Labor Market Discrimination and Substance Use Disorders

描述（由申请人提供）：物质使用障碍在生产力和收入损失方面给美国经济带来了巨大的负担。有药物使用障碍的人比有其他健康状况的人更容易受到侮辱，这表明部分损失可能是雇主歧视造成的。我们的初步研究发现有证据表明，药物滥用/依赖史对就业率有显著的负面影响，但尚不清楚就业差异的哪一部分是由于有和没有药物使用障碍史的人在与生产力相关的特征上的差异，以及哪一部分可能归因于耻辱。没有研究应用最先进的计量经济学技术来具体衡量耻辱与生产力相关因素在决定这一群体就业结果方面的相对重要性。拟议的研究使用1991-92年全国酒精纵向流行病学调查和2001-02年全国酒精及相关疾病流行病学调查的数据，对歧视对物质使用障碍者就业结果的潜在影响进行严格的经济分析。总体目标是使用最先进的计量经济学工具，分析这两项具有全国代表性的大型工作年龄人口调查，以确定在实施《美国残疾人法案》之前和之后有物质使用障碍的人就业的具体决定因素。为了与《美国残疾人法》的覆盖范围相一致，研究样本仅限于以前有物质使用障碍的人，而不是目前有物质使用障碍的人。我们利用在ADA之前对物质使用障碍患者的就业保护的州际差异来估计法律对该群体就业结果的可能影响。该研究填补了文献中的一个重要空白，因为在实施十年后，关于《美国残疾人法》在改善物质使用障碍患者就业机会方面的有效性的客观经验信息仍然缺乏。拟议的项目与公共卫生有关，因为其结果将为旨在改善曾经有药物使用障碍的人的就业机会的政策干预提供信息。生产性就业已被证明是精神障碍患者的康复、自我价值和一般福祉以及他们融入社会的一个重要组成部分。该项目使用最先进的计量经济模型来估计歧视对前物质使用障碍患者就业结果的潜在影响，并分析1990年《美国残疾人法案》在改善这一人群就业机会方面的效果。例如，如果发现歧视具有潜在的重要性，适当的干预措施是有针对性的教育，以减少与药物使用史相关的耻辱。如果结果表明《美国残疾人法》没有达到预期的效果，那么就需要进一步调查，以确定政策变化对这一群体无效的原因。

DESCRIPTION (provided by applicant): Substance use disorders impose a tremendous burden on the U.S. economy in terms of lost productivity and income. Persons with substance use disorders are more stigmatized than persons with other health conditions, suggesting that part of the losses may be attributed to employer discrimination. Our preliminary research finds evidence that a history of substance abuse/dependence has a significant negative impact on employment rates, but it is unclear what part of the employment differential is attributed to differences in the productivity-related characteristics of those with and without a history of substance use disorders, and what part can potentially be attributed to stigma. No studies have applied state-of-the-art econometric techniques to measure specifically the relative importance of stigma vs. productivity-related factors in determining employment outcomes for this group. The proposed research uses data from the 1991-92 National Longitudinal Alcohol Epidemiologic Survey and the 2001-02 National Epidemiologic Survey on Alcohol and Related Conditions to conduct a rigorous economic analysis of the potential impact of discrimination on employment outcomes for persons with substance use disorders. The overall objective is to analyze these two large, nationally representative surveys of working-age persons, using state-of-the-art econometric tools, to identify specific determinants of employment for persons with former substance use disorders in periods before and after implementation of the Americans with Disabilities Act (ADA). Study samples are restricted to persons with former, but not current, substance use disorders to be consistent with coverage of the ADA. We exploit inter-state variations in employment protections for persons with substance use disorders prior to the ADA to estimate the likely impact of the law on employment outcomes for this group. The research fills an important gap in the literature because, ten years after implementation, objective empirical information on how effective the ADA has been in improving employment opportunities for persons with substance use disorders is still lacking. The proposed project is relevant to public health because the results will inform policy interventions designed to improve employment opportunities for persons with former substance use disorders. Productive employment has been shown to be an essential component to the rehabilitation, self-worth and general well being of persons with mental disorders, and to their integration into the community. The project uses state- of-the-art econometric models to estimate the potential impact of discrimination on employment outcomes for persons with former substance use disorders, and to analyze how effective the Americans with Disabilities Act of 1990 has been in improving employment opportunities for this population. If, for example, discrimination is found to be potentially important, an appropriate intervention is targeted education to reduce the stigma associated with a history of substance use. If the results suggest that the ADA has not had its intended effects, then further investigation is needed to identify why the policy change has been ineffective for this group.