Work and identity in substance abuse recovery.

Reduction in length of stay due to managed care has forced medical model treatment to focus on detoxification and "medically necessary" services at the expense of "wraparound" social services addressing employment, housing, and family problems. Lower staff and infrastructure costs enable social model programs to offer more (nonmedical) services and a longer stay at comparatively lower cost. Among the services they provide are vocational rehabilitation and job-search training, with the view that participants are better off if re-entry is mediated by sober social networks, stable environments, and employment. This paper demonstrates that employment training/job search activities are integrated into social model programs, and offers qualitative evidence of how staff and advanced residents teach the value of work. Longitudinal quantitative data collected at the same time suggest the focus of social model on employment does make a difference in posttreatment functioning: 1-year follow-up Addiction Severity Index (ASI) scores show decreases in employment problems among social model clients, along with comparable improvement on other composite scores of the ASI.