Challenges in areas ranging from education to the environment, gender to governance, health to housing don’t exist in a vacuum. Each month, Abt experts from two disciplines explore ideas for tackling these challenges in our monthly podcast, The Intersect. Sign up for monthly e-mail notifications here. Catch up with previous episodes here.
Opioids. Employment. The relationship between the two is complex. Abt experts Karin Martinson and Amy Berninger discuss the co-dependencies, and the efforts to develop programs that both promote recovery from substance use disorders and improve economic well-being.
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Read the Transcript
Eric Tischler: Hi and welcome to The Intersect; I'm Eric Tischler. Abt Associates tackle complex challenges around the world, ranging from improving health and education, to assessing the impact of environmental changes. For any given problem, we bring multiple perspectives to the table. We thought it would be enlightening—and maybe even fun—to pair up colleagues from different disciplines, so they can share their ideas and perhaps spark new thinking about how we solve these challenges. Today I'm joined by two of those colleagues. Karin Martinson and Amy Berninger.
Karin has 30 years of experience, studying a wide range of programs and policies that affect low income populations, with a focus on workforce development strategies. Amy has more than 10 years of experience supporting public health and health policy oriented research projects for a range of clients, including the Centers for Disease Control and Prevention, and the Substance Abuse and Mental Health Services Administration. Thank you both for joining me.
Karin: Thanks for having us. I'm happy to be here.
Eric: We know there's a strong correlation between poverty and unemployment rates and the prevalence of prescription opioids and other substance use disorders. Amy can you set the stage for us and talk a bit about these relationships?
Amy: Sure. We know that the opioid epidemic has impacted people of all different ethnicities, and all different socioeconomic classes. And there's definitely a correlation between poverty, unemployment rates, and the prevalence of opioid use or misuse. Research has found that counties that have worse economic prospects are more likely to have higher rates of opioid prescriptions, opioid related hospitalizations, and drug overdose and death. Given that, it's really no surprise that areas that are more rural have been particularly hard hit by the current opioid epidemic, because there tends to be fewer economic prospects in those locations. This has also made the current opiod epidemic kind of unique.
Historically, social minority groups have been the most impacted by similar epidemics. And in rural areas, around 80 percent of the population is white. So we kind of have this unique epidemic of opioid use among white rural Americans. And one question that makes us think about is whether or not poor economic conditions help to really kind of propel the current opioid crisis. Are people using opioids because there are fewer employment opportunities? Are they bored, and they kind of have a bleak outlook on life? Or is there something else going on?
And that also leads to the question, "How can we improve employment opportunities in these areas, and among those groups that have really been impacted by the opioid epidemic?" Not only as kind of a preventative measure, but also as a facilitator to recovery and a part of treatment. Particularly in areas where there are already so many other inherent barriers to prevention, treatment and recovery efforts.
Eric: Right. Karin do you want to talk a bit about how opioids are affecting and impacting the workforce? Because it's sort of a chicken and egg, or it's like a vicious cycle, right?
Karin: Right, exactly. The opioid epidemic has resulted in a negative impact, both for employers and society as a whole. There's been lost wages, lost productivity, increased healthcare costs. So it's really impacted how employers operate, and their ability to be as efficient as possible. They've had to make adjustments sometimes because of the epidemic: instituting drug testing, support groups. So you see a lot of issues going on, and employers kind of have to adjust how to hire and kind of keep employees given the crisis going on.
Eric: So what are some strategies we've got, then, for bridging that gap? Between the challenges to employment, and then the need for employment to keep people in recovery?
Karin: In the past, you've actually seen a pretty strong divide between the treatment community and the employment workforce community. Where you went into treatment, and you would focus on that, and go into recovery. And there'd really be no connection between coming out of recovery and finding a job. I think more recently, and part because of the opioid crisis, but also just because of a range of other factors, people are beginning to see employment as part of recovery. And then if you have a job, it can actually help you maintain your recovery. Keep you connected to something. Keep you part of a community.
Karin: So there's really been an effort to bring these services together. Also in the past, you saw that a lot of the funding for these treatment and employment services came from different agencies, and different... The typical kind of siloed funding that didn’t integrate. So now, I think in part because of the opioid crisis, there has been a real effort to bring some of this funding together. And it's resulted in a whole range of new programs that are really focused on helping people in treatment move to recovery and stay there.
I think another issue though, that makes it hard, is that people in recovery, as Amy said, they're in low-income communities. They tend to have a lot of barriers to employment. They have a substance abuse disorder. They tend to have low skills. There's not a lot of jobs. A lot of them will have criminal history, maybe resulting from their opioid use disorder. So there's a lot of barriers that programs have to address. So it is pretty challenging to bring all these components together.
Amy: And like Karin said, there are a lot of barriers, and there's limited services. And the services that are out there, this hasn't really been a focus. So it'd be helpful to kind of look at, what is out there in terms of services, and how can we kind of build on what already exists. And expand so that there's more comprehensive treatment options that incorporate all types of recovery support services, including employment for individuals, particularly in the lower-income and rural areas.
Karin: We are focused on the opioid crisis. And that did bring a lot of things to the forefront. And it brought more money into the system that allows us to do these things. But there are a range of substance abuse disorders that people are working on. And opioids is just one of them. Usually these programs treat multiple types of substance abuse disorder. Because you actually find that people can abuse more than one type of drug.
You also hear pretty consistently in the field that, because there has been some crack down on opioids, that crystal meth is kind of increasing. So, it's a really evolving and challenging field for practitioners who are on the front lines. And it's been difficult for them to address the shifting landscape, and all the issues that come at them pretty rapidly.
Eric: Right. So let me ask both of you, about what you just said Amy, what are some approaches we might want to take for those programs? And Karin, you were talking about how different agencies have started to talk to each other. What direction do you think we should be tacking in?
Karin: Well I think we see a lot of interesting things coming out of the field. Because it is a new area. I think it's an important area for the field to kind of... They're the experts, right? They're kind of the program operators. I've been there on the ground. And there, we see a lot of different program models emerging. And we're actually in the process of evaluating how they work, and which ones might be most effective. I think that you do see programs … some are based in residential treatment programs.If you really are in crisis, you can go into a residential treatment, and get kind of inpatient and outpatient services. And that's kind of bringing the employment services into those settings. And that's one approach.
Karin: We also see approaches that are more outside the treatment center. Where people in recovery come in and say, "I really want to find a job." And they help them, provide the employment services, they support them through their treatment, and they may even provide more connections to employers that are helpful. A lot of these programs might kind of work with them because employers can be resistant to hiring someone with a substance abuse problem. So they actually do sometimes work closely with employers, to kind of help do some screening and say, "This person would still work for you. We can kind of get around these issues." So you see that type of model. We've also, as I said earlier, see some employers doing innovative things themselves. Trying to support people in treatment. And kind of providing more services at the job. So there's different ways of doing it. And I think, because it is so new, we're still really looking at kind of how they can work best.
Eric: Right. Are we doing any clearinghouse work in this area? Should we be?
Karin: As part of this national scan, we've done reviews of kind of the existence studies out there. I mean there's not a lot. It's been a very new area, that kind of integration of employment and treatment services. A lot of the studies have been pretty small scale. A lot of the programs are really small scale.
Karin: So part of the issue is, bringing programs to scale. I think the opioid crisis, again substance abuse disorder has been around for a while, I think, just over the decades. We see alcohol, crystal meth. Opioids is kind of new. But it really kind of expanded the numbers, and expanded the need. So, there's really been a push on kind of scaling up, and as a result, also building evidence on what works. Because it just hasn't really been there in the past.
Eric: Got it. So what do we need? What's next? How do we get that evidence base? What can we be doing to sort of help build that foundation of data to work from?
Amy: Well, I think one of the issues that kind of comes up is that, it's hard to get really high quality randomized controlled trials, to kind of prove that something works. Because when you're dealing with a group of people who have substance use disorder you don't want to randomly assign somebody to treatment, or no treatment, or one group or another. So that makes it kind of difficult to prove the effectiveness of some of these interventions.
So, just kind of building up and having programs that are designed with the evaluation component in mind. We want to evaluate more programs, in order to demonstrate the effectiveness of these interventions so that we have, I guess, for lack of a better term, more tools in our tool kit that providers can use when we're working with folks who are suffering from substance use disorders or opioid disorders, or whatnot.
Eric: Got it, got it.
Amy: I think that regardless of, and this is just my opinion, whether or not something is proven to be evidence, in evidence based practice or whatnot, certain things are going to work for certain people. I think it's just most important that people end up getting the services that they need, whatever those might be.
Karin: It is a somewhat new area. The focus really is on building the evidence and learning from what is going on in the field. And the scaling up effort. So I think that is where Abt is focused: on building evidence on effective practices. And getting those lessons out to the field. But I also think there are just kind of operational lessons, about things people have learned about bringing these services together, different settings that it would work in, the issues that make sure that you can address. And I think those are all just important lessons that we can focus on while we are investing in really developing evidence-based practices.
Eric: Well here at Abt, you can never go wrong when ending with “evidence-based practices.” So, on that note, thank you both for joining me.
Amy: Thanks for having us.
Karin: Thank you. It's great to be here.
Eric: And thank you, for joining us at The Intersect.