Good job,bad job: The employment experiences of women in recovery from substance abuse

1 Introduction

Employment is a fundamental activity of daily life [1] that provides social-psychological benefits and the economic opportunity to be self-sufficient [2]. In contrast, underemployment, which includes involuntary part-time work, income underemployment, and over-qualification, has been related to poorer physical health and lower levels of psychological well-being than adequate levels of employment [3]. Women and residents of metropolitan areas are at high risk for underemployment [4] and women who live in metropolitan areas have lower employment participation and employment rates than men [5]. For example, compared to white men, women of any race and men of color are more likely to have a “bad” job—a job with low pay, and neither health insurance nor pension—and about one in seven jobs in the United States meets this criteria in all three domains [6]. Research has also shown that the need for employment benefits and community, workplace, and household support is greater for workers who have the least access to them [7].

It is clear that women are at high risk for underemployment experiences, and this risk may be more evident among specific subsets of women. Women with former substance use disorders may face substantial barriers as they attempt to re-enter the workforce. Active substance use negatively impacts work experiences, and can contribute to absenteeism and neglecting work responsibilities [8]. However, employment has been shown to be important in facilitating recovery among individuals with substance use disorders. For example, in outpatient alcohol abuse treatment, employed individuals had positive changes in well-being, neuropsychological functioning, and responses to treatment compared to non-employed individuals [9]. Qualitative interviews with individuals in recovery suggested that employment was the second most important life priority after working towards long-term recovery [10]. However, individuals with former substance use disorders might experience work differently compared to those without substance use disorders [11]. For example, although there were no differences in employment rates or full-time employment between individuals with and without former substance use disorders, individuals with former substance disorders reported greater rates of involuntary job loss [11]. In addition, treatment outcome studies have demonstrated that women had lower employment rates than men six months after treatment completion [12].

Recovery residences are transitional settings that provide housing and support for individuals after substance abuse treatment. There are several types and levels of recovery homes [13] and the most well-researched are Oxford House. These houses are located in the United States as well as Canada, and Australia, and most recently Ghana and England. Individuals who agree to maintain abstinence and pay rent live in these member-run, drug- and alcohol-free, rented, single-family residences with no time constraints. Unlike traditional substance use recovery programs, which are run by professional staff, Oxford Houses emphasize personal development within a mutual-help setting. In terms of employment-related outcomes, Oxford House residents had significantly higher positive employment outcomes [14] and increased income compared to individuals in the usual aftercare condition [15]. Thus, Oxford Houses offer a unique opportunity to examine employment experiences—such as whether the support provided in the group residence enhances the likelihood of individuals finding jobs—because residents are likely to have had work experience and are expected to financially contribute to the house. However, income earnings among Oxford House residents differed when considering gender and ethnicity, as women reported significantly lower average incomes compared to men, and African Americans reported significantly more work experience compared to Whites [16].

Given the importance of employment to the substance use recovery process, it is important to understand how access to employment supports impact actual employment experiences among women in metropolitan areas. The present exploratory, qualitative study examined perceived employment benefits, work history and demographic characteristics among women in recovery from substance use. We were most interested in women’s employment experiences in Oxford House. Specifically, qualitative interviews examined 1) the role of resident support on obtaining employment, and 2) women’s perceptions of employment benefits and their impact on the recovery process.

2 Method

3 Results

Overall, participants held a wide variety of previous and current job positions. Examples of jobs that were “bad” in at least one dimension of lacking access to health insurance, retirement benefits or low compensation, included modelling, line cook, substance abuse treatment outreach staff, retail merchandiser, cashier, wait staff, social worker, certified nursing assistant, and janitorial staff. Examples of “good” jobs that were previously held included accountant and physician. Among the twelve participants who were currently employed, five (41.6%) had jobs that were “bad” in all three dimensions, four (33.3%) had jobs that were “bad” in two dimensions, and two (16.6%) had jobs that were “bad” one dimension. Only one (5%) participant currently had a “good” job.

Four participants (20%) described participating in illegal activities for income in the past, such as stealing, writing bad checks, hustling, and selling drugs. On average, participants engaged in these activities for 10 years (SD = 9.42).

Participants were asked about their views on employment and how it affected their life. As demonstrated in the following quotes, employment was viewed as a central part of life and recovery, as it often helped participants rebuild life after active substance use.

Participants commented on the need for community, workplace and household support. One full-time janitor whose job was “bad” in two domains reported her frustration with her current job, and having little workplace and household support.

Women described many challenges related to lack of employment benefits, precarious and unstable work hours, and limited financial resources. For example, the work hours of a 42-year-old full-time chef in Chicago were reduced from 40 hours per week to 24 hours per week for four months due to seasonal weather changes. Additionally, a 50-year-old retail merchandiser in Washington D.C. experienced a reduction of more than 50% from 40 hours per week within the first six months of employment. The lone participant in the study who currently had a “good” job also had an employment history of precarious work hours.

Additionally, one participant reported previous trouble managing her money and accumulating savings due to employer practices such as paying workers in cash and giving unlimited paycheck advances.

Participants identified the importance of employment to their recovery process, and cited challenges related to managing both their recovery process and work demands conflicting with that process. However, even though employers did not always understand the demands related to recovery, work still appeared to benefit participants by providing an outlet that helped to fill their time.

In terms of satisfaction related to current work experiences compared with past experiences, participants varied in their satisfaction with their current work.

Although some participants enjoyed their current employment experience, others struggled to be working in a position that was lower in status compared to their previous work experiences.

Participants were also asked about future job aspirations. Among those who weren’t working, obtaining employment was a central theme in their responses.

One participant described perceived discrimination that she felt as an older woman when searching for employment.

For those who were employed, several indicated the desire for employment opportunities specifically for individuals who were in recovery and who had criminal records.

A few participants also indicated that other Oxford House members had helped them find work by referring them to opportunities or using their networks to support the employment of other house members.

Five (25%) participants described a house environment where members provided employment support, such as conducting Internet job searches together, sharing job posting information, and encouraging unemployed residents. Although two (10%) participants stated that they found job positions through other Oxford House members, the remaining 13 (65%) participants did not indicate receiving employment support or finding job positions though housemates.

4 Discussion

The present study explored perceived employment benefits, work history and employment support among women in urban, communal-living environments in the United States. Qualitative data from our interviews provided support for the importance of employment to women in substance abuse recovery, not only as a means for financial support, but also as a life priority. Additionally, women highlighted how employer scheduling practices, low-level positions, and lack of employment supports impacted their recovery experience. Findings from the present study provide insight into the need for employment support services, including employer education and flexible policies for women in recovery.

Most of the women in this study were employed in ‘bad jobs’ with little or no room for career advancement. These women wanted more stable jobs and had few employment supports such as stable work hours or access to benefits [7]. Participants’ voiced frustration at having to work in employment settings with no benefits, a lack of security, lower pay than in previous positions, and little room for advancement. Similar to previous findings, full and part-time workers encountered instability as a result of employer scheduling practices [21]. Scheduling practices also seemed to influence the demands related to maintaining sobriety, such as participating in self-help groups. Participants also reported that unemployment and financial instability had an adverse impact on their personal welfare. Unfortunately, most of the women who participated in this study held ‘bad’ jobs, which left them with little income, medical and/or retirement benefits. Research has found that precarious employment experiences also negatively influence well-being [22]. Future research should compare the employment experiences between women in recovery and women with no history of substance use to better understand the types of employment opportunities that are available to this population.

Even though participants’ work experiences were not ideal, most were able to describe the benefits of employment to their substance abuse recovery process. Whether employment was viewed as a task to fill time or a more meaningful experience, the overall impact of employment on recovery appeared to be positive. Consistent with prior research, these findings suggest that employment is crucial to the process of rebuilding a life after substance use [9, 10]. Flexibility in working conditions and social support from workmates positively influenced maintaining abstinence as well as employment.

Oxford House residents sometimes found employment opportunities through other housemates. One participant was recommended to become an Oxford House recruiter, and one participant found a temporary position through a housemate. Although social support in Oxford Houses, such as information sharing and personal recommendations for job positions were frequently mentioned, most participants did not report having employment support from housemates. Past research with Oxford Houses residents suggests that these communal living environments have been associated with positive employment outcomes compared to individuals in usual aftercare [15]. Treatment and recovery-home settings should consider providing more employment-related supports to residents, as a lack of employment may negatively impact recovery. In addition, women in recovery may benefit from further education and training to support them in their search for meaningful and stable employment experiences.

Limitations of the present study included a small sample size, which makes it difficult to generalize the results to the general population of women in recovery. Furthermore, the sample was drawn from a convenience sample of women in Oxford House, and may not be representative of all women who live in Oxford House. Men and women who were not in recovery should be included in future studies to compare employment experiences. However, the qualitative data provided rich descriptions of employment experiences of women in substance abuse recovery residing in urban areas. Another limitation of the study was that data were collected via telephone interviews. Additionally, one author was primarily responsible for identifying themes in the data analysis, which may have increased bias in interpreting the results. We attempted to reduce bias through having the second author discuss the themes and discrepancies that arose during the analysis phase. Future research should continue to explore employment experiences among women in recovery, and have the capacity to meet with them one-on-one to facilitate a better understanding of how employment impacts their recovery process.

In summary, the present study explored the relationship between demographic variables and workers’ rights knowledge and also sought to better understand the employment experiences of women who were former substance users and lived in large metropolitan areas. Taken together, our findings suggest that this population needs additional educational, community, and social support related to becoming employed in a ‘good’ job. Women tended to report low levels of income, as well as no medical or retirement benefits. Furthermore, women were articulate about the importance of gainful employment to their recovery process. Treatment and aftercare providers should attempt to provide job-training and/or access to employment support for women [23]. In addition, policy-makers should consider ways to create meaningful employment opportunities for women in recovery. This could include providing tax breaks for agencies who hire former patients as staff members, or requiring easier access to medical and/or retirement benefits. Finally, research should continue to explore the employment experiences of women in recovery from substance use, and should focus on designing interventions to promote meaningful employment among all citizens.

Conflict of interest

None to report.