From addiction to employment: Linking medical and vocational rehabilitation more closely
Alcoholism and unemployment lead to a vicious circle: If you are unemployed, you are more likely to fall prey to an addiction – and if you are addicted, you are more likely to lose your job. “That is why employment is a core element for success in the rehabilitation of alcoholics. However, only a minority asks for a vocational rehabilitation after they have completed medical rehab”, says Prof. Dr. Joachim Thomas, holder of the Chair of Psychological Diagnosis and Intervention at the Catholic University of Eichstätt-Ingolstadt (KU).
What hurdles these people have to take after detoxication to get the support they need on their way back to competitive employment, he now wants to research with his associate Dr. Fanny Loth and Prof. Dr. Dr. Janusz Surzykiewicz, Chair of Social and Health Pedagogy at the KU. The two-and-a-half-year project is funded by RehaConnect, a program of the German pension fund Deutsche Rentenversicherung Mitteldeutschland. The project has found a cooperative partner in the vocational promotion center Berufsförderwerk Thüringen GmbH.
Only a small minority of those entitled will take part in a vocational rehabilitation program that could help them back to an active work life after detoxication, although counseling services and stationary clinics offer a multitude of very diverse high-quality programs. This is confirmed, to give just one example, by a survey of the Fachverband Sucht, an association in which treatment, care and counseling facilities for addicts have joined forces throughout Germany. The association regularly interviews patients one year after they have undergone medical rehabilitation. Of 4,000 people that completed their rehab in 2017 over 90 percent were treated for alcoholism. The survey showed that nearly half of them were still unemployed a year later. More than a quarter of them had relapsed. At the time of answering the questionnaire twelve months after their medical rehab, only two percent of that group was taking part in a vocational rehabilitation program that can be labeled by the official name of the program “benefits for participating in working life – “Leistung zur Teilhabe am Arbeitsleben” (LTA). The main provider for such services are the vocational promotion centers. They are charitable education centers for life-long learning.
“An analysis of the data from one of the clinics showed that not even ten percent of patients apply for LTA”, says Professor Surzykiewicz. Aim and concern of our project must therefore be to investigate at the interface of medical and vocational rehabilitation how barriers can be lowered and transitions between these two phases smoothed. “One factor, for example, is the very long wait until the start of a vocational rehabilitation. Although these programs have been shown to lead to abstinence in 80 percent of participants, patients sometimes have to wait for nine months until they get placed” says Dr. Fanny Loth.
In their research, the scientists not only want to investigate how this procedure could be streamlined, but also specifically approach patients at two acute care facilities and four rehab centers to get answers to the questions: What individual factors and what factors in their environment keep people from applying for vocational rehabilitation, although they are motivated? How can you encourage people to apply? How is the outcome influenced by the length of the waiting period after detox rehab and before the start of the vocational rehabilitation?
Professor Thomas says: “A better awareness of support services as well as an interdisciplinary management at the interface of the different rehabilitation services are essential requirements for sustainable abstinence and a successful reintegration of the target group into competitive employment.” The scientific analysis of the interfaces is expected to yield specific conclusions as to the organization of the vocational rehabilitation system: The management of transitional periods must be improved by making services tailored to the target group available at an early stage. In addition, the application process must be accelerated and so-called critical phases identified, in order to break the vicious circle of addiction and unemployment. “We hope that our research findings will give important impulses for the improvement of the care system as far as services for participation in the job market are concerned. In this way, the next step will be to evaluate the approaches that we were able to develop in this project. Should this show positive employment outcomes, they can then be multiplied and implemented throughout Germany, says Professor Surzykiewicz.