Unemployment and substance use: a review of the literature (1990-2010).
ABSTRACT 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.
SourceAvailable from: Alexander M. Ponizovsky[Show abstract] [Hide abstract]
ABSTRACT: Abstract Objectives To examine the trends in the incidence of dual diagnosis (DD) of severe mental illness and substance-related disorders among inpatients in Israel, and 2) the demographic and clinical correlates of DD patients. Method Using data from the National Psychiatric Case Register, we identified 56,774 inpatients aged 15-64 whose first psychiatric hospitalization occurred between 1996 and 2010. We compared the characteristics of inpatients having DD with drugs, alcohol or drug/alcohol abuse with those with mental disorder only. Results Over the period, DD with drugs decreased from 8.2% in 1996 to 6% in 2010; DD with alcohol increased from 3% to 4% and DD with drugs/alcohol from 2% to 4%. DD with drugs was highest, whereas DD with alcohol was lowest for the youngest age- group in 1996 but increased to the same as other age-groups in 2006-2010. Male gender, a previous suicide attempt, compulsory hospitalizations and marital status were positive predictors for all DD. Immigrant status was a positive predictor of DD with alcohol, but the opposite for DD with drugs; being Jewish and psychotic diagnosis was a positive predictor of DD with drugs, but negative for DD with alcohol. Conclusions Over the study period, DD with drugs has decreased among young patients, although it is still higher than among older groups. However, DD with alcohol or drugs/alcohol has increased in the younger group. The clinical-demographic profile of DD patients was similar to that from the relevant literature, except for immigrant status that was negatively associated with DD with drugs. Keywords: Dual diagnosis, Mental disorder, Substance related disorder, Co-occurrence, Temporal trends, Incidence, IsraelDrug and Alcohol Dependence 01/2015; 148. DOI:10.1016/j.drugalcdep.2015.01.009 · 3.28 Impact Factor
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ABSTRACT: To examine changes in the use of alcohol, cannabis and hypnotics/sedatives between two periods (before and during Spain's economic crisis), and to identify differences in the change between employed and unemployed individuals. Using cross-sectional data from four editions of the Spanish Household Survey on Alcohol and Drugs we selected economically active individuals aged 16-64 years (total sample = 62,440) and defined two periods, pre-crisis (P1 = 2005-2007) and crisis (P2 = 2009-2011). Poisson regression models with robust variance were fitted to obtain prevalence ratios (PR) of heavy and binge drinking, and multinomial regression models to obtain relative risk ratios (RRR) of cannabis and hypnotic/sedative use, between the two periods, also considering the interaction between period and employment status. While the prevalence of alcohol use remained stable, heavy drinking declined in P2 in men both overall (PR = 0.73; 95%CI:0.67-0.79) and in the two age groups (16-34 and 35-64), and in women also overall (PR = 0.86; 95%CI:0.75-0.99) and in the older age group. In contrast, binge drinking increased overall in P2 in men (PR = 1.17; 95%CI:1.12-1.22) and in women (PR = 1.62; 95%CI:1.49-1.76), and in both age groups. No differences in the change were observed between employed and unemployed individuals. Overall cannabis use remained stable in P2, but unemployed men and women of the older age group were more likely to have increased sporadic use compared to their employed counterparts (RRR = 2.24; 95%CI:1.36-3.68 and RRR = 3.21; 95%CI:1.30-7.93, respectively). Hypnotic/sedative use remained stable in P2 in men, but unemployed men were less likely to have increased heavy use in P2 compared with employed men (RRR = 0.69; 95%CI:0.49-0.97). In women, heavy use increased in P2 overall and in the older age group, irrespective of employment status. In a period of economic recession in Spain heavy drinking decreased and binge drinking increased. Sporadic cannabis use increased among older unemployed men and women. Heavy use of hypnotics/sedatives increased among employed men while older women increased use irrespective of employment status. This article is protected by copyright. All rights reserved.Addiction 03/2015; DOI:10.1111/add.12923 · 4.60 Impact Factor
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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