Employment outcomes for hard-to-reach persons with chronic and severe substance use disorders receiving assertive community treatment

Authors: Gold, P., Meisler, N., Santos, A., Carnemolla, M., Williams, O., & Keleher, J.
Year Published 2004
Publication Substance Use and Misuse
Volume 39
Number 13
Pages 2425-2489
Publisher Informa Healthcare

Individuals with the most chronic and severe substance use disorders receive little clinical and rehabilitative benefit from treatment programs.The majority drop out of intensive outpatient programs and therapeutic communities within 30 days of admission. Those who do complete planned treatment fail to generalize the benefits associated with abstinence and the development of other skills to employment. Less than one third work and those who do earn wages below poverty levels. This population may improve employment outcomes with long term integrated substance abuse rehabilitation and support services like the Assertive Community Treatment (ACT)approach. This team based approach will be expensive. Cost-benefit analysis is needed to persuade states to adopt this method.


The purpose of this study was to evaluate the effectiveness of the ACT approach with individuals who experience severe substance use disorders.


The setting for the study was Ernest E. Kennedy Center, a private nonprofit center providing treatment for substance dependence serving Berkeley and Charleston counties in coastal South Carolina.


The study sample included 35 individuals with severe substance use disorders.

Data Collection

A wide range of clinical, functional, and psycho-social processes and outcomes were measured. Measures were completed at three time-points: admission to the ACT program (baseline), and 6 months and 12 months post admission.


The study included a single-group design. Participants functioned as own controls.


Thirty four of the 35 clients completed the 2-year service demonstration project. Generally, clients modestly reduced substance misuse and increased employment.


The project shows promising outcomes, however the sample size was small and limits inferences of causation and generalization of the process.

URL http://www.ncbi.nlm.nih.gov/pubmed/15603010
Populations Male & Female
Outcomes Employment acquisition | Return to work | Wages
Research Design Single group
Peer Reviewed Yes