Unemployment and Substance Use: A Review of the Literature (1990-2010)

Institute of Addiction Research, University of Applied Sciences, Frankfurt a.M., Germany.
Current Drug Abuse Reviews 04/2011; 4(1):4-27. DOI: 10.2174/1874473711104010004
Source: PubMed


The current article summarizes the results of a comprehensive review of the international research published between 1990 and 2010. The research was focused on the prevalence of substance use/disorders among the unemployed and employed, the impact of substance abuse on unemployment and vice versa, the effect of unemployment on alcohol/ drug addiction treatment and smoking cessation, and the relationship between business cycle, unemployment rate and substance use. Over hundred-thirty relevant studies were identified investigating these issues. The main results are as follows: (1) Risky alcohol consumption (associated with hazardous, binge, and heavy drinking) is more prevalent among the unemployed. They are also more likely to be smokers, to use illicit and prescription drugs, and to have alcohol and drug disorders (abuse, dependence). (2) Problematic substance use increases the likelihood of unemployment and decreases the chance of finding and holding down a job. (3) Unemployment is a significant risk factor for substance use and the subsequent development of substance use disorders. However, the current research provides only limited information about which individuals are more likely to be affected. (4) Unemployment increases the risk of relapse after alcohol and drug addiction treatment. (5) The exact nature of the relationship between unemployment and the probability of smoking cessation remains unclear due to the mixed results observed in the literature review. (6) Drinking and smoking patterns appear to be procyclical. We see a decrease in both when the economy declines and the unemployment rate increases. In contrast, a countercyclical trend was observed amongst adolescent drug users. However, these studies do not provide any convincing or additional information about substance use amongst the unemployed. This paper discusses the merits, limitations and problems of the research, proposes numerous future research questions, and outlines important implications for policy makers and practitioners, especially with regard to prevention and vocational promotion and rehabilitation.

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    • "It is interesting to note that Henkel et al. [24] found that unemployment had a strong connection to drinking problems in men. In our study, we found that being a man was a risk factor for presenting with a drinking problem. "
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    ABSTRACT: Alcohol misuse is generally not detected in hospital settings. The goal of this study was to estimate the prevalence of alcohol abuse and dependence in hospitalized patients in a university hospital in Sao Paulo (Brazil). Patients were randomly selected from all hospital admissions. The final sample consisted of 169 adult inpatients. Two screening tools were used: the Short Alcohol Dependence Data (SADD) and the CAGE questionnaires. In this sample, 25.4% of patients could be considered alcohol dependent according to the CAGE questionnaire, whereas 32.9% of patients fulfilled the criteria according to the SADD. The only predictor of alcohol dependence was gender; male inpatients were 3.2 times more prone to alcohol dependence with female inpatients. All inpatients should be systematically screened for alcohol use disorders. The choice of the screening tool will depend on whether the goal is to identify inpatients with hazardous drinking behaviors or with established alcohol-related problems. To maximize proper case identification, the CAGE questionnaire should be used as a first-step screening tool, and patients who screen positive on this scale should be subsequently administered the SADD questionnaire to assess the severity of the condition.
    International Journal of Environmental Research 05/2014; 11(6):5783. DOI:10.3390/ijerph110605783 · 1.10 Impact Factor
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    • "Alcohol consumption has a strong effect on work performance and is thus strongly associated with job loss [10]. It has also been proven that job loss is associated with increased frequency of alcohol addiction [11]. "
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    ABSTRACT: Background Alcohol use disorders (AUDs) are associated with the highest all-cause mortality rates of all mental disorders. The majority of patients with AUDs never receive inpatient treatment for their AUD, and there is lack of data about their mortality risks despite their constituting the majority of those affected. Absenteeism from work (sick leave) due to an AUD likely signals worsening. In this study, we assessed whether AUD-related sick leave was associated with mortality in a cohort of workers in Germany. Methods 128,001 workers with health insurance were followed for a mean of 6.4 years. We examined the associations between 1) AUD-related sick leave managed on an outpatient basis and 2) AUD-related psychiatric inpatient treatment, and mortality using survival analysis, and Cox proportional hazard regression models (separately by sex) adjusted for age, education, and job code classification. We also stratified analyses by sick leave related to three groups of alcohol-related conditions (all determined by International Classification of Diseases 9th ed. (ICD-9) codes): alcohol abuse and dependence; alcohol-induced mental disorder; and alcohol-induced medical conditions. Results Outpatient-managed AUD-related sick leave was significantly associated with higher mortality (hazard ratio (HR) 2.90 (95% Confidence interval (CI) 2.24-3.75) for men, HR 5.83 (CI 2.90-11.75) for women). The magnitude of the association was similar for receipt of AUD-related psychiatric inpatient treatment (HR 3.2 (CI 2.76-3.78) for men, HR 6.5 (CI 4.41-9.47) for women). Compared to those without the conditions, higher mortality was observed consistently for outpatients and inpatients across the three groups of alcohol-related conditions. Those with alcohol-related medical conditions who had AUD-related psychiatric inpatient treatment appeared to have the highest mortality. Conclusions Alcohol use disorder-related sick leave as documented in health insurance records is associated with higher mortality. Such sick leave does not necessarily lead to any specific AUD treatment. Therefore, AUD-related sick leave might be used as a trigger for insurers to intervene by offering AUD treatment to patients to try to reduce their risk of death.
    Addiction science & clinical practice 01/2013; 8(1):3. DOI:10.1186/1940-0640-8-3
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    • "Openly accessible at ling it [6]. Many persons who suffer from mental illness also have substance abuse problems, and many of those with substance abuse problems suffer from severe mental health difficulties [8] [9]. "
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    ABSTRACT: Background: Participating in working life is im- portant for most peoples’ economy, self-confi- dence, independence, social life, and feeling of belonging. Persons with co-occurring severe mental health difficulties and substance use problems have challenges in entering working life. Objective: The aim of the study was to ex- plore the importance of work and activity for the recovery of persons with co-occurring severe mental health difficulties and substance use problems and to determine the significant ele- ments that aid them in getting into work and/or meaningful activities. Methods: A professional development program was conducted to explore how following-up on these persons could lead to participation in working life. The data were col- lected through qualitative interviews with 24 participants, and with 25 of those carrying out the follow-up. Results: The participants de-scribed the benefit from the follow-up as well. They expressed enthusiasm for work and voca- tional training, although they all did not obtain work. Many had a better life, with more daily structure and less substance abuse. The per- sonal encounter between the helper and the participant was ascribed crucial importance— being respected and valued, being relied on, and being able to be honest were considered sig- nificant. Conclusions: The participants valued work and regular activities, a more structured life, decreased drug abuse, and altogether a better life. The helpers’ respect, recognition and their ability to see dignity through wretchedness and broken agreements were important. The participants emphasized the importance of get- ting help for different problems from different helpers at the same time, and the providers’ in- terdisciplinary collaboration in teams was es-sential. It seems that the supported employ- ment philosophy on speedy job seeking ought to be adapted to this target group and that prior social training may be necessary.
    Health 01/2013; 5(No.6A2):78-86. DOI:10.4236/health.2013.56A2012 · 2.10 Impact Factor
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