Positive changes in employment status are associated with reduced alcohol use frequency at discharge from outpatient specialty treatment.

Background: Workforce engagement can provide structure, income, feelings of accomplishment, and personal contacts, growing an individual's recovery capital (RC). Employed individuals are also more likely to complete addiction treatment. We sought to investigate whether changes in employment status from alcohol treatment admission to discharge correlated with changes in alcohol use frequency over those time points.

Methods: The Treatment Episode Dataset-Discharges (2017-2021) provided the data. Employment status (full-time, part-time, unemployed, and not in labor force) and alcohol use frequency (daily use, some use, and no use in past month) were assessed at treatment admission and discharge. Changes in alcohol use frequency during treatment were recorded as Reduction or No reduction. Logistic regression using reduced alcohol use frequency as the dependent variable included employment status at admission and discharge separately. A second analysis included employment status at both admission and discharge and their interaction term. An adjusted model included all covariates (race, ethnicity, age, education, and referral source), with its results being used to derive the marginal probabilities of reduced alcohol use frequency.

Results: There were 856,085 alcohol treatment admissions over the 5 years, with 221,724 (25.9%) first admissions. Transitioning from not in the labor force or unemployed to full-time saw the largest percentage of encounters decreasing alcohol use frequency: 71.9% (95% CI: 70.0-73.7) and 69.3% (95% CI: 68.1-70.5), respectively. Those remaining unemployed had the lowest reduction at 26.7% (95% CI: 26.3-27.1), with a sample reduction of 42.7% (95% CI: 42.5-42.9) overall. Far more people (60.4%) completed treatment within the Reduction group than in the No reduction group (30.2%).

Conclusions: Findings suggest that improving employment status may be relevant for reducing alcohol use frequency. This aligns with past work showing overall improved health outcomes with lower unemployment levels. Incorporating vocational training and workforce engagement activities into outpatient treatment may help augment traditional approaches to improve an individual's RC.