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Patterns in Referral and Admission to Vocational Rehabilitation Associated with Coexisting Psychiatric and Substance-Use Disorders

Boston University School of Medicine

Robert Rosenheck

Yale School of Medicine

Russell Schutt

University of Massachusetts, Boston

Wesley J. Kasprow

Yale School of Medicine

Walter Penk

Harvard Medical School, Cambridge Hospital

Archival data from 17,929 homeless adults entering the Veterans Health Administration's Healthcare for Homeless Veterans program were analyzed to identify whether the rate of referral and admission to vocational rehabilitation differed between adults with psychiatric disorders alone and those with psychiatric disorders with a coexisting substance-use disorder (SUD). Participants with an SUD had an 11% greater chance of being referred to vocational rehabilitation than did those with a psychiatric disorder alone. Of the participants referred to vocational rehabilitation, those with an SUD were almost twice as likely to participate. Those with an SUD also had a higher rate of employment prior to evaluation than did those with a psychiatric disorder alone. These advantages were significant after covarying for demographic variables, specific psychiatric diagnosis, and Addiction Severity Index (McLellan, Luborsky, & Woody, 1980) psychiatric composite score. These findings fail to support the hypothesis that there is a bias in the process of referral or admission into vocational rehabilitation and suggest that work and participation in work rehabilitation are not negatively affected by a coexisting SUD.

Rehabilitation Counseling Bulletin, Vol. 47, No. 1, 15-23 (2003)
DOI: 10.1177/00343552030470010301


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