Building Evidence-Based Strategies to Improve Employment Outcomes for Individuals With Substance Use Disorders

Publication Date: March 23, 2021
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  • Published: 2021


This paper examines the impetus and existing evidence on programs that integrate employment services with treatment and recovery services for people with opioid and other substance use disorders (SUDs). It includes an overview of the nature and recent history of SUDs and their treatment, including the important role that employment can play in recovery, and discusses the factors that historically limited the role of employment services in treatment programs. It also provides a brief review of the limited but promising evidence on the effectiveness of integrating substance use disorder treatment and employment services in improving participants’ employment outcomes.

The Building Evidence on Employment Strategies for Low-Income Families (BEES) project studies programs that combine employment services with substance use disorder treatment and recovery services. It is funded by the Office of Planning, Research, and Evaluation within the Administration for Children and Families. Through a series of rigorous evaluations, BEES aims to increase the understanding of effective interventions that help low-income individuals find jobs and advance in the labor market.


The United States is in crisis as it attempts to address the wide-ranging and growing needs of persons with substance use disorders, driven by both the opioid epidemic as well as the ongoing misuse of other drugs and alcohol. Recently, in large part due to the opioid crisis, there has been a growing focus on and increased federal funding for programs that address both treatment and employment outcomes. The provision of employment services specifically designed to be part of substance use disorder treatment or recovery efforts provides opportunities to develop programs that can achieve the dual goals of sustaining recovery and improving economic well-being. The paper considers how the growing number of programs that offer this combination of services offers opportunities to learn more about the efficacy of the approach, and how the BEES project plans to use it.

Key Findings and Highlights

  • While alcohol is the most common substance linked to a SUD, opioid misuse has increased at an alarming rate during the past two decades. Opioids now represent a significant share of substances linked to SUDs in the United States.
  • Substance use disorders have hit low-income populations the hardest. They are more prevalent among those who are unemployed, have lower earnings and educational levels, and live in communities with higher unemployment rates.
  • Employment can help people with substance use disorders stay on the path to recovery, reflecting both the economic and noneconomic benefits of work. But many people with substance use disorders face challenges in finding and keeping a job, including discrimination based on having a criminal history, mental or physical health problems, and limited education and skills. Many employers are also reluctant to hire those with a history of substance use disorder.
  • While much attention has been given to developing and implementing effective treatment efforts for substance use disorder, employment services have historically not been a primary element in these programs. There are many reasons for this outcome, including limited resources for employment services, lack of SUD treatment staff with appropriate employment-related skills, and limited research on how to sequence employment-focused services most effectively in treatment programs.
  • Evidence gathered from numerous studies of employment services for those in treatment and recovery shows that some programs that combine employment services and substance use disorder treatment services have produced some positive results on employment outcomes. However, because many of these studies were not designed as rigorous randomized controlled trials and the study samples were generally small, it is difficult to draw conclusions about the efficacy of any specific approach.
  • Further research is needed to understand how to integrate employment and SUD treatment services to improve both economic and treatment outcomes for people with substance use disorders. The BEES project provides an opportunity to examine this approach for serving low-income populations with SUDs.


Martinson, Karin, Doug McDonald, Amy Berninger, and Kyla Wasserman. 2021. Building Evidence-Based Strategies to Improve Employment Outcomes for Individuals with Substance Use Disorders. OPRE Report 2020-171. Washington, DC: Office of Planning, Research, and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services.