,612 17,451 13,769 22,760 12,290 23,183

Note: The percentages are for column subsets. For example, 1996, Alcohol, Gender: Male (74%) + Female (26%) = 100%


Table 2Case Closure Status by Disability and Year for Vocational Rehabilitation Consumers

1996 2000Case Closure Outcome Alcohol

2004Drug Alcohol Drug Alcohol Drug

Rehabilitated

Not Rehabilitated

6,278(54%) 9,330(53%) 7,882(57%) 13,063(57%) 6,330(52%) 11,820(51%)

5,334(46%) 8,121(47%) 5,887(43%) 9,697(43%) 5,960(48%) 11,363(49%)

Note: "Not Rehabilitated" included only those cases in which eligibility had been determined, a rehabilitation plan had been devel-oped, and services had been initiated, but the individual did not achieve a successful rehabilitation outcome. Of the clients who were"Rehabilitated," about 90% were "competitively employed." The percentages in the table are for the columns.

imately 90% were "competitively employed" uponcompletion of services.

In 1996, there were 15,608 consumers with sub-stance abuse disorders who were rehabilitated and13,455 who were not rehabilitated. In that year,there was relative equality between the percentagesof rehabilitated versus not rehabilitated consumerswho received: (1) Assessment (82% vs, 82%), (2)Restoration Services (30% vs, 24%), (3) CollegeTraining (11% vs, 12%), (4) Business-VocationalTraining (13% vs, 11%), (5) Adjustment Training(22% vs, 17%), (6) On-the-Job Training (5% vs,2%), (7) Transportation (41% vs, 44%), and (8)Maintenance (31% vs, 24%), However, there wererelatively greater differences for rehabilitated versusnot rehabilitated clients who received: (1) JobFinding Services (38% vs, 20%) and (2) .JobPlacement Services (27% vs, 11%), The readershould note, however, that Job Finding Services andJob Placement Services usually are provided nearthe end of the rehabilitation process after unsuccess-ful clients have dropped out, and when those whohave made good progress are nearing the end ofrehabilitation training and intervention.

In 2000, there were 20,945 consumers with sub-stance abuse disorders who were rehabilitated and15,584 who were not rehabilitated. In that year,there was relative equality between the percentagesof rehabilitated versus not rehabilitated consumerswho received: (1) Assessment (69% vs, 68%), (2)Restoration Services (36% vs, 32%), (3) CollegeTraining (9% vs, 10%), (4) Business-Vocational Training (13%vs, 11%), (5) Adjustment Training (20% vs, 18%), (6) On-the-JobTraining (4% vs, 3%), (7) Transportation (45% vs, 38%), and (8)Maintenance (26% vs, 21%), However, there were relativelygreater differences for rehabilitated versus not rehabilitated clientswho received: (1) Job Finding Services (43% vs, 26%) and (2) JobPlacement Services (36% vs, 18%),

In 2004, there were 18,150 consumers with substance abusedisorders who were rehabilitated and 17,323 who were not reha-bilitated. In that year, there was relative equality between the per-

Table 3Top Occupational Outcomes for Alcohol Abuse and Drug Abuse CasesAchieving Vocational Rehabilitation (1996 plus 2000 plus 2004)

Occupation Category Number of Persons

1, Food & Beverage Preparation & Service2, Construction3, Packaging & Materials Handling4, Building & Related Service5, Stenography, Typing, Filing, & Related6, Mise, Personal Service7, Motor Freight8, Misc. Sales9, Computing & Account Recording10,Medicine & Health11, Managers & Officials12,Electrical Assembling, Installing, & Repairing13,Mechanics & Machinery Repairing14,Life Sciences15.Structural Work16,Barbering, Cosmetology, & Related Service17,Mise, Professional, Technical, & Managerial18,Lodging & Related Service19.General Industry Mechanics & Repairing20, Information & Message Distribution

5,0634,5472,5972,4422,0592,0542,0232,0051,8481,2661,2341,1541,1081,0871,077

969913895838836

Note: Each Occupational Category represents a two-digit Dictionary ofOccupational Titles (DOT) code. For example, 31 is the DOT code for"Food and Beverage Preparation and Service Occupations,"

centages of rehabilitated versus not rehabilitated consumers whoreceived: (1) Assessment (60% vs. 68%), (2) Restoration Services(46% vs, 48%), (3) College Training (7% vs, 9%), (4) Business-Vocational Training (14% vs, 13%), (5) Adjustment Training (2%vs, 2%), and (6) On-the-Job Training (3% vs, 2%), However,there were relatively greater differences for rehabilitated versusnot rehabilitated clients who received: (1) Job Finding Services(34% vs, 21%), (2) Job Placement Services (36% vs, 18%), (3)Transportation (47% vs, 35%), and (4) Maintenance (27% vs,16%),


In 1996, the mean case costs were $1,856 for individuals suc-cessfully rehabilitated and $ 1,031 for those who were not rehabil-itated. In 2000, the mean case costs were $2,458 for consumerssuccessfully rehabilitated and $ 1,571 for those who were not reha-bilitated. In 2004, the mean case costs were $2,465 for clients suc-cessfully rehabilitated and $1,736 for those who were not rehabil-itated. Thus, the cost of a not rehabilitated case averaged abouttwo-thirds (63%) of the cost for a rehabilitated case.

Research Question 3What occupations were involved for those Vocational

Rehabilitation consumers whose outcomes were successful (reha-bilitated)? They showed remarkable consistency in occupationaloutcomes across the three time periods: (1) Service Occupationsremained the top category with (2) Clerical and Sales Occupationsand (3) Stmctural Work Occupations essentially tied in secondand third place, based on one-digit Dictionary of OccupationalTitles (DOT) Codes. Table 3 indicates the 20 most prevalentoccupations for alcoholism and drug addiction cases achievingvocational rehabilitation. Those data represent "occupation atcase closure" documented by two-digit Dictionary ofOccupational Titles (DOT) codes. As noted in Table 3, Food andBeverage Preparation and Service was the most prevalentemployment outcome across the three time periods. In addition,more than 2,000 consumers gained employment in Constmction(e.g., carpenter, plumber). Packaging and Materials Handling(e.g., hoisting and conveying). Building and Related Services(e.g., janitor, pest control), Stenography/Typing/Filing-Related(e.g., secretary, file clerk). Miscellaneous Personal Services (e.g.,stewardess, baggage handler). Motor Freight (e.g., dump tmckdriver, trailer truck driver), and Miscellaneous Sales (e.g., auc-tioneer, rental clerk).

Research Question 4In the JAN case data for substance abuse calls from 1996 to

2005, what are the relative proportions of (a) Causative Factor, (b)Caller Industry, (c) Job Function, and (d) Issue Discussed? In theJAN database, there were 1,365 total cases conceming job accom-modations and the Americans with Disabilities Act (ADA) forsubstance abuse disorders involving dmg addiction and alco-holism from 1996 to 2005. In Table 4, the numbers of cases aresummarized by who contacted JAN. Results show that the pointof contact was: Employees (n = 475), Employers (n = 806), andRehabilitation Professionals (n = 87). These job accommodationcases are subdivided by Causative Factor, identified as drugaddiction, alcoholism, or both (combined dmg and alcohol abusedisorders). There were 715 cases conceming alcoholism, 333cases conceming dmg addiction, and 320 cases conceming both(Table 4).

The second section of Table 4 presents the caller's industry.The most frequent cases involving the Employee calling withquestions about job accommodations (or related issues) werefrom: Local Govemment, Health Care and Social Services,Transportation, Manufacturing, Merchant Wholesalers, and StateGovemment. The most frequent cases involving the Employerinquiring about job accommodations (or related issues) werefrom: Health Care and Social Services, Local Govemment,

Business Support Services, Manufacturing, State Govemment,and Federal Govemment. The most frequent cases involvingRehabilitation Professionals inquiring about job accommodations(or related issues) for a client involved: Educational Services,Hospitals, Federal Govemment, and Health Care and SocialServices. Some of these categories included more than one busi-ness specialty (e.g., tmck transportation, rail transportation, airtransportation, represented as "Transportation") (Table 4).

The third section of Table 4 displays the job function of theindividual in question. Employees with substance abuse disorderswere most concemed about the following job functions: AttendingWork (travel to/from), exhibiting appropriate Interpersonal Skills,Working Safely, and Tolerating Stress. The most frequentEmployer concems about job functions for their employees withsubstance abuse disorders were: Attending Work (travel to/from),exhibiting appropriate Interpersonal Skills, Working Safely, andWorking at Full Production Level. The most prevalent job func-tion concems of Rehabilitation Professionals in relation to theirclients with substance abuse disorders were: exhibiting appropri-ate Interpersonal Skills, Attending Work (travel to/from).Concentrating on Work/Task, and Tolerating Stress. Thus, theconcems about particular job functions were remarkably consis-tent for the employees with substance abuse disorders, employerswho contacted JAN regarding an employee, and rehabilitationprofessionals who contacted JAN regarding a client (Table 4).

The fourth section of Table 4 lists Issue Discussed. The mostprevalent issues discussed between Employees with drug addic-tion, alcoholism, or both and the JAN consultants were ADAissues, including the rights of an employee and the responsibilitiesof the employer, whether the impairment was a disability, what isinvolved with filing a disability discrimination complaint, referralto an enforeement agency (EEO & EEOC), and the accommoda-tion of modifying a schedule. Additionally, the inquiry ofteninvolved a discussion about whether legislation other than theADA (e.g., state laws) may also apply. Employers who contactedJAN also were most concemed about ADA issues, including therights of an employee and the responsibilities of the employer,whether the impairment was a disability, what is involved with fil-ing a disability discrimination complaint, and the accommoda-tions of modifying a schedule and acquiring a service to performa job. Discussions often also involved other legislation besides theADA (e.g., state laws) that may apply. For RehabilitationProfessionals, topics most commonly discussed were ADA issues,including the rights of an employee and the responsibilities of theemployer, whether the impairment was a disability, whether anemployer could give a dmg and/or alcohol test during the pre-employment stage of the application process, and the accommo-dation of acquiring a service to perform a job. Other relevant leg-islation besides the ADA (e.g., state laws) also was discussedwhen applicable (Table 4). When of relevance to a job accom-modation, functional limitations also were discussed by the JANconsultant with the inquirer (caller). Those limitations mayinclude stress intoleranee, organizing/prioritizing, control ofanger/emotions, concentration, decreased stamina, and tardiness.


Examples of Employee and Employer cases were selectedfrom the JAN database. They were not selected randomly. Rather,these four cases were selected with purpose to illustrate the diver-sity of issues concerning job accommodations for consumers withsubstance abuse disorders. They are described briefly in the fol-lowing paragraphs.

Employee Case 1 involved an employee who was just firedfrom his job and wanted to know if alcoholism is considered a dis-ability under the ADA, According to the caller (inquirer), theemployer told him that he was terminated for not welding jointsproperly (from back to as many as six months). The employee,however, believed that the reason for his termination was that herecently had a car accident and was citedfor driving under the influence (DUI), TheJAN consultant advised the caller thatbecause the employer had only 12 employ-ees, employees were not covered under theADA, In addition, the consultant providedthe phone number for the state civil rightsagency in order for the person to see if anystate laws addressed his termination. Casedetails were: (1) The causative factor wasalcoholism, (2) the limitations were atten-tiveness and concentration, and (3) the jobfunction was concentration on work tasksand details.

Employee Case 2 involved an employ-ee who contacted JAN after completing adetox program for cocaine addiction. Theemployee said he did not use drugs at workand did not know if the employer wasaware that his attendance and performanceproblems were related to his drug addition.The JAN consultant discussed with thecaller how an employee with a disabilitycan be held to the same standards as otheremployees, how an individual who engagesin illegal use of drugs is not protected underthe ADA, and that there is a distinctionunder the ADA between people who arecurrently illegally using drugs and peoplewho have illegally used drugs in the past.The consultant followed up by referringhim to information on drug addition and theADA,

Employer Case 1 involved an employ-er who contacted JAN over a drug testingissue. The employer recently had anemployee who tested positive for drug use.The employee verified to the testing agencythat he was in a supervised methadonemaintenance treatment program. Uponreceipt of this information, the testingagency changed this employee's test resultto negative. The employer was concemed

that this may lead to unfair or inconsistent interpretation of drugtesting and results. The JAN consultant suggested that theemployer examine the reason for the test, A test to determine ille-gal drug use would not affect this employee, as he was in a super-vised and prescribed methadone maintenance program. However,it was suggested that if testing was to identify drugs that maycause safety problems, then the employer would need to deter-mine whether a safety problem existed due to the employee'smethadone use.

Employer Case 2 involved a call to JAN from an employerwho recently hired an individual who subsequently got a DUIwhile off the job. The employee then disclosed an addiction to

Table 4Job Accommodation Network (JAN) Case Data for Substance Abuse Calls

Causative FactorAlcoholism

Drug AddictionBoth Alcoholism & Drug Addiction

Total

Caller IndustryBusiness Support Services

Colleges & Trade SchoolsEducational ServicesFederal Govemment

Financial & Insurance ServicesFood & Beverage

Health Care & Social ServicesHospitalsLocal Govemment

ManufacturingMerchant WholesalersRecreationState GovemmentTelecommunicationsTransportationOther

Total

Job FunctionAdjust to Schedule ChangeAttend Work, Travel to/fromCommunicate with OthersConcentrate on Work/Task

Drive or Operate VehicleInterpersonal Skills

Tolerate StressWork at Full Production LevelWork Safely

Total

Employees

26812186475

40121243253321614414121934208

7783201244352838274

Caller TvpeEmployers

420188198806

24814199126852923582041127286

1946221092254583404

Rehab Pros

27243687

103200230010011114

030311132225

(Continued on page 41)


alcohol. The employer inquired if this person was protected underthe ADA. The JAN consultant informed the employer that theADA does not protect an employee from needing to comply withworkplace conduct rules. Thus, if it was the employer's policy toterminate employees for DUIs, then termination of this employeewas permitted. The consultant also informed the caller that theADA prohibits employers from more severely discipliningemployees (e.g., for being late) on the basis of alcoholism than forother reasons. Testing issues were discussed with the employer aswere the ADA guidelines related to drug testing.

Research Question 5What commonalities link the findings from the RSA cases to

the findings from the JAN cases on substance abuse disorders?Although the two datasets are from different agencies and meas-ure different constructs, the nature of the disorders and their impli-cations have potential relationships between the datasets.

The results of the analyses from Table 4 indicate that the pri-mary Issue Discussed in the JAN cases was ADA. This was truefor the Rehabilitation Professionals, the Employers, and theEmployees. Sociefy is reluctant to see drug or alcohol abuse as adisability, and employers often want to know what is legal or ille-gal in their interaction with such employees. Usually, from a dif-

Table 4 (Continued)Job Accommodation Network (JAN) Case Data for Substance Abuse Calls

Employees

Issue DiscussedAccommodation 12

Acquire Service to Perform Job 39Flexible Leave 33Limited Scheduling 16Modifying Work Schedule 50Reassignment to Vacant Position 13ADA 389Complaint Process 65Definition of Terms 25Deflnition of Disabilify 80EEO & EEOC Referral 59Pre-Employment Stage Inquiries 18Rights & Responsibilities 101Other Employment Legislation 55JAN Web Page Referral 8State Human Rights Referral 31Other Information(e.g., housing, insurance) 46

Total 1,072

Caller TvpeEmployers Rehab Pros

8462462313724707135211101717355329

48

1,717

6710215922101812923

0

140

Note 1 : "Employees" included individuals with disabilities who currently were work-ing, as well as individuals with disabilities who currently were not working.Note 2: The Employees, the Employers, and the Rehabilitation Professionalslinked. Although it is possible that some were callingthere were no links among the cases.

ibout the same issue orwere notincident.

ferent standpoint. Rehabilitation Professionals and Employeesalso are concerned about the following issues. (1) Does the personhave a disability, and is he or she protected (covered) by theADA? (2) What accommodations have to be considered (e.g.,leave time, modified schedule)? (3) Is the employer required toprovide accommodations for the consequences of drug or alcoholuse (e.g., hangover, DUI)? (4) When can employers test for pres-ence of illegal drugs or alcohol (e.g., when the employee is actingstrange, unable to concentrate, staggering, smelling like an illegalsubstance)?

In addition to seeking advice on what is necessary (legallyrequired) to be done, employers often wish to know how they (andthe company) can help this employee. Employers may try to assistby referring the individual to Vocational Rehabilitation or byfacilitating self-referral to Vocational Rehabilitation. In the 2004RSA database, there were 2,437 Self-Referrals and 5,305 Other-Referrals (including employers) for alcohol cases. Similarly, therewere 3,660 Self-Referrals and 11,406 Other-Referrals (includingemployers) for drug cases. These referrals from these two sourceswere far more numerous than the referrals to VocationalRehabilitation from any other referral source (Schools, Post-Secondary Institutions, Medical Personnel/Institutions, Welfare,

Community Rehabilitation Programs,Social Security Programs, or One StopEmployment/Training Centers). Although itis impossible to determine from the RSA-911 data how many employers wereinvolved in the referrals of their employeesto receive Vocational Rehabilitation servic-es, the interactions of employers with JANconsultants provide clear evidence of sub-stantial involvement and concern.

In the JAN case data for substanceabuse calls, the job ftanction most frequent-ly addressed was "attend work, travelto/from." This was true for both employees(people with disabilities who were workingor not working) and employers. Similarly,in the RSA case data for substance abusecases, "Transportation" was one of the mostoften provided services. For instance, 47%of those rehabilitated and 35% of those notrehabilitated received transportation servic-es (overall 41%) in 2004. Even though thereis no direct linkage between the JAN data-base and the RSA database, both sourcescontribute to understanding the concernsand interventions. Transportation is a com-monality. For the RSA-911 data, successversus non-success for substance abusecases was found to be related to transporta-tion as well as a number of other variables(listed below). A multiple regression analy-sis (Tabachnick & Fidell, 2001) was com-puted in which case outcome (rehabilitatedversus not-rehabilitated) was the criterion


(dependent) variable. Most of the variables in this analysis weredichotomous, which are often termed "dummy variables"(Tabachnick & Fidell, 2001), The overall multiple regressionmodel for the 2004 RSA data yielded F (16, 35345) = 110.65, p <,0001, a statistically significant result. Individual predictor (inde-pendent) variables that demonstrated a statistically significantrelationship to a successful case outcome were Greater EducationLevel (p < ,0001), Self-Support (p < ,0001), Occupational-Vocational Training (p < ,001), On-the-Job Training (p < .0001),Other Training, e.g., GED (p < ,0001), Job Search Assistance (p <,0001), Job Placement Assistance (p < ,0001), MonetaryMaintenance (p < ,0001), and as noted previously. TransportationServices (p < ,0001), Thus, both transportation and job variables(job training, job search, and job placement) show strong linkagesbetween the data of consumers served by RSA and JAN.

DiscussionVocational Rehabilitation (including services such as voca-

tional assessment, post-secondary and/or vocational training, jobplacement, supported employment, job accommodations) is apotential vehicle for linking the documented value of gainfulemployment to the substance abuse recovery process. There were101,065 Vocational Rehabilitation clients (consumers) in the pres-ent research. More than half of these individuals achieved suc-cessful rehabilitation. Regardless of gender, age, and education,somewhat more than half the people with alcoholism and drugaddition achieved successful employment outcomes. That criteri-on requires the individual to be employed for a minimum of 90days. Thus, the provision of Vocational Rehabilitation serviceswas a substantial intervention with the consumers included in theanalyses of the current study,

A report from the Rehabilitation Services Administration(2006) found Vocational Rehabilitation clients with substance-usedisorders had fewer functional limitations in "gross motor func-tion" and fewer limitations in "cognitive function" than con-sumers with vision impairment, hearing impairment, orthopedicimpairment, non-orthopedic-physical impairment, mental illness,mental retardation, and learning disability. But the craving, lossof control, and physical dependence pose severe challenges.These challenges, however, have been demonstrated to be reducedthrough employment concepts, employment training, and employ-ment, which can interact with residential, medication, or sub-stance-free outpatient therapies (e,g,, Adamson, Sellman, &Frampton, 2009; Durkin, 2002; Magura, 2003; Wolkstein,Bausch, & Weber, 2000), Vocational Rehabilitation can assist insubstituting productive endeavor for counterproductive substanceabuse. But because of the variety of relationships among type ofsubstance abuse, degree of dependence, form of therapy, employ-ment type, and other variables, there is, by no means, a single suc-cess equation.

As shown in the present research with JAN data, job accom-modations can assist with improving employment outcomes,which are targeted to reduce the limitations that the employeewith substance abuse is experiencing. Job functions most affect-ed by substance abuse include attendance, concentration, stress or

fatigue, organization, and exposure to alcohol or drugs (Batiste,2005a; Batiste, 2005b), Job accommodations for attendanceissues include: (1) providing leave or flexible scheduling for med-ical treatment and counseling and (2) developing a self-pacedworkload with the ability to modify a daily schedule if needed.Job accommodations for maintaining concentration include: (1)reducing workplace distractions, (2) moving to a private workarea, (3) implementing frequent breaks, (4) dividing large assign-ments into smaller tasks, and (5) restructuring a job to includeonly essential functions. Job accommodations for stress orfatigue include: (1) using positive reinforcement and praise, (2)providing counseling and employee assistance programs, (3)modifying daily schedules and breaks, (4) modifying supervisorymethods, (5) assigning individual to a less stressful or physicallydemanding job, (6) working from home, and (7) implementing anergonomie workstation. Job accommodations for organizationinclude: (1) providing clerical support, (2) keeping a daily to-dolist, (3) using an electronic organizer, (4) maintaining calendars,(5) providing reminders of important dates or deadlines, (6) hav-ing weekly meetings with supervisor on goals, progress, ques-tions, and concerns, and (7) implementing clear goals, expecta-tions, and consequences in writing. Job accommodations forexposure to alcohol or drugs in the workplace include: (1) pro-viding workplace supports, (2) implementing extra supervision,(3) reassigning to a position that does not involve exposure todrugs or alcohol, and (4) limiting mandated social functions withexposure (Batiste, 2005a; 2005b),

Limitations in the present research are (a) lack of exact serv-ice specifications and job accommodation details for the RSAservices with the Vocational Rehabilitation consumers and (b)lack of follow-up data to determine the effects of job accommo-dations discussed in JAN cases. Job accommodations allow manyindividuals with disabilities to be successful in the workplace, butit is difficult to determine just how many. The number of poten-tial scenarios (cause, degree, industry, job function, issue/con-cern) is huge, but the derived principles of job accommodationsthat are sensitive to needs and sensible for productivity are broad-ly beneficial. Similarly, on the Vocational Rehabilitation side ofthis study, there are no tightly controlled experimental conditions.Regardless of that, however, more than half of the RSA clientswere rehabilitated.

RecommendationsImplications are reflective of both success and failure. The

data analyzed for the State-Federal Vocational Rehabilitation pro-gram revealed 17,000 people with "alcohol abuse or dependence"who were not rehabilitated and 29,000 people with "drug abuse ordependence" who were not rehabilitated. Although the numberson the opposite side (rehabilitated) remain encouraging across theyears, what can be done to flirther assist these people (not reha-bilitated) gain or regain productive lives? The following sugges-tions are based on evidence (a) from current findings (ResearchQuestions 1, 2, 3, 4, and 5) and (b) from previous literature (e,g,,Adamson, Sellman, & Frampton, 2009; Batiste, 2005a; 2005b;Charles, 2004; Comerford, 1999; Drake, Mueser, Bumette, &McHugo, 2004; Durkin, 2002; Friedman, 1993; Gorske, et al.,2006; Magura, 2003; Platt, 1995; SAMHSA, 2000; Schottenfeld,


Pascale, & Sokolowski, 1992; Veach, Remley, Kippers, & Sorg,2000; Wehman, Targett, Yasuda, & Brown, 2000; Wolkstein,Bausch, & Weber, 2000), (a) Recognize that ñxnctional limita-tions vary (e.g,, interpersonal and safety), (b) Make workplaceaccommodations that directly impinge on limitations related tojob functions (e.g., attend work was the primary function), (c)Publicize funding sources for workplace accommodations (e,g,,VR and other programs), (d) Assist employers in providingappropriate job accommodations (e,g,, JAN), (e) Make the laws(regulations) as clear as possible on rights and responsibilities(e,g,, ADA confusing for substance abuse), (f) Assist all con-cerned in understanding the legal requirements (e,g,, ADA pri-mary issue), (g) Provide training to counselors and therapists toreduce misconceptions and increase effective strategies (e,g,.Tables 1, 2, 3), (h) Keep contact current between counselors andconsumers in order to reduce "unable to locate or contact" case-closure outcomes (e,g,, assessment, maintenance, and adjust-ment), (i) Help people who are unemployed set realistic employ-ment goals (e.g,. Table 3), (j) Provide individuals in recovery withwork-related skills (e,g,. Tables 3, 4), (k) Assist them with mon-etary maintenance, vocational training, job-fmding services, job-placement services, and on-the-job training (e,g,, VR servicesreceived). (1) Give employees post-employment services (e,g,,VR transition to employer), (m) Consider attention to attendance,transportation, concentration, stress/fatigue, organization, andsubstances in the workplace (e,g,. Table 4), These implicationscan make continuing and increasing contributions to reversing thedebilitating effects for individuals with substance abuse disorders.

ReferencesAdamson, S, J,, Sellman, J, D,, & Frampton, C, M. A, (2009),

Patient predictors of alcohol treatment outcome: A sys-tematic review. Journal of Substance Abuse Treatment,56(1), 75-86,

Batiste, L, C, (2005a), Accommodation and compliance series:Employees with drug addiction. Retrieved May 22,2006, from http://www,jan,wvu,edu/media/drugadd,html

Batiste, L, C, (2005b), Accommodation and compliance series:Employees with alcoholism. Retrieved May 22, 2006,from http://www,jan,wvu,edu/media/alcohol,html

Brown, A, L., & Saura, K, M, (1996), Vocational rehabilitationneeds of individuals Dually diagnosed with substanceabuse and chronic mental illness. Journal of AppliedRehabilitation Counseling, 27(3), 3-10,

Charles, K, K, (2004), The extent and effect of employer compli-ance with the accommodations mandates of theAmericans with Disabilities Act, Journal of DisabilityPolicy Studies, 75(2), 86-96,

Comerford, A, W, (1999), Work dysfunction and addiction:Common roots. Journal of Substance Abuse Treatment,70(3), 247-253,

Deren, S,, & Randell, J, (1990), The vocational rehabilitation ofsubstance abusers. Journal of Applied RehabilitationCounseling, 27(2), 4-6,

Drake, R, E., Mueser, K, T,, Brunette, M, F,, & McHugo, G, J,(2004). A review of treatments for people with severe

mental illness and co-occurring substance use disorders.Psychiatric Rehabilitation Journal, 27(4), 360-374,

Durkin, E, M, (2002), An organizational analysis of psychosocialand medical services in outpatient drug abuse treatmentprograms. Social Service Review, 76, 406-429,

Friedman, S, (1993), Accommodation issues in the work place forpeople with disabilities: A needs assessment in an edu-cational setting. Disability, Handicap & Society, 8{l), 3-23,

Gorske, T, T,, Daley, D, C, Yenerall, E,, & Morrow, L, A. (2006),Neuropsychological function of employment status in awelfare-to-work sample. Applied Neuropsychology,75(3), 141-150,

Greer, B, G, & Walls, R, T, (1997), Emotional factors involved insubstance abuse in a sample of rehabilitation clients.Journal of Rehabilitation, 63, 5-8,

Leshner, A, (2001), Director's column: When the question is drugabuse and addiction, the answer is all of the above, NidaNote, 70(2), 2001,

Magura, S. (2003), The role of work in substance dependencytreatment: A preliminary overview. Substance Use andMisuse, 55(11-13), 1865-1876,

Platt, J, J, (1995). Vocational rehabilitation of drug abusers.Psychological Bulletin, 777(3), 416-433,

Rehabilitation Research and Training Center on Substance Abuseand Disability. (1996), Substance abuse, disability andvocational rehabilitation. Wright State University/NewYork University,

Rehabilitation Services Administration, (2006), Functional limi-tations of vocational rehabilitation (VR) con-sumers final report, Washington, DC: U,S, Departmentof Education, Office of Special Education andRehabilitation Services,

Renwick, R, M,, & Krywonis, M, (1992), Personal and environ-mental factors related to employment: Implications forsubstance abuse intervention. Journal of Rehabilitation,58(1), 23-28,

SAMHSA (Substance Abuse and Mental Health ServicesAdministration), (2000), Integrating substance abusetreatment and vocational services. Rockville (MD): U,S,Department of Health and Human Services, PublicHealth Service, Substance Abuse and Mental HealthServices Administration, Center for Substance AbuseTreatment; 225 p. (Treatment Improvement Protocol[TIP] Series ; no, 38),

SAMHSA (Substance Abuse and Mental Health ServicesAdministration), (2008), Results from the 2007 nation-al survey on drug use and health: National findings.Rockville, MD: Dept, of Health and Human Services,Substance Abuse and Mental Health ServicesAdministration, Office of Applied Studies (NSDUHSeries H-34, DHHS Publication No, SMA 08-4343),

Schottenfeld, R, S,, Pascale, R,, & Sokolowski, S, (1992),Matching services to needs: Vocational services for sub-stance abusers. Journal of Substance Abuse Treatment, 9,3-8,

Tabachnick, B, G, & Fidell, L, S, (2001), Using multivariate sta-tistics (4th ed,), Needham Heights, MA: Allyn & Bacon,


Veach, L. J., Remley, T. P, Kippers, S. M., & Sorg, J. D. (2000).Retention predictors related to intensive outpatient pro-grams for substance abuse disorders. American Journalof Drug & Alcohol Abuse, 26(3), 417-428.

Wehman, P, Targett, P, Yasuda, S., & Brown, T. (2000). Retumto work for individuals with TBI and a history of sub-stance abuse. NeuroRehabilitation, 75(1), 71-77.

West, S. L., & Miller, J. H. (1999). Comparisons of vocationalrehabilitation counselors' attitudes toward substanceabusers. Journal of Applied Rehabilitation Counseling,30(4), 33-37.

Wolkstein, E., & Spiller, H. (1998). Providing vocational rehabil-itation services to clients in substance abuse rehabilita-tion. Directions in Rehabilitation Counseling, 9, 65-78.

Wolkstein, E., Bausch, R., & Weber, G (2000). Work as a criticalcomponent of recovery. Retrieved January 11, 2005,from http://www.med.wright.edu/citar/Sardi/WorkAndRecovery.html

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Vocational Rehabilitation and Job Accommodations for ...€¦ · Vocational Rehabilitation services in 1996, 2000, and 2004 who had a primary disabilify of alcohol abuse or dependence