Health  Vol.5 No.6 B , June 2013
Work and activity in rehabilitation of persons with co-occurring severe mental health difficulties and substance use problems

Background: Participating in working life is important for most peoples’ economy, self-confidence, 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 explore 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 elements 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 collected through qualitative interviews with 24 participants, and with 25 of those carrying out the follow-up. Results: The participants described the benefit from the follow-up as well. They expressed enthusiasm for work and vocational training, although they all did not obtain work. Many had a better life, with more daily structure and less substance abuse. The personal 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 significant. 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 getting help for different problems from different helpers at the same time, and the providers’ interdisciplinary collaboration in teams was essential. It seems that the supported employment philosophy on speedy job seeking ought to be adapted to this target group and that prior social training may be necessary.

Cite this paper: Steihaug, S. , Werner, A. and Lossius, T. (2013) Work and activity in rehabilitation of persons with co-occurring severe mental health difficulties and substance use problems. Health, 5, 78-86. doi: 10.4236/health.2013.56A2012.

[1]   Crowther, R.E., Marshall, M., Bond, G.R. and Huxley, P. (2001) Helping people with severe mental illness to obtain wok: Systematic review. Bulletin Medical Journal, 322, 204-208. doi:10.1136/bmj.322.7280.204

[2]   Rinaldi, M. and Perkins, R. (2007) Comparing employment outcomes for two vocational services: Individual placement and support and non-integrated pre-vocational services in the UK. Journal of Vocational Rehabilitation, 27, 21-27.

[3]   Beyer, S. (2012) The progress towards integrated employment in the UK. Journal of Vocational Rehabilitation, 37, 185-194.

[4]   Becker, D., Whitley, R., Bailey, E.L. and Drake, R.E. (2007) Long-term employment trajectories among participants with severe mental illness in supported employment. Psychiatric Services, 58, 922-928. doi:10.1176/

[5]   Koletsi, M., Niersman, A., van Busschbach, J.T., Catty, J., Becker, T., Burns, T., Fioritti, A., Kalkan, R., Lauber, R., Rössler, W., Tomov, T. and Wiersma, D. (2009) Working with mental health problems: clients’ experiences of IPS, vocational rehabilitation and employment. Social Psychiatry and Psychiatric Epidemiology, 44, 961-970. doi:10.1007/s00127-009-0017-5

[6]   Henkel, D. (2011) Unemployment and substance use: A review of the literature (1990-2010) Current Drug Abuse Reviews, 4, 4-27. doi:10.2174/1874473711104010004

[7]   Laudet, A.B. (2012) Rate and predictors of employment among formerly polysubstance dependent urban individuals in recovery. Journal of Addictive Diseases, 31, 288-302. doi:10.1080/10550887.2012.694604

[8]   Sacks, S., Chandler, R. and Gonzales, J. (2008) Responding to the challenge of co-occurring disorders: Suggestions for future research. Journal of Substance Abuse Treatment, 34, 139-146. doi:10.1016/j.jsat.2007.03.008

[9]   Swendsen, J., Conway, K.P., Degenhardt, L., Glantz, M., Jin, R., Merikangas, K.R., Sampson, N. and Kessler, R.C. (2010) Mental disorders as risk factors for substance use, abuse and dependence: Results from the 10-years followup national comorbidity survey. Addiction, 105, 1117-1128. doi:10.1111/j.1360-0443.2010.02902.x

[10]   Todd, F.C., Sellmann, J.D. and Robertson, P.J. (2002) Barriers to optimal care for patients with coexisting substance use and mental health disorders. Australian and New Zealand Journal of Psychiatry, 36, 792-799. doi:10.1046/j.1440-1614.2002.01049.x

[11]   Adams, M.W. (2008) Comorbidity of mental health and substance misuse problems: A review of workers’ reported attitudes and perceptions. Journal of Psychiatric and Mental Health Nursings, 15, 101-108. doi:10.1111/j.1365-2850.2007.01210.x

[12]   Becker, D.R., Drake, R.E. and Naughton W.J., Jr. (2005) Supported employment for people with co-occurring disorders. Psychiatric Rehabilitation Journal, 28, 332-328. doi:10.2975/28.2005.332.338

[13]   Laudet, A.B., Magura, S., Vogel, H.S. and Knight, E.L. (2002) Interest in and obstacles to pursuing work among unemployed dually diagnosed individuals. Substance Use & Misuse, 37, 145-170. doi:10.1081/JA-120001975

[14]   Judd, P.H., Thomas, N., Schwartz, T., Outcalt, A. and Hough, R. (2003) A dual diagnosis demonstration project: Treatment outcomes and cost analysis. Journal of Psychoactive Drugs, 35, 181-192.

[15]   Kelly, T.M., Daley, D.C. and Douaihy, A.B. (2012) Treatment of substance abusing patients with comorbid psychiatric disorders. Behavioral Addiction, 37, 11-24. doi:10.1016/j.addbeh.2011.09.010

[16]   Carpenter-Song, E., Hipolito, M.M. and Whitley, R. (2012) “Right here is an oasis”: How “recovery communities” contribute to recovery for people with serious mental illnesses. Psychiatric Rehabilitation Journal, 35, 435-440. doi:10.1037/h0094576

[17]   NAV (2006) National strategy plan for work and mental health 2007-2012. In English.

[18]   Kvale, S. and Brinkman, S. (2009) Interviews: Learning the craft of qualitative research interviewing. 2nd Edition, California Sage, Los Angeles.

[19]   Malterud, K. (2012) Systematic text condensation: A strategy for qualitative analysis. Scandinavian Journal of Public Health, 40, 795-805. doi:10.1177/1403494812465030

[20]   Liebschutz, J., Savetsky, J.B., Saitz, R., Horton, N.J., Lloyd-Travaglini, C. and Samet, J.H. (2002) The relation between sexual and physical abuse and substance abuse consequences. Journal of Substance Abuse Treatment, 22, 121-128.

[21]   Weber, K., Rockstroh, B., Borgelt, J., Awiszus, B., Popov, T., Hoffmann, K., Schonauer, K., Watzl. H. and Pöpster, K. (2008) Tress load during childhood affects psychopathology in psychiatric patients. BMC Psychiatry, 8, 63.

[22]   Wu, N.S., Schairer, L.C., Dellor, E. and Grella, C. (2010) Childhood trauma and health outcomes in adults with comorbid substance abuse and mental health disorders. Addictive Behaviors, 35, 68-71.

[23]   Schibbye, A.-L. L. (1999) The role of “recognition” in the resolution of a specific interpersonal dilemma. Journal Phenomenological Psychology, 24, 175-189. doi:10.1163/156916293X00134

[24]   Brousselle, A., Lamothe, L., Sylvain, C., Foro, A. and Perreault, M. (2010) Integrating services for patients with mental and substance use disorders: What matters? Health Care Management Review, 35, 212-223.

[25]   Burns, T., Catty, J., Becker, T., Drake, R. E., Fioritti, A., Knapp, M., Lauber, C., Rössler, W., Tomov, T., van Busschbach, J., White, S. and Wiersma, D. (2007) The effectiveness of supported employment for people with severe mental illness: A randomised controlled trial. Lancet, 370, 1146-1152. doi:10.1016/S0140-6736(07)61516-5

[26]   Bond, G.R., Drake, R.E. and Becker, D.R. (2008) An update on randomized controlled trials of evidence-based supported employment. Psychiatric Rehabilitation Journal, 31, 280-290. doi:10.2975/31.4.2008.280.290

[27]   Wehman, P. (2012) Supported employment: What is it? Journal of Vocational Rehabilitation, 37, 139-142.

[28]   Cook, J. A, Razzano L.A., Burke-Miller J.K., Blyler, C.R., Leff, H.S., Mueser, K.T., Gold P.B., Goldberg, R.W., Shafer, M.S., Onken S.J., McFarlane, W.R., Donegan, K., Carey, M.A., Kaufmann, C. and Grey, D.D. (2007) Effect 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 & Development, 44, 837-850. doi:10.1682/JRRD.2006.07.0079

[29]   Frouenfelker, R.L., Wilkniss, S.M., Bond, G.R., Devitt, T.S. and Drake, R.E. (2011) Enrollment in supported employment services for clients with a co-occurring disorder. Psychiatric Services, 62, 545-547. doi:10.1176/

[30]   Mueser, K.T., Campbell, K. and Drake, R. (2011) The effectiveness of supported employment in people with dual disorders. Journal of Dual Diagnosis, 7, 90-102. doi:10.1080/15504263.2011.568360

[31]   Glover, C.M. and Frounfelker, R.L. (2011). Competencies of more and less successful employment specialists. Community Mental Health Journal. doi:10.1007/s10597-011-9471-0