Return to work for individuals with TBI and a history of substance abuse.

Authors: Wehmeyer, M. L., Palmer, S. B., Smith, S. J., Davies, D., & Stock, S.
Year Published 2000
Publication NeuroRehabilitation
Volume 15
Number 1
Pages 71-77
Publisher IOS Press

Substance abuse can be a problem for any person. However, it is more prevalent among individuals with disabilities than society in general. Individuals with substance abuse problems often have trouble gaining and maintaining work. Among those disability groups demonstrating a prevalence of substance abuse are individuals who survive traumatic brain injury (TBI).When individuals have a dual diagnosis of substance abuse and disability like TBI the treatment of both conditions becomes more complex. This may increase the possibility of medical complications and heighten the the symptoms of the disability for the person. It can also decrease the effectiveness of interventions designed to assist a person with employment post TBI. Research that specifically examines strategies or models that enhance employment rates of persons with TBI and substance problems is scant. Supported Employment is one return to work strategy for individuals with severe TBI and substance abuse problems


The purpose of this paper is to describe how substance abuse can be addressed within the context of a vocational rehabilitation program that provides supported employment services to individuals with severe TBI and substance abuse problems.


The setting was a place of employment in Virginia.


A case study illustrate how a man with a long history of substance abuse and a TBI gained and maintained work using a supported employment approach.

Data Collection

Information was collected from the employment specialist who worked with individual described in the case study through face to face interview. In addition, case file information including daily notes were reviewed.


There was no control or comparison condition.


The individual described in the case study remained employed for over one year at the time of publication. The employment specialist took on a variety of roles in response to his needs. Roles included: providing feedback and encouragement, on the job site new skills training including designing and implementing compensatory strategies, ongoing support and case management.Employment specialists will need training and ongoing education to effectively support individuals with TBI and substance abuse histories. Lack of transportation remains a barrier to work and impacts the ability to get to substance abuse treatment (ie. AA meetings). Repeated efforts may be needed to assist individuals with successfully returning to work. Furthermore, many programs do not serve individuals with active substance abuse, so these people do not get help.


Substance abuse further complicates TBI and return to work. Supported employment providers need to provide a mix of services that are career oriented and unique to a person‚ specific needs and circumstances.Individualized support should include assisting a person with issues outside of work, particularly those that may negatively impact employment or substance abuse treatment.

Disabilities Traumatic brain injury (TBI)
Populations Male
Outcomes Return to work
Research Design Case reports
Peer Reviewed Yes