The impact of employment on perceived recovery from opiate dependence

Purpose: Less than 15 per cent of people starting opiate substitution treatment (OST) in England are employed, but few gain employment during treatment. Increasingly punitive approaches have been tried to encourage individuals with substance dependence into employment in the hope of facilitating recovery. It is not clear which factors are associated with the successful maintenance of employment whilst receiving OST, and whether this group can be said to be “in recovery”. The paper aims to discuss these issues.

Design/methodology/approach: A cross-sectional study of the OST population in one English region was conducted between January and April 2017. Measures of physical health, employment patterns, drug use, mental health, recovery capital, and dependence severity were administered to 55 employed and 55 unemployed clients.

Findings: Those in employment had higher levels of “recovery capital”, better physical and mental health, fewer drug problems, and less severe dependence, despite reporting heroin use at a similar level. Three variables were significantly associated with employment: longest period of employment (OR=1.01, p=0.003); number of chronic medical conditions (OR=0.44, p=0.011); and number of days of psychological problems in the last month (OR=0.95, p=0.031).

Practical implications: These results suggest that abstinence may not be required in order to maintain stable employment when OST is in place. Different treatment strategies are required for clients receiving OST already in employment compared with those who are unemployed.

Originality/value: This is the first UK study to the author’s knowledge to focus on people receiving OST who are also in employment.