Abstract
BACKGROUND:
Employment is a predictor of sobriety for women in recovery from addiction, however, finding and maintaining employment is often a challenge. A number of interventions and a large body of research exist related to improving employment outcomes of women in recovery, but most fail to account for employment as an on-going, uneven process.
OBJECTIVE:
This study applied a longitudinal, qualitative design to explore employment experiences of women in recovery, as well as how those experiences interact with participants’ sobriety, health, and well-being.
METHODS:
Nineteen women from two residential recovery programs were interviewed four times over the course of nine months. Data were analyzed using longitudinal coding.
RESULTS:
Women encounter on-going struggle to find and keep employment, and multiple forces exacerbate this struggle. At the same time, positive work experiences described by some participants illustrate opportunities for the creation of new workplace structures that address employment needs of women in recovery while supporting sobriety and overall well-being.
CONCLUSION:
Understanding employment as an on-going process that interacts with addiction and sobriety in complex and multiple ways could contribute to improved employment and health outcomes for women in recovery.
Introduction
When a person in recovery from drug addiction desires employment, but is not able to achieve it, the effects on the individual’s health, recovery and well-being can be devastating. Lack of income associated with employment means an individual is unlikely to be able to access or afford follow-up treatment, not to mention experience a multitude of other health risk factors associated with poverty [1]. Furthermore, there is substantial evidence that participation in employment is a strong predictor of maintaining sob-riety for persons in recovery from addiction [2]. The direct links between employment and sobriety are not well understood. Scholars hypothesize that factors such as the stability and structure of a work place environment, decreased time to participate in drug-related activities, improved self-efficacy, and the development of identity and relationships related to something other than drug use are potential protective factors [3]. Vocational rehabilitation programs are considered a primary means of social reintegration [4], and as a result, job skills training and placement efforts are typically named as necessary components to most comprehensive recovery programs [2].
Despite these efforts, studies have found that the number of former substance abusers who are able to find and maintain employment is low, and the barriers to employment are pervasive [5]. At the individual level, barriers to employment include lack of skills or training, unrealistic goals about employment, and family obligations [6]. At the program level, inflexibility of treatment programs and lack of access to quality employment training can be barriers, and at the societal level, stigma about substance use, emplo-yment practices that frown upon gaps in employment and/or criminal charges, and lack of employment opportunities can make it exceedingly difficult to find legal work [7].
Women tend to face additional challenges in finding sustainable employment due to factors such as gender discrimination in the work place and additional burdens related to single parenthood or car-egiving duties for other family members [8], and these challenges are amplified by racism, classism, ableism, etc. When women in recovery are able to find employment, it is often found in “bad jobs” (i.e. jobs that are characterized by low pay and/or lack of benefits such as health insurance or pension) [9], jobs that are known to compromise health and well-being [1].
Although there is ample research examining exp-eriences of women in recovery vis-á-vis a particular characteristic of employment (e.g. job-training and employment; individual factors and employme-nt; family duties and employment; criminal history and employment), there are few studies that examine all of these factors together, and even fewer that ex-plore the ways in which these factors interact over time. Indeed, few to no studies conceptualize empl-oyment as an on-going process, although this appr-oach is recommended by scholars who research other types of vocational programs, such as return to work after injury and supported employment for persons with disabilities [10]. Furthermore, much of the research exploring employment for people in rec-overy from addiction measures employment as a bin-ary or tertiary variable (employed/unemployed/underemployed) [7] as opposed to utilizing a fuller concept of employment that considers the effect of employment on an individual’s health and well-being.
Gaining a fuller understanding of post-recovery employment and the ways in which it affects women’s health and well-being requires a methodological approach that conceptualizes employment as a process that is embedded in and co-constructs other life experiences. This study explored the employment experiences of women in recovery from addiction from multiple perspectives and at multiple time-points with the aim of improving current knowledge and practice surrounding health-promoting employment access, support and maintenance.
Method
To capture women’s employment experiences in a systematic and rigorous manner, we conducted a qualitative study that involved interviewing women in recovery at multiple stages of their recovery and employment processes. Since the study was exp-loratory and intended to capture a variety of phenomena, qualitative research was an appropriate and preferred method of data collection [11]. In addition to providing rich and layered descriptions, this approach encouraged participants to narrate their experiences and perceptions, and allowed researchers to capture often un-observed complexities, interpretations, and meaning-making processes [12]. The research was oriented around the following primary research question: How do employment barriers and supports interact over time to determine positive health, well-being, and employment outcomes for women in recovery from addiction?
Study context
Participants were recruited from two residential recovery organizations in a mid-sized southeastern city in the United States, Lena Circle and Family Renewal (both pseudonyms). Both organizations provide long-term residential treatment for women with histories of addiction and substance abuse. Although there are some organizational and programmatic differences between Family Renewal and Lena Circle, the services they provide and women they serve are similar enough to warrant inclusion in the same sample. Furthermore, a key difference between the two programs is the existence of Recovery Cooperatives, Lena Circle’s social enterprise that provides supported employment and job training for residents and graduates of Lena Circle prior to their attempts at finding outside employment. This allowed the authors to explore differences in employment experiences among women who have a variety of different types of supports and resources when it comes to accessing full-time employment. Approximately 12–15 women/year enter Lena Circle, and 20–25 women/year enter Family Renewal.
According to staff and residents of the two organizations, two critical time points in the employment seeking process are six months into residential treatment and the time at which women transition out of residential treatment. Because the women who live in these two facilities typically enter treatment with a host of complicated health, mental health, and lifestyle-related problems, women spend the first 6 months of the program focusing on “getting well.” It is not until the six-month mark that most women start to seek employment and/or job-related training. This represents a significant stage in the employment continuum because it is the point at which women start to identify their goals, seek resources, and access education or employment. Understanding entry into the workforce begins at this time point and extends through job placement and (hopefully) retention. When women transition out of residential treatment, the stakes related to employment rise exponentially, as she is suddenly solely responsible for her own economic well-being, and the economic well-being of any others who depend on her. Although Lena Circle and Family Renewal both have extensive transition supports, this is nevertheless a stressful and precarious process.
Data collection
Women in both programs begin to seek employment at approximately six months after entry into treatment, and begin to plan for transition out of residential treatment at approximately 18 months after entry into treatment. To understand the employment process at multiple time points, while also being realistic about the challenges of tracking this population over an extended period of time [13] the authors recruited two study groups: one group that was recruited after they had been in treatment for six months, and another group that was preparing to transition out of treatment. Both of these groups received follow-up interviews every 3 months for nine months, which allowed our data to cover the recovery experience from six-months into treatment (and the beginning of employment seeking) until nine-months post treatment (a time at which many women struggle to maintain employment). Study recruitment lasted for approximately one year, during which time program staff at the two recovery organizations informed women of our study and asked them to contact us if they were interested in participating. Of approximately 34 women who were eligible for the study, 19 women were initially enrolled in the study (12 in the six-month group and seven in the transition group). Seventeen women were enrolled at three-month follow up, 16 were enrolled at six-month follow up, and 14 were enrolled at the nine-month follow up interview. Because we were not able to recruit participa-nts directly, we were pleased to have 19/34 eligible participants contact us to participate. Program staff could not give us data about women who did not enroll, but informal conversations with staff indicated that there were no explanatory differences between the groups who did and did not participate in the study. Not having these data ourselves to examine possible differences is, however, a limitation. Additionally, although we were not able to contact the study attriters and did not hear this information first-hand, program staff and other residents told us that the people we were not able to contact for follow-up interviews had relapsed. This is again a limitation, however, it also leads us to believe that the women whose perspectives we captured in our interviews are “best case scenarios,” lending even more weight to the many difficulties women describe. Interviews were conducted by the authors and generally took between 20 and 30 minutes. Interview questions included questions about the participants’ employment experiences, as well as how those experiences were affecting their health and well-being. All interviews were recorded and transcribed verbatim to facilitate analysis. This study was approved by the Vanderbilt University Institutional Review Board (Study #140980), and each participant provided written consent at each interview.
Data analysis
To capture employment as a process and experience that takes place over time, we analyzed the data using a longitudinal coding strategy [14]. We read all the interviews for one person in succession, created analysis memos describing themes across time, and then coded both the themes and the in-terview transcripts themselves with the following codes: past, initiate, increase, decrease, idiosyncrasy, turning point, and future. Codes, along with their definitions and short examples, are listed in Table 1.
Codes, definitions and examples
Codes, definitions and examples
We coded interviews for all participants, and met throughout the coding process to compare our analyses and reach consensus on coding schemes and key findings. We then extracted text by codes using NVivo qualitative data analysis software, and developed categories and themes related to employment experiences and the many factors that affect them over time. Based on our analysis, we identified overall trends related to employment, as well as qualities and experiences that marked different phases of employment over time. In the next section, we outline the overall trends, and then report our findings organized temporally. Specifically, we discuss past education and employment experiences, current employment experiences (including finding employment, supporting employment, and maintaining employment, and future employment aspirations. We discuss how these experiences constitute an on-going “grind” of legal work, illegal work, and the work of recovery.
The women interviewed ranged in age from 21–50, with an average age of 37. Ten women identified as white and nine women identified as black. Sixteen women reported having children, but only 12 of those women had children under the age of 18. Of those 12 women, eight had custody of their children. Time without the use of drugs or alcohol ranged from one month to four years, and 10 of the women had been clean for 12 months or more. Education levels ranged from 8th grade to a college degree, but for most of the women (n = 10), a high school diploma or GED was their highest level of education. Fourteen women reported misdemeanor charges, twelve reported felony charges, and nine reported that they were still paying fines tied to old charges. The number of jobs women had held in their lifetimes ranged from 0–20, with an average of eight jobs. Nine women indicated that they had worked more than 10 jobs in their lifetimes. Only five of the women reported ever working in any job that was not a low-wage job: one woman had been a nurse, three women had worked in some type of managerial positions in retail sales, and one woman was a fleet service clerk for a national airline. In addition to holding jobs in the formal economy, all women noted working informally as well: fifteen participated in sex work, six took time off from work to provide care to their children or other family members, and one reported significant volunteering hours during times that she was unable to find work.
Past employment
Twenty, seventeen, none. These are some of the responses we received when we asked the question, “how many legal jobs have you held in your lifetime?” The polarity of responses - many, many jobs, or almost none at all - demonstrate the quality of employment experiences most women brought to the post-recovery job hunt. Cali followed up her response, “More than twenty?” with a typical description:
I’ve worked since I was like 15. So like, goodness, I couldn’t even begin to say. I’ve worked Kroger’s, Shoney’s, Ruby Tuesday’s, a carpet store for 2 years, and then they opened up another carpet store and I worked there for about a year. And then I had my own business at one point that lasted about 6-7 months, several jobs I worked just a couple of days ... and, uh ... I’ve had a lot of jobs. A lot of gaps, too.
Every woman we interviewed discussed gaps in employment, and many noted that they had more time in gaps than in jobs. There were multiple reasons for gaps in employment, but the most common was active addiction –women explained they just stopped going to work when they were getting high. Other women stopped working because of health problems or to take care of children or family members; some cited difficulty with reliable transportation, and a few talked about having “mean, horrible” bosses. Many women had worked jobs that they liked and all had worked jobs that they hated. At the very least, it is accurate to say that the job history women brought with them was unstable –a result of life challenges, but also the cause of some, too.
Women who held jobs such as waitressing, cleaning, warehouse work, or manual labor noted the physical toll these jobs had on their bodies and overall health: back pain, physical exhaustion, and other injuries combined with inability to take time off or pay for needed health services left many women with long-term health problems that interfered with their ability to work once they got clean. Although we did not ask specifically about health related to sex work, previous interviews with this same group of women indicate that most if not all of the women who earned money or drugs by performing street-based sex work suffered from trauma, abuse, and/or sexually transmitted infections. The “grind” of many past jobs combined with the “grind” of health problems (including addiction) meant that women ended up describing their past as a type of frantic effort that led to little (if any) forward progress in terms of economic security, family stability, or mental and physical health–a discouraging and defeating experience.
When women talked about ways to leave the types of jobs that had failed to meet their expectations and/or compromised their health in the past, they often cited education and training as the mechanism by which to accomplish this. Previous experiences with training, however, were remarkably similar to previous work experiences: specifically, most women either had little to no training, or multiple sporadic training experiences that signaled qualification for several types of low-wage jobs, but never led to a career or advancement. Mindy described her past job training as follows:
In 2002 after I got my GED, I went through a class called Building Trades, where I learned core curriculum and carpentry 1. Then in 2012, I went to cosmetology school and obtained 400 hours. And basically, I mean, well, that’s not the only skills I have. When I worked at Taco Bell, I was trained to do everything in the restaurant. So I was trained to sub-steam and expedite food, make the food, work the register, work with people, clean, open, close - so those are some good skills to have. And then, I think I have skills just by being a mother, being a homemaker, doing the things you have to.
Not all women had this many different training experiences or ability to articulate their skills, but many did. Furthermore, the fact that those who did and those who did not typically found themselves in very similar job situations seems to demonstrate that barriers related to employment, education, and economic stability had marked our participants lives for a very long time.
The daily grind
Most women cited lack of education, tenuous job history, and past criminal charges as among the biggest barriers to employment, but there were others as well. Once women found work, challenges related to transportation, lack of affordable childcare, and the need to maintain appointments and practices related to recovery contributed to workplace difficulties. This section includes data coded “initiate,” “increase,” “constant,” and “idiosyncratic,” and will discuss the specific experiences of women related to finding and maintaining employment, and how women and their recovery communities have sought to mitigate these challenges.
Finding employment
Regardless of the organization or employment model the women were following, most women voiced the same fears, hopes and anticipations as they initiated employment. Women feared lacking skills and abilities to do their jobs, and they feared being able to balance work while maintaining recovery. For the most part, however, women talked about their excitement about gaining knowledge, learning skills, and developing relationships with fellow employees and clients. They talked about the pride they would feel once they were making enough money to be independent and provide for their families. Jenni said:
... the things that excite me are having that stability in my life, knowing that I have a job and that I have resources to take care of myself and my children, being able to be productive and have my own place and you know, eventually a car and just ... I don’t really have to have everything I want. I just want to be able to have everything I need.
When women started the process of finding employment, however, their modest hopes were often met with substantial barriers. Job histories including multiple, short-term stents of employment and lots of gaps are just one of the challenges women face when they begin to seek employment. For women who had never worked legally, lack of job skills and references were difficult to explain. Misdemeanors and felony charges disqualify them before they step in the door, despite Equal Employment Opportunity laws suggesting otherwise.
It is very...It has been very hard for me several times. And I’ve had many “no’s” you know. It feels like a door being slammed in my face, because they said well, you have this on your record. And sometimes it feels like I’m still paying for what I’ve done even though I’m not locked up anymore ... And sometimes it’s hard when you go out all day in the heat and you are looking for a job and you just get told, “no, no, no, no.” This is what goes on for a couple weeks at a time. It’s hard to keep going. You know? Cuz it gets you really frustrated. You start getting depressed and thinking, “I’m not never going to get a job.” My background is always going to keep this from happening.
Because of experiences such as these, participants frequently found themselves in positions in which their pasts made certain types of employment (e.g. fast food, cleaning services) much more likely than others, but also perceived conflict between these types of jobs and other life duties, including going to treatment and meetings that contribute to recovery, and caring for children. When asked, “What do you perceive to be the barriers to get that job?” Mary responded:
My felonies. My felonies is the number one thing for me that always scares me when I look for a job. But you know, also hours. A lot of places don’t want you to tell them what hours you work, especially fast food. They want you to be able to work what they want you to work. But see, that’s where I have to be adamant about that, because this is my recovery and this is what I have to do, so. I think that is going to present a problem. It is going to take me a lot longer to find something.
Due to a wealth of experience walking through the job acquisition process with the women they serve, Lena Circle and Family Renewal had multiple resources to support re-entry into employment. Both recovery programs in which women were engaged had resources for assisting the women in their job search process. Family Renewal had classes in which women constructed a resume and practiced interviewing; they also provided computers to search for job leads and bus passes to travel to places of work to inquire about applying. In some cases, connections that Family Renewal held would facilitate the job process, but for the most part, women searched, selected, and applied on their own. At Lena Circle, women were required to take computer classes with a job readiness organization in their city, and then were required to work at Recovery Cooperatives for at least 6 months. Recovery Cooperatives is string of social enterprises owned by Lena Circle, and includes a bath and body company, a café, and a sewing studio. At the beginning, women are only allowed to work 15 hours/week to make time for therapy, appointments, and other health-maintaining activities. Lena Circle provides all services (including lodging and food) for free, so the assumption is that limiting work hours should not pose a financial problem on the residents.
The perception of this requirement varies from participant to participant: most were grateful not to have to enter the discouraging and often overwhelming process of searching for a job so early in their recovery, and most reported liking working at Recovery Cooperatives. At least a few women we interviewed voiced frustration over having to wait 6 months to work and then only being allowed to work 15 hours/week. Women reported being bored while waiting, and then wanting to be busier and earning more money once they started working.
Supporting employment
Despite these frustrations, women at Lena Circle who worked at Recovery Cooperatives tended to fair better than women at Family Renewal, especially in terms of employment, health, and recovery. Family Renewal participants were often not working in the same job or did not have the same plan from one interview to the next. They tended to have more difficulty finding and keeping jobs. There were many reasons for this - relapse, not liking a job, not being able to manage travel to a job, or needing to quit for family reasons - but across the board, these difficulties meant that women were not able to experience the acquisition and accumulation of skills, income, or independence that they had hoped. At a follow-up interview for one of the 6-month group participants, Sherrie said:
Yes, actually, not too long after I spoke with you, I ended up- I went out and I got a job at a warehouse. And I was able to work it for like a 2 week span, but then I ended up having to move from where I was at, in the recovery program, out to the country. So it ended up being like an hour drive there and back, and with...for the rate of the job, it wasn’t paying for gas. So yeah, I had to come out to the country, and move in with an extended family.
Sherrie left Family Renewal before most women do because she was being prescribed gabapentin, a non-narcotic pain medication that the recovery facility does not allow, and needed to live with her extended family in order to maintain custody of her daughter. Her parting was amicable and regrettable on the part of some facility staff, but the theme she described –finding a job and then moving, experiencing health problems, transportation problems, or problems with childcare –was common across women at Family Renewal.
At Lena Circle, women’s employment experiences were generally a little more aligned with the hopes and expectations they identified at the outset. Women reported finding and maintaining employment, increasing their knowledge, skills, and self-concept, and improving their abilities to work with others. Lynn described:
Today, we had an educational session and we each brought the products we work on ... And we each went over you know, ‘This is what I sell. These are the big bags of tea; this is the tea kit; here’s the tin of them.’ And we all went around the table. One of the people sells shirts - she is in charge of the apparel. She brought all that available apparel. Another one works in the Paper Studio, so she brought - I mean so it’s, that’s the kind of stuff I like, where I’m learning. You know, I’m getting confidence in myself.
Lena Circle Women also talked about decreases in their desires to “use,” their mental health symptoms, economic anxieties and doubts about their abilities. When asked about how her job affected her well-being, Cara gave a somewhat typical response:
It gives me a positive feeling: feeling like I’ve accomplished something at the end of the day ... it’s a positive effect on my mental health. I have been diagnosed with depression and a mood disorder for which I am, you know, on the proper medication. So I really don’t find myself with my moods being really high and low. I come in and try to be positive with a smile on my face and that kinda sets the tone for my mental health knowing that I’m smiling and I’m cordial. Yeah so, it’s positive. Most things about this job are positive for me.
For most women who performed their job duties well, there were opportunities to advance within the company and earn raises, and for women who did not perform as well, the job still seemed to have a stabilizing effect on other life factors. The guarantee of stable job seemed to help women weather the storm of finances, housing woes, health problems, and other frustrations. Recovery Cooperatives allowed women paid maternity leave and sick leave, and worked with women to accommodate life demands at work. One woman had her child in daycare but was allowed to bring her to work when the daycare was closed for various reasons. Another woman explained how Recovery Cooperatives worked with her to determine which job tasks she could do without exacerbating her chronic health problems:
One thing that I thought was very considerate was when I first started working here last November, I had been having a lot of problems with my blood sugar, and I was falling a lot. I wasn’t myself. I wasn’t sharp. And they found me things to do; one of them was making sashays. I had to make a bunch of things because Christmas was coming up ... so I was able to do that sitting down and I punched holes in the candle boxes which was also important for Christmas because they needed to get a lot of candles done. You know so even though it wasn’t the most exiting work in the world, I still was grateful that they came and let me work and the tasks that I was given at that time and still made me feel useful and productive.
When women who were working at Recovery Cooperatives did not have positive experiences they were generally due to dissatisfaction with hours or pay, challenging relationships with others, and feeling “pimped” in a job that (depending on one’s position) was heavily focused on sales. One woman who was transitioning out of Lena Circle explained why she left her job at Recovery Cooperatives:
I wasn’t comfortable. And again, I’m not talking bad about Recovery Co-ops –it’s fine for some people. For me, I watched another woman who had a history, her story is just like mine, and she went back out ... because it gets to the point that you’re working and talking, you’re selling a product and in return we’re making money off this product for a good reason, but it started to feel like that same familiar feeling like when I was on the streets: I would tell you what you needed to hear to sell this product ... In order to make money for someone else ... And it became where I was doing the same thing it was just a different product. And somewhere in my recovery that became uncomfortable as I grew.
The concern over the connection between sales and sex work is something that has been a topic of conversation at the social enterprise for a long time, and the organization is developing ways to accomplish selling products without causing problems for the women it triggers. One of the difficult aspects of these conversations, however, is that some women experience the sales aspect quite differently from one another –for some women, it is just another form of selling oneself, but for others, it is an opportunity to use well-developed skills to earn much needed money. For those who find this work most problematic, it seems as though these feelings are particularly centered on the low wage nature of their work and the perception that they, as workers, should be profiting more than they do.
Maintaining employment
It was not atypical for women at both Lena Circle and Family Recovery to have more than one job, especially after they transitioned out of the residential facility associated with the recovery program. Although some women did this because they reported liking to be busy, most did so out of economic necessity. Both programs are located in a city with little affordable housing and no public transit, making the cost of living quite high. Of all the women we interviewed, the highest reported rate of pay for a full time job was $10/hour. Other women reported having part-time or temporary employment that paid slightly more than that for a season. For some women, having additional jobs was a positive experience and gave them the opportunity to do new and different things, for others having additional jobs created unwanted stress. Multiple women complained about having to work with people who were using drugs and alcohol while at work, despite previous complaints that working with women in recovery (and therefore with co-workers who were guaranteed not to be using) was difficult. Although none of our interview questions addressed this directly, one of our observations was that women who were married or had long-term partners were more stable in terms of work, finances, health, and employment.
Future
None of the women we interviewed indicated that they expected or even wanted to earn an extravagant salary, change the world, or win a prize. Rather, they wanted to be able to afford safe, sufficient housing for themselves and their families, to be able to pay for the things they needed, do work that was challenging and meaningful, be respected by their bosses and coworkers, and have some control over their schedules and tasks. They describe ideal work environments as environments that supported their health and development and allowed them to participate in the health and development of others.
Despite their ability to articulate goals and identify how to get there, women noted very real obstacles such as the necessity to integrate employment, recovery, and care for their children. Limited pay available in low-wage jobs lead most women to feel that they either needed to further their education (which takes time and money) or work an additional job (which takes more time) to be able to provide for themselves and their families. However, time is also required for maintaining sobriety, parenting children, and rest. For those who relied on public transportation, coordinating travel time for themselves and their children was an additional barrier to achieving the future they envisioned. Perhaps because of these barriers, women were fearful as well as hopeful about their futures. In response to the question, “Is there anything that scared you about transitioning out?” Bonnie told us:
Oh hell yeah ... the disease of addiction. It scares the shit out of me. I have a lot more freedom there [living on her own] than I do at Lena and I still have to be accountable; I still gotta do some things and the disease of addiction comes in a million ways ... but I mean the disease of addiction yes that scares me because I live with that the rest of my life.
Interviewer: Yeah. Is there anything else that scares you?
Bonnie: At my age trying to get a house, my health - will I be able to work long enough to be able to pay for it? Will I end up being homeless on the street because I didn’t build up my life 40k or whatever you call those things.
Based on general knowledge about addiction, employment, and housing, as well as other studies with this population in particular, Bonnie’s fears were not unfounded.
Discussion
Although the women in this study varied considerably in terms of education level, family histories, and specific trajectories of their drug use, there are some remarkable commonalities in terms of job history. First, most women have spent a large part of their lives doing work that does not count in the public imaginary [15]. Despite being unquestionably hard work in most cases, the work that the women in this study spent most of their lives doing: caring for children and family members, selling drugs, selling sex, and maintaining spotty formal employment is not seen by the law or potential employers as work, but rather an illustration of their lack of fitness for the work place.
When women were working –both before and after recovery - they were almost always working in low-wage jobs that presented them with little stability or opportunities for advancement, and often threatened their already tenuous mental and physical health. Although it is likely that the qualities of their employment prior to entering recovery –multiple short-term jobs with many gaps, lots of “starts” with no advancement –are in part due to substance abuse, it is also true that these qualities are generally true of low-wage work in general [16]. Functionally, what this means for women in recovery seeking employment (as well as the recovery organizations attempting to assist them) is that they are fighting more than one battle: they must find jobs that accommodate their health vulnerabilities and social histories, allow them to care for their families and their recovery, and do so in an environment that is hostile to most workers, even those without amplified needs.
In particular, for women in recovery, available low-wage positions are often found in the accommodations and food service industries, because these tend to be industries that tolerate employment gaps and criminal records. Unfortunately, these are also industries in which 19% of workers indicated that they had used illicit drugs in the past month [17]. One can imagine that a work environment in which approximately one in five coworkers has recently used illicit drugs (even if only recreationally) would be detrimental to recovery and sobriety. Beyond substance abuse, we can extrapolate more generally from well-established findings from other studies exploring the health and mental health of low-wage workers. Specifically, work that is characterized by high instability, high triviality, or high demand paired with low control (traditional hallmarks of low-wage labor) is related to a wide variety of poor health outcomes independent of income effects on health [18]. Qualities of low wage work such as chronic instability regarding schedules and work conditions as well as the security of employment itself, the high-demand, low control nature of the work, and lack of meaning or purpose associated with work can be a particularly toxic combination [18].
Although this study was not meant to be a comparison of recovery programs that have supported employment options and those that do not, the stark contrast in outcomes for women at Lena Circle and those at Family Renewal are worth noting. In the presence of the above barriers, the Lena Circle model sought to mitigate substantial barriers to health-promoting, stable employment by providing a work place that offered socially accepted work to its residents and graduates, and did it in a way that is very flexible around issues that concern its residents in particular, but, one might argue, many women in general. For example, work hours and demands were structured in such a way that maintaining appointments and recovery meetings was possible and easy. The work environment allowed for many types of abilities, preferences, and vulnerabilities, especially related to mental health, addiction, and past experiences with trauma. Because it offered preferred employment to all women in the Lena Circle program, it overcame barriers related to lack of formal education, gender, race, class, tenuous employment patterns, and histories of involvement with the criminal justice system.
Limitations
The focused, qualitative nature of this study is part of what allowed us to examine in-depth experiences with employment over time in a particular population of women. At the same time, this design means that our findings are not necessarily generalizable beyond the communities from which we recruited participants. It would be valuable to expand the research to include more participants in more geographic areas (for example, in areas with better mass transit or higher minimum wage rates), or women in different types of programs. Additionally, because there were some women we did not recruit into the study, and some women we were not able to track for the entirety of the study, we cannot speak to their employment experiences. As stated previously, we believe the women who participated in the study were examples of women who had been reasonably successful in their recovery and thus in a better position to access and maintain employment, but we do not know that for sure. Finally, it would be beneficial to study long-term employment trends of this population to test if the trends we observed persist.
Conclusion
By examining employment experiences over time in such a way that allowed exploration of the many factors affecting those experiences (and the ways in which those experiences shaped the women who had them), we were able to gain a fuller understanding of the many barriers, supports, failures, and successes of women in recovery from addiction related to employment.
One of the most salient themes in our findings was the perpetual challenges faced by women at almost every stage of employment, especially if they were seeking employment outside of the supported work environment of Recovery Cooperatives. These challenges did not necessarily mean that women never acquired or maintained employment, but rather than it required a tremendous level of on-going effort to coordinate work and other life demands.
The on-going challenges related to employment gain magnitude when considered in relation to another one of the themes in our findings: work matters. Work (or lack of work) occupies a substantial portion of time in one’s day, shapes one’s sense of purpose, and has very real consequences for one’s ability to accomplish life goals. When work experiences are positive, they have the ability to positively impact these aspects of one’s life –they provide a sense of purpose, create a stabilizing and health-supporting environment, and contribute to overall quality of life. When work experiences are not positive, they are detrimental in many respects, not the least of which are related to health and sobriety.
The implications of these findings for persons in recovery, researchers, and service providers are that developing a fuller account of employment in one’s past, present, and future are essential to one’s health and sobriety. Considering types and locations of employment, as well as their fit with a person’s likes, dislikes, and needs would make employment more likely the be health-promoting for persons in recovery, as would other, known society-level needs: increased wages, flexible work schedules, accessible public transportation, and affordable childcare. Supporting women who live at the intersection of various forms of marginalization (mental health status, race, class, gender) requires attention to the ways in which they contribute to society formally and informally and determining ways that these contributions can facilitate rather than detract from their own health and well-being.
Conflict of interest
None to report.
Footnotes
Acknowledgments
This study was made possible in part by the Peabody College small grants program. Additionally, the authors would like to thank Michelle Wijaya, Erin Boddy, and the staff and residents of Lena Circle and Family Renewal.