Exploring Barriers and Facilitators of Employment in Veterans with Opioid Use Disorders

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Significance: Living with an opioid use disorder (OUD) can make obtaining and sustaining employment a significant challenge. Adults who have a current OUD are significantly more likely to be unemployed and make less income compared to those with past OUD or those without lifetime OUD. For most individuals in treatment for an OUD, being employed is an important part of their recovery journey. Employment has several benefits, including reductions in preoccupation with symptoms, social isolation, risk of suicide, hopelessness, and economic instability, which often results in homelessness. However, with the advent of the COVID-19 pandemic, a significant number of Veterans have lost their jobs are currently seeking meaningful and competitive employment. Individual Placement and Support (IPS) is an evidenced-based supported employment intervention that is considered the gold standard of vocational rehabilitation. Only one small study has examined the effectiveness of IPS among individuals with OUD on methadone maintenance (n=45) and found that 50% of the IPS participants gained competitive employment compared to 5% of the waitlist control participants at 6 months (p<0.001). Prior to launching a well-warranted large-scale study of IPS for OUD, a better understanding of the barriers, facilitators, preferences, and employment accommodations in this unique patient population is needed to better tailor IPS delivery for Veterans recovering from OUD. Specific Aim: Examine the barriers and facilitators of sustained employment, including evaluation of employment challenges, occupational functioning, community integration, and quality of life and satisfaction among Veterans with OUD diagnosis. Methods and Procedures: This pilot study primarily utilizes a qualitative design, specifically phenomenology. Quantitative data will also be collected to better understand the patient population and will include (a) socio-demographic information such as age, level of education, employment history, income and source of income, housing and experiences with homelessness (b) history of substance use, (c) mental health- specifically depressive symptomology, (d) occupational functioning, and (e) quality of life related information. Utilizing phenomenology approach, qualitative interviews will be conducted with 50 Veterans, at least 6 of whom are or will be engaged in IPS services, 6 vocational rehabilitation specialists (includes 4 IPS specialists), 6 mental health or addiction recovery providers, and at least 6 employers/potential employers who may have or would be willing to employ persons with OUD. The participants must read and sign an IRB-approved informed consent prior to participating. To conduct the data analyses, the seven steps to procedural data analysis in phenomenological studies will be utilized. This approach examines participants associated meanings to the phenomenon under investigation and provides researchers the ability to identify the emerging themes. Primarily, an inductive thematic approach will be utilized as the primary method of data analysis. Conclusion: This SPiRE proposal addresses an area that lacks preliminary data, gathers new knowledge for an urgent need, informs the refinement of a tailored IPS intervention for OUD, allows an early career investigator to conduct a small study, allows a senior investigator to explore a new research area, leverages the investigators’ strengths and expertise, and advances the knowledge needed to promote successful recovery and reintegration into society for Veterans recovering from OUD, especially during and after the COVID-19 pandemic.