Using Employment Services to Complement Opioid Treatment, A Case Study With Lessons Learned

Monday, September 10, 2018

With the help of our partners at the talent development firm Maher & Maher, IMPAQ International’s policy researchers have been studying the plight of communities and identifying some of the most effective solutions to combat the opioid crisis. This is the second of a four-part blog series. 


As we discussed in a previous post, Research Shows That Investing in our Workforce Can Help Counter the Opioid Crisis, current research indicates that interventions with workforce development elements can support recovery and reintegrate people back into society.

Around the country, state and local governments are recognizing the importance of this research and moving evidence into practice. This blog highlights the Access to Recovery (ATR) voucher program and discusses how in 2012 Massachusetts expanded the scope of the program to include the Career Building Initiative (CBI). This innovative service has seen impressive results, with CBI participants being twice as likely to be employed or in school at 6 months after program completion, as compared to other ATR participants.1

Access to Recovery: A Holistic Approach to Long-Term Sobriety

While opioid addiction in America has intensified in recent years, the issue of substance abuse is not new. President George W. Bush created the federal ATR grant program for states in 2003 to expand access to treatment and other recovery-promoting services.2 With vouchers available for a wide variety of services, participants are empowered through their ability to choose what benefits are most valuable to them.

This highly individualized style of delivering services is unique to the ATR program. Though it initially was met with skepticism by community partners, the ATR program fundamentally changed how recovery service providers interact with individuals who have substance abuse issues.3 It engages participants in recovery by working with them to develop personalized recovery plans and respecting their service choices.

MA-ATR Innovates with Job Training Services

The 6-month program in Massachusetts targets the vulnerable populations of military members and veterans, individuals re-entering the community after incarceration or drug court, and women with children. In recent years, MA-ATR was expanded to specifically engage heroin and opioid users who are receiving medication-assisted treatment (MAT).1 The vouchers in this program can be used for basic needs, housing, recovery coaching, transportation, group sessions, health & wellness, education, employment, and faith-based services.1

Early in the rise of the opioid crisis, Massachusetts recognized the value of employment in supporting addiction recovery. The Career Building Initiative teaches job readiness skills and connects participants to occupational training programs, while additionally paying participants for attending.4

CBI is intended to help participants overcome barriers to employment that include stigma, irregular work histories, and past criminal convictions. MA-ATR recruited and trained job training providers on how to best meet the unique needs of people in recovery through “education about addiction issues, MAT, compassion fatigue, and provider self-care”.4

Since its conception in 2012, more than 1,500 individuals have completed the CBI training. According to a 6-month follow-up survey, 55 percent of them were employed or in school. This is a four-fold increase in occupation rates from when CBI participants entered the program.1

Prominent Lessons from Program Implementation

Through being aware and responsive to the needs of CBI participants, MA-ATR was able to enhance its ability to engage and serve those in recovery.

For example, the program adjusted from being a voucher service option to a separate opt-in career program after initial low enrollment. The program management team understood that it was difficult for MA-ATR participants to prioritize the long-term goal of employment over pressing urgent needs, such as clothing and housing. Enrollment quickly filled up following the modification.4

Additionally, opioid abuse increases the risk for involvement with the criminal justice system. An examination of the 2015-2016 National Survey on Drug Use and Health respondents reveals that 20 percent of people who abuse prescription opioids reported being recently arrested or on probation. This increases to 40 percent for heroin users.5 Being aware of this barrier to employment, CBI tailors job services to fields that are receptive towards hiring people with criminal backgrounds, such as food service, building maintenance, construction, and hospitality.1 It is hoped that the success of previous participants will lead to future job opportunities for others in more mainstream employment programs.3

Finally, coordination between recovery service providers and treatment providers was difficult to foster.4 It was apparent to the CBI management team that these partners had a weak understanding of each other’s role. To address this issue, MA-ATR communicated with state and local leaders, shared information, and encouraged strategic planning.4


The Access to Recovery program in Massachusetts stands out as a noteworthy example of how employment services can complement opioid addiction treatment. The issues encountered during program implementation, including responding to participant needs and aligning efforts across agencies, are likely going to be faced by other emerging state initiatives.

Maher & Maher and IMPAQ International believe that developing recovery service programs should look to the experiences of existing ones, such as MA-ATR, to guide their development for the most efficient use of resources.

Read Part Three Here