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.
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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; · 3.28 Impact Factor
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ABSTRACT: Studies have established a graded association between mental health and socioeconomic status (SES). However, scarce research has examined the impact of substance use disorders (SUD) and depression comorbidity on SES. We use data from the Woodlawn Study, a longitudinal cohort study, which recruited a cohort of first graders from Chicago starting 1966–1967 (N=1,242). Analyses focus on those interviewed in young adulthood and followed up through midlife. Regression analyses adjusting for childhood confounders showed that young adults with depression and SUD comorbidity had higher likelihood of having any periods of unemployment, higher likelihood of being unemployed for 3 or more months, and lower household income in midlife than those with neither disorder. Moreover, young adults with SUD without depression had higher odds of having any periods of unemployment and higher odds of being unemployed for 3 or more months than those with neither disorder. Findings point to the possibility of social selection where depression and SUD comorbidity contributes to a downward drift in SES. Clinical interventions that integrate the treatment of SUD and depression may be more effective at reducing socioeconomic disparities among minority populations.Psychiatry Research 11/2014; · 2.68 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. · 2.10 Impact Factor