The impact of psychotic disorders and co-morbid substance abuse on vocational rehabilitation: results from an Australian national survey of psychosis

Abstract

Introduction

It is unclear from prior research whether or not substance abuse co-morbid with psychosis is an added barrier to success in vocational rehabilitation. The aim of this study was to examine the relationships among three types of co-morbid substance abuse or dependence, by type of employment assistance received (disability employment services, mainstream unemployment services, other government programmes, and own resources), and by type of employment attained (competitive and non-competitive).

Method

Data were drawn from the Australian National Survey of High Impact Psychosis (N = 1825). The survey was conducted in seven Australian catchment areas March to December 2010. Descriptive statistics and logistic regression methods were used.

Results

There were no added effects of lifetime substance abuse or dependence on any employment. However, there were some minor substance-specific effects. Past year cannabis use was negatively associated, while alcohol use was positively associated with being employed. All categories of lifetime substance abuse or dependence were associated with reduced utilisation of intensive forms of employment assistance.

Conclusion

At a population level, lifetime substance abuse or dependence had no added impact on current employment status. Those with psychosis co-morbid with lifetime substance abuse or dependence could benefit from greater utilisation of evidence-based supported employment.

Keywords

Substance abuse or dependence severe mental illness psychotic disorders employment competitive employment

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References

An AB (2004) Performing logistic regression on survey data with the new survey logistic procedure. Proceedings of the Twenty-Seventh Annual SAS Users Group International Conference. Available at: http://www2.sas.com/proceedings/sugi27/p258-27.pdf (accessed June 2012).

Australian Bureau of Statistics (2010) Standards for social, labour and demographic variables. Report, Australian Bureau of Statistcs, Canberra, Australia. Available at: http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/1288.0Main+Features11996?OpenDocument (accessed 11 December 2012).

Australian Government (2009) National Mental Health and Disability Employment Strategy. Report, Department of Employment, Education and Workplace Relation, Canberra, Australia. Available at: https://www.dss.gov.au/our-responsibilities/mental-health/programs-services/national-mental-health-and-disability-employment-strategy (accessed 11 December 2012).

Biegel

Beimers

Stevenson

(2009) Predictors of referral to supported employment among consumers with co-occurring mental and substance use disorders. Community Mental Health Journal 45(6): 427–438.

Cantwell

(2003) Substance use and schizophrenia: Effects on symptoms, social functioning and service use. The British Journal of Psychiatry 182(4): 324–329.

Castle

Jablensky

McGrath

(2006) The Diagnostic Interview for Psychoses: development, reliability and applications. Psychological Medicine 36: 69–80.

Cook

Razzano

Burke-Miller

(2007) Effects of co-occurring disorders on employment outcomes in a multisite randomized study of supported employment for people with severe mental illness. Journal of Rehabilitation Research and Development 44(6): 837–849.

Dickerson

Stallings

Origoni

(2008) Predictors of occupational status six months after hospitalization in persons with a recent onset of psychosis. Psychiatry Research 160(3): 278–284.

Drake

Becker

Bond

(2012) Individual Placement and Support: An Evidence-based Approach to Supported Employment, New York, NY: Oxford University Press.

10.

Drebing

Fleitas

Moore

(2002) Patterns in work functioning and vocational rehabilitation associated with coexisting psychiatric and substance use disorders. Rehabilitation Counseling Bulletin 46(1): 5–13.

11.

Frounfelker

Wilkniss

Bond

(2011) Enrollment in supported employment services for clients with a co-occurring disorder. Psychiatric Services 62(5): 545–547.

12.

Goldberg

Lucksted

McNary

(2001) Correlates of long-term unemployment among inner-city adults with serious and persistent mental illness. Psychiatric Services 52(1): 101–103.

13.

Jablensky

McGrath

Herrman

(2000) Psychotic disorders in urban areas: an overview of the Study on Low Prevalence Disorders. Australian and New Zealand Journal of Psychiatry 34(2): 221–236.

14.

Kavanagh

Waghorn

Jenner

(2004) Demographic and clinical correlates of comorbid substance use disorders in psychosis: multivariate analyses from an epidemiological sample. Schizophrenia Research 66: 115–124.

15.

Kozaric-Kovacic

Folnegovic-Smalc

Folnegovic

(1995) Influence of alcoholism on the prognosis of schizophrenic patients. Journal of Studies on Alcohol and Drugs 56(6): 622–627.

16.

McGuffin

Farmer

Harvey

(1991) A polydiagnostic application of operational criteria in studies of psychotic illness. Development and reliability of the OPCRIT system. Archives of General Psychiatry 48: 764–770.

17.

McGurk

Mueser

DeRosa

(2009) Work, recovery, and comorbidity in schizophrenia: a randomized controlled trial of cognitive remediation. Schizophrenia Bulletin 35(2): 319–335.

18.

Moore

Mancuso

Slade

(2012) The impact of alcohol and illicit drugs on people with psychosis: the second Australian national survey of psychosis. Australian & New Zealand Journal of Psychiatry 46(9): 864–878.

19.

Morgan

McGrath

Jablensky

(2013) Psychosis prevalence and physical, metabolic and cognitive co-morbidity: data from the second Australian national survey of psychosis. Psychological Medicine 44(10): 2163–2176.

20.

Morgan

Waterreus

Jablensky

(2012) People living with psychotic illness in 2010: The second Australian national survey of psychosis. Australian and New Zealand Journal of Psychiatry 46: 735–752.

21.

Morosini

Magliano

Brambilla

(2000) Development, reliability and acceptability of a new version of the DSM-IV Social and Occupational Functioning Assessment Scale (SOFAS) to assess routine social functioning. Acta Psychiatrica Scandinavica 101: 323–329.

22.

Mueser

Campbell

Drake

(2011) The effectiveness of supported employment in people with dual disorders. Journal of Dual Diagnosis 7(1–2): 90–102.

23.

Nafees

van Hanswijck de Jong

Stull

(2012) Reliability and validity of the personal and social performance scale in patients with schizophrenia. Schizophrenia Research 140: 71–76.

24.

Patrick

Burns

Morosini

(2009) Reliability, validity and ability to detect change of the clinician-rated personal and social performance scale in patients with acute symptoms of schizophrenia. Current Medical Research and Opinion 25: 325–338.

25.

Razzano

Cook

Burke-Miller

(2005) Clinical factors associated with employment among people with severe mental illness: findings from the employment intervention demonstration program. The Journal of Nervous and Mental Disease 193(11): 705–713.

26.

Rebgetz

Kavanagh

Hides

(2015) Can exploring natural recovery from substance misuse in psychosis assist with treatment? A review of current research. Addictive Behaviors 46: 106–112.

27.

SAS Institute (2012) SAS version 9.3, Cary, NC: SAS Institute.

28.

Sengupta

Drake

McHugo

(1998) The relationship between substance use disorder and vocational functioning among people with severe mental illness. Psychiatric Rehabilitation Journal 22(1): 41–45.

29.

Swartz

Lurigio

Goldstein

(2000) Severe mental illness and substance use disorders among former supplemental security income beneficiaries for drug addiction and alcoholism. Archives of General Psychiatry 57(7): 701–707.

30.

Todd

Green

Harrison

(2004) Social exclusion in clients with comorbid mental health and substance misuse problems. Social Psychiatry and Psychiatric Epidemiology 39(7): 581–587.

31.

Wade

Harrigan

Edwards

(2006) Substance misuse in first episode psychosis: 15-month prospective follow-up study. British Journal of Psychiatry 189(3): 229–234.

32.

Wilk

West

Rae

(2006) Relationship of comorbid substance and alcohol use disorders to disability among patients in routine psychiatric practice. The American Journal on Addictions 15(2): 180–185.

33.

World Health

Organization

(1992) The ICD-10: Classification of mental and behavioural disorders: Clinical descriptions and diagnostic guidelines, Geneva, Switzerland: World Health Organization.

34.

World Health

Organization

(1999) Schedules for clinical assessment in neuropsychiatry, Geneva, Switzerland: World Health Organization.