Substance Abuse Treatment Programs Research Articles

Is substance abuse treatment actually ‘treating’? The effectiveness of pre- and post-release substance abuse programming within the reentry process

ABSTRACTThe process of reintegrating back into society can be a difficult time for formerly incarcerated individuals in desisting from substance use. Although prior work has shown that experiences like securing employment or abstaining from criminal peers can help individuals desist from substance use, one aspect about which criminologists know considerably less concerns the role of substance abuse treatment programming during reentry. Using the Serious and Violent Offender Reentry Initiative data, we explore the role of substance treatment programming on substance use through multiple avenues. Namely, we investigate the impact of substance abuse treatment during prison, during reentry, and over time. Results of longitudinal models demonstrate that individuals who participated in pre-release substance abuse treatment programming report significantly lower levels of substance use than those who did not participate in pre-release substance programming. Yet, we find that individuals who participated in substance treatment programming post-release reported significantly higher levels of substance use than those who did not participate in post-release programming. Finally, we find no evidence that substance use treatment programming relates to decreases in substance use across time.

Women's Barriers to Specialty Substance Abuse Treatment: A Qualitative Exploration of Racial/Ethnic Differences.

To explore barriers to specialty substance abuse treatment programs among women with recent substance use disorders by race/ethnicity. Qualitative interviews were conducted with 28 women of White, Black, and Latino racial/ethnic descent who reported a substance use disorder in the past 5years. Interviews were conducted by telephone and were audio-recorded. A codebook was developed using the Theory of Planned Behavior to code and identify barriers within the domains of attitudes, subjective norms, and perceived control toward specialty treatment. Frequencies for coded themes were then compared across all participants and by race/ethnicity. We identified several key differences in barriers to treatment by race/ethnicity. Attitudinal barriers were more pervasive among the narratives of Latinas relative to Black and White women. Latinas were more likely to report not needing treatment and that treatment would not be effective; Latinas were the only group to describe cultural barriers to treatment. Within the subjective norms domain, namely stigma and lack of support, were key barriers. Stigma was more pervasive among the narratives of Latinas and Black women than White women; Latinas were more likely to report a lack of social support for using treatment than both Black and White women. Findings provide deeper insight into barriers that may be contributing to racial/ethnic disparities in the use of substance abuse treatment among women.

Older marijuana users in substance abuse treatment: Treatment settings for marijuana-only versus polysubstance use admissions

ObjectiveGrowing numbers of older adult marijuana users make understanding the marijuana-related treatment needs and treatment-related characteristics of this age group increasingly important. In this study, we examined four types of marijuana-involved admissions (marijuana as the only substance; marijuana as the primary substance with other secondary/tertiary substances; marijuana as the secondary substance; and marijuana as the tertiary substance) by treatment setting. MethodsData came from the 2012–2017 Treatment Episode Data Set-Admissions (TEDS-A), which includes 851,652 admissions by those aged 55+. Using multinomial logistic regression analysis, we focused on the 120,286 marijuana-involved admissions to test the hypothesis that polysubstance use would be associated with a higher likelihood of using detoxification and rehabilitation settings than ambulatory/outpatient settings. ResultsOf all marijuana-involved admissions, 7.5% were marijuana-only, 12.7% were marijuana-primary, 58.4% were marijuana-secondary, and 21.4% were marijuana-tertiary admissions. Compared to marijuana-only admissions, admissions involving other substances were associated with a higher likelihood of detoxification and rehabilitation than ambulatory/outpatient treatment (e.g., RRR = 5.79, 95% CI = 5.08–6.61 for detoxification and RRR = 3.19, 95% CI = 2.89–3.52 for rehabilitation among marijuana-tertiary admissions). Referral source, first age of marijuana use, race/ethnicity, and homelessness were significant covariates. ConclusionsGiven increasing numbers of older-adult marijuana users, healthcare providers should screen older adults for marijuana and other substance use, and substance abuse treatment programs should become more responsive to older adults' needs.

The Moderating Effect of Substance Abuse Treatment Engagement on the Connection Between Support From Program Participants and Substance-Related Recidivism for Justice-Involved Women.

This study examines the prediction of substance-related technical violations and arrests from (a) a three-dimensional measure of substance abuse treatment engagement-treatment satisfaction, treatment participation, and counselor rapport-and (b) support from peers in the treatment program. The study focuses on 204 women on probation or parole who attended a substance abuse treatment program in the first 9 months of supervision. Data were collected in face-to-face interviews and from official records of violations and arrests. Generalized linear mixed-effects modeling was used to assess the main effects and the interaction effect of within-program peer support and other indicators of engagement as predictors of substance-related technical violations and arrests. Peer support was positively related to violations/arrests when treatment engagement was low. Findings suggest that for women who do not score high in treatment engagement, support from peers is related to increased recidivism, and group treatment may be contraindicated.

The Effect of Treatment Motivation Levels on Patients Sent to a Conditional Substance Abuse Treatment Program

The main purpose of this study is to examine the effect of treatment motivation levels on substance abuse behaviors of patients sent to a substance dependence treatment program based on the decision of Supervised Release made during a six-week psycho-educational group treatment program. The sample consisted of 112 participants who applied to the Ministry of Health Turkey, Sakarya University Training and Research Hospital, Psychiatry Clinic between the years 2012–2014, and were selected among patients who attended a six-week treatment program. The Treatment Motivation Questionnaire (TMQ), Demographic Information Questionnaire and interview methods were used in data collection. Patients with high treatment motivation levels were found to have a low substance abuse rate, and their adaptation to the treatment program was high. Patients who had high motivation levels at the beginning of the treatment, had low rates of substance abuse at the end of the treatment. This trend was confirmed for all of the measured four sub-types of motivation.

An Outcome Evaluation of a Substance Abuse Program for Probationers: Findings from a Quasi-Experimental Design

The current study provides an evaluation of a substance abuse treatment program for probationers in a county in the state of Texas. Relying on a quasi-experimental design with a propensity score matched sample of 69 treatment group subjects and 69 control group subjects, the results revealed that while a significant treatment effect was observed for program participants in terms of a reduction in recidivism, a significant treatment effect on the percentage of people failing drug tests or the rate of failed drug tests was not detected. Study limitations and implications are also discussed.

Evaluating the impact of a targeted brief HIV intervention on multiple inter-related HIV risk factors of knowledge and attitudes among incarcerated drug users

Increases in HIV prevalence indicate ongoing need for HIV interventions. A brief manualized intervention called the Texas Christian University (TCU) WaySafe, which addresses multiple HIV risks, was further evaluated to determine how it addressed individual’s knowledge deficiencies in the assessed risks. The sample of 1,256 offenders in eight correctional substance abuse treatment programs participated either in treatment as usual (TAU) or TCU WaySafe. From multivariate multilevel analysis, WaySafe was more effective in improving the greatest need area, whether knowledge, motivation, or confidence regarding HIV risky behaviors. Findings underscored the importance of addressing HIV risk areas with the greatest need for change and strengthens previous findings of the intervention’s potential for individuals with varying HIV risks.

A validated workflow for drug detection in oral fluid by non-targeted liquid chromatography-tandem mass spectrometry

Oral fluid is recognized as an important specimen for drug testing. Common applications are monitoring in substance abuse treatment programs, therapeutic drug monitoring, pain management, workplace drug testing, clinical toxicology, and driving under the influence of drugs (DRUID). In this study, we demonstrate that non-targeted LC-MS/MS with subsequent compound identification by tandem mass spectral library search is a valuable tool for comprehensive detection and confirmation of drugs in oral fluid samples. The workflow developed involves solid-phase extraction and chromatographic separation on reversed phase materials. Mass spectrometric detection is accomplished on a quadrupole–quadrupole-time-of-flight instrument operated with data-dependent acquisition control. The workflow was optimized for 500 μl of neat oral fluid collected with the Greiner Bio-One saliva collection system. The fitness of the developed method was tested and proven by analyzing blank and spiked samples as well as 59 authentic patient samples. We could demonstrate that compounds with logP values in the range 0.5–5.5 are efficiently detected at low nanograms per milliliter concentrations. The true positive and true negative rates of automated library search were equal or close to 100%. The beauty of the non-targeted LC-MS/MS approach is the ability to detect compounds hardly included in routinely applied targeted assays, and this was demonstrated by detecting the synthetic opioid U-47700 in two patient samples.Graphical abstractᅟ

Chronic Disease Burden of the Homeless: A Descriptive Study of Student-Run Free Clinics in Tampa, Florida.

Variation between homeless populations due to socioeconomic and environmental factors necessitates tailoring medical, health policy, and public health interventions to the unique needs of the homeless population served. Despite the relatively large size of the homeless population in Florida, there is a paucity of research that characterizes the homeless population who frequent homeless clinics within the state. This project describes the demographics, disease prevalence, and other risk factors among homeless individuals in Tampa, Florida. We conducted a retrospective chart review on adult homeless patients seen in 2015 and 2016 at two free clinic sites operated by Tampa Bay Street Medicine, a medical student-run organization from the University of South Florida in Tampa, Florida. Rates of diseases and substance use were recorded and Charlson Comorbidity Index (CCI) was calculated to assess mortality risk. Of the 183 homeless patients in this study, 34.4% reported hypertension, 13.7% reported diabetes, 27.1% reported a respiratory disease, 5.6% reported hyperlipidemia, and 32.8% reported a psychiatric disorder. Tobacco use was reported by 65.6% of patients, 32.2% reported alcohol use, and 17.5% reported illicit drug use. CCI was positively associated with age. Females reported higher rates of anemia, anxiety, chronic obstructive pulmonary disease, and psychiatric disorders. Hypertension, diabetes, certain respiratory diseases, and mental health disorders were more prevalent in the homeless population than in the general population in Tampa, Florida. Homeless women appeared to have higher morbidity than homeless men. Rates of tobacco and illicit drug use were significantly higher whereas alcohol use was lower in the study population than the general population. This study underscores the critical need for mental health initiatives, substance abuse treatment programs, and women's health programs that are accessible to the homeless in Tampa.

Methadone Maintenance Treatment: A 15-year Retrospective Study in Split-Dalmatia County, Croatia.

The aim of this retrospective study is to use existing epidemiological data on patients in methadone maintenance treatment in Split-Dalmatia County from 2001 to 2015 to evaluate the substitution treatment system and policy of opiate addicts treatment, the epidemiological trend, and risk of overdose mortality. In addition, we would like to highlight the problem of poor control of methadone therapy and thus the possibility of selling methadone. The result is a greater number of deaths caused by methadone in people who were not in methadone therapy. The research included data collected from 3189 patients who had been in the drug abuse treatment program in Split-Dalmatia County during 2001-2015 and data gathered from autopsy examinations of patients in Split-Dalmatia County with emphasis on data for 186 overdosed patients during research period. The total number of patients in the methadone treatment program in Split-Dalmatia County during the research period, except in 2005 and 2006, has been stable, while the number of new opiate patients, being in first-time treatment, decreased by 62.5%. The number of addicts who were in a long-term maintenance program has increased by 198%, whereas the number of addicts who were in a short-term detoxification treatment has decreased by 96.4%. According to results obtained from performed autopsies, 186 death cases were determined as overdoses. Methadone was found in 56 of those cases and was declared as the cause of death in 39 cases (70%). Of the total number of autopsied patients with diagnosed methadone overdose, only 23 (59%) had been recorded to receive methadone therapy in Public Health Institute of Split-Dalmatia County database. The results of this study show the favorable epidemiological trend because of the decreasing number of new opiate patients in treatment. The retention of opiate patients in substitution therapy indicates the effectiveness of methadone maintenance programs. Our research did not determine any influence of methadone substitution therapy on an increasing risk of specific (overdose) mortality.

Safety and psychological impact of sailing adventure therapy among Veterans with substance use disorders

ObjectivesMany Veterans suffer from substance use disorders (SUDs). Treatment challenges include poor treatment engagement and high relapse rates. Complementary interventions have the potential to enhance both. This study was a preliminary evaluation of sailing adventure therapy (SAT) for this population. DesignRetrospective chart review. Participants in the intervention were 22 Veterans (20 male, 2 female) aged 22–65 who entered a Veterans Administration residential SUD treatment program. All subjects had two or more SUDs, and many had psychiatric (95%) and/or medical (77%) comorbidities. The age, gender and diagnosis-matched control group (n = 22) received residential SUD treatment as usual (TAU) in the same program but without SAT. SettingResidential SUD treatment program at a Veterans Administration Medical Center. InterventionSailing adventure therapy. Main Outcome MeasuresPositive and Negative Affect Schedule (PANAS), State Trait Anxiety Inventory six-item short form (STAI: Y-6 item), Acceptance and Action Questionnaire II (AAQ II), Five Facet Mindfulness Questionnaire (FFMQ) and a locally developed patient survey. Outcome comparison among SAT plus TAU group versus TAU – only group included measures of successful completion of residential SUD treatment program as well as psychiatric hospitalizations and/or residential SUD treatment program readmissions within 12 months. ResultsNeither physical injuries nor increases in anxiety or negative affect occurred, as measured by the PANAS (positive change, p = 0.351; negative change, p = 0.605) and the STAI: Y-6 item (p = 0.144) respectively. There was no significant change in FFMQ (p = 0.580) but a significant increase occurred in AAQ II scores (p = 0.036) indicating an increase in psychological flexibility. Survey responses indicated the participants perceived the experience to be both pleasurable and calming. The preliminary outcome evaluation revealed a significant between-group difference (X2 = 5.34, DF = 1, p = 0.02, r = 0.35) indicating participating in SAT was associated with a greater likelihood of successfully completing residential SUD treatment. However, there were no significant between-group differences in number of psychiatric hospitalizations (X2 = 1.09, DF = 1, p = 0.29, r = 0.16) or residential substance abuse treatment program readmissions (X2 = 0.23, DF = 1, p = 0.64, r = 0.07) in the 12 months after discharge from the program. ConclusionsPreliminary evidence suggests that SAT is physically safe and not associated with increased anxiety or negative affect. Participant’s perceptions of the experience were positive. Preliminary outcome measures suggest associations between participation in SAT and increased psychological flexibility as well as successful completion of a residential SUD treatment program. Further research is indicated to determine whether SAT may be developed as an effective complementary intervention for Veterans with SUDs.

Helping Older Adults With the Ageless Challenge of Substance Abuse

Helping Older Adults With the Ageless Challenge of Substance Abuse

Assessment of barrier severity and willingness to enter opioid agonist treatment among people who inject drugs in Ukraine

BackgroundOpioid agonist therapies (OAT) in Ukraine were first introduced in 2004 not as addiction treatment, but for HIV prevention. Numerous obstacles have thwarted OAT scale-up, including individual constraints and structural barriers. MethodsA cross-sectional survey of 1613 opioid dependent people who inject drugs (PWID) were recruited in 2014–2015 using stratified sampling in Kyiv, Odesa, Mykolayiv, Dnipro and Lviv. Analysis was restricted to a subset of 811 PWID who never received OAT. Barriers to OAT were assessed based on reasons why study participants were reluctant to enroll into OAT. A Rasch model from the Item Response Theory was applied to 24 potential barriers, used to score their severity and estimate a latent composite measure for each person’s willingness and ability to participate in OAT. ResultsThe Rasch model confirmed the cumulative nature of barriers with concerns over treatment efficacy, safety and tolerability being more prevalent than barriers related to logistical constraints, opportunity costs and social stigma. If barriers related to treatment perception and logistics were eliminated, the average barrier number would decrease from 10 to 2.2. Participants were more likely to have a higher resistance to OAT entry if they experienced fewer overdoses, did not attain higher education, were not previously incarcerated and if their peers did not have a higher level of resistance to OAT. ConclusionsUnderstanding the interdependence of various barriers and attitudes toward OAT can improve the rate of OAT expansion and ameliorate entry into substance abuse treatment programs in Ukraine.

2094 Validation of a set of “healthcare trust” scales for women seeking substance abuse treatment in community-based settings

OBJECTIVES/SPECIFIC AIMS: To validate previously published psychometric scales capturing interpersonal or healthcare-related trust in a target population of women with a history of substance use disorder seeking substance abuse treatment in a community-based setting. METHODS/STUDY POPULATION: Participants are enrolled at The Next Door, Inc. (TND) and Renewal House (RH), 2 community agencies in metropolitan Nashville that provide substance abuse treatment and post-incarceration re-entry services for women with a history of substance use disorder. We will enroll 300 participants to provide sufficient power for statistical psychometric validation. Inclusion criteria include adult women with self-identified history of substance use disorder seeking substance abuse treatment within seven days of initiation of inpatient residential or intensive outpatient treatment at TND or RH. Participants complete a one-time online survey comprising a demographics questionnaire, Rotter Interpersonal Trust Scale, Wake Forest Trust in Physician Scale, Revised Health Care System Distrust Scale, 5-item RAND Social Desirability Scale, and Adverse Childhood Events Survey. Participants then individually participate in a modified protocol of the “Trust Game.” Predictor variables for multivariate analysis collected include age, race/ethnicity, gender identification, number of days in current treatment, number of prior substance abuse treatment programs, and number of adverse childhood events. RESULTS/ANTICIPATED RESULTS: Each individual scale will be assessed for item analysis, factor analysis, construct validity, content validity, and reliability and compared with general population sample values published in the literature. We will use multivariate analysis to determine the impact of potential predictor variables on specific types of interpersonal or healthcare-related trust. We anticipate having preliminary results to present in April. DISCUSSION/SIGNIFICANCE OF IMPACT: Women who seek substance abuse treatment in the community face unique challenges compared to their male counterparts, including higher rates of prior interpersonal trauma, co-occurring psychiatric diagnoses, and more serious physical health problems. Characteristics such as these highlight the need for regular healthcare engagement in the setting of an increased risk of decreased interpersonal or healthcare-related trust. Prior qualitative research demonstrates that trust building is seen as an essential component of care in ongoing substance abuse treatment for women in this population. Validation of psychometric healthcare-related trust scales in a population of women seeking substance abuse treatment in a community based setting will provide a framework for future quantitative inquiry into the impact of healthcare-related trust on health outcomes, healthcare engagement, and treatment retention for this target population. Similarly, it will also facilitate inquiry into the effectiveness of specific treatment programs or interventions on improving therapeutic trust building.

The Pregnancy Recovery Center: A women-centered treatment program for pregnant and postpartum women with opioid use disorder

ObjectiveTo evaluate the impact of women-centered substance abuse treatment programming on outcomes among pregnant women with opioid use disorder (OUD). MethodsWe compared two retrospective cohorts of pregnant women with OUD on buprenorphine maintenance therapy who delivered an infant at the University of Pittsburgh from 2014 to 2016. Cohort 1 was composed of pregnant women who received women-centered OUD treatment services through the Pregnancy Recovery Program (PRC) and Cohort 2 was composed of pregnant women who received buprenorphine at OUD programs without women-centered services (non-PRC). Women-centered outcomes were defined as a) pregnancy-specific buprenorphine dosing, b) prenatal and postpartum care attendance, c) breastfeeding and d) highly effective contraception utilization. Chi-square and t-tests were used to compare outcomes between PRC and non-PRC patients. ResultsAmong 248 pregnant women with OUD, 71 (28.6%) were PRC and 177 (71.4%) were non-PRC patients. PRC patients were significantly more likely to initiate buprenorphine during vs. prior to their pregnancy (81.4% vs. 44.2%; p < .01) and have a higher buprenorphine dose at the time of delivery (16.0 mg vs. 14.1 mg; p = .02) compared to non-PRC patients. Likewise, PRC patients were significantly more likely to attend their postpartum visit (67.9% vs. 52.6%; p = .05) and receive a long-acting reversible contraceptive (LARC) method (23.9% vs. 13.0%, p = .03) after delivery compared to non-PRC patients. Finally, PRC patients had a smaller percent decrease in the rate of breastfeeding during their delivery hospitalization (−14.7% vs. −37.1%). ConclusionsIncorporating women-centered services into OUD treatment programming may improve gender-specific outcomes among women with OUD.

Buprenorphine Added on Brief Cognitive Behavioral Therapy for Treatment of Methamphetamine Use Disorder

Background: Methamphetamine (MA) use remains a major public health concern around the world. Recent findings suggest that buprenorphine may be helpful for cocaine use reduction. Moreover, animal studies described reduced dopamine peak effect following MA use, due to the administration of low dose buprenorphine. Objectives: This study examined the effectiveness of buprenorphine with brief cognitive behavioral therapy on MA use disorder. Methods: The study was conducted in an outpatient substance abuse treatment center in Qazvin, Iran. Nineteen MA users received buprenorphine for 24 weeks combined with brief cognitive behavioral therapy in an outpatient substance abuse treatment program, three times per week, as a before and after non - randomization study. Clinical outcomes included treatment retention, MA use, degree of MA dependency and craving, quality of life, cognitive abilities questionnaire, addiction severity and also adverse events. Data was analyzed by performing repeated measures analysis and the Friedman test for nonparametric variables. Results: Fifteen participants completed the study during six months and frequency of MA use was significantly decreased at 24 weeks (P < 0.001). There were also significant reductions in craving (P < 0.001), degree of MA dependence (P < 0.001), and improvements in quality of life, cognitive ability, and some subscales of addiction severity. Conclusions: The results of this preliminary clinical study demonstrated that buprenorphine could potentially attenuate MA craving and alternate rewarding effects of MA and had promising effects on cognitive impairment. Furthermore, buprenorphine can be considered as a harm reduction intervention in some communities, in which the people, as a result of cultural beliefs, do not accept a therapy, which only consists of counseling and no medications.

The social work services in screening process of compulsory treatment interventions in addicts in Iran: A content analysis study

Compulsory treatment has had a detrimental impact on drug abuse treatment policies and programs in Iran. Physicians are currently required to conduct initial treatment screening. Social workers are a part of the treatment team but have no authority to initiate a compulsory drug treatment plan. For this reason, the present article investigates social work service participation in the process of compulsory drug treatment. The study methodology is content analysis. Nine social workers participated in seven focus group discussions. Overall, 110 codes were extracted from the sessions and were categorized into five main themes: interview and initial assessment; referral; investigation of ineligibility criteria; report to judicial authority; and follow‐up and advocacy. The results of this research suggest amending executive bylaws based on a social work approach to the screening process for compulsory drug treatment.

Breastfeeding Intention Compared With Breastfeeding Postpartum Among Women Receiving Medication-Assisted Treatment.

Women taking methadone or buprenorphine are encouraged to breastfeed if stable without polysubstance use. We aimed to determine the difference between stated intention to breastfeed prenatally in women taking methadone or buprenorphine compared with breastfeeding at discharge and 2 months postpartum. Secondary outcomes were determining whether breastfeeding was more common in women taking buprenorphine, in women without hepatitis C infection, and in women without a history of heroin use, and whether breastfeeding reduced the need for pharmacological treatment of neonatal opioid withdrawal syndrome. This was a retrospective cohort study of 228 women enrolled in a perinatal substance abuse treatment program. Electronic medical records were reviewed to abstract data on mother-infant dyads. Chi-square tests were used to analyze our outcomes. Women taking buprenorphine had a higher prevalence of breastfeeding compared with women taking methadone (83% [ n = 100] vs. 71% [ n = 76]; χ2 = 4.35, p = .03), despite no difference in their prenatal intention to breastfeed (87% vs. 81%; χ2 = 1.28, p = .25). Only 31% ( n = 38) of women taking buprenorphine and 19.6% ( n = 21) of women taking methadone exclusively breastfed at discharge (χ2 = 5.43, p = .06). Exclusively breastfed infants required less pharmacological treatment for neonatal opioid withdrawal syndrome compared with formula-fed infants (15.8% [ n = 21] vs. 47.4% [ n = 38]; χ2 = 19.72, p < .05). Despite most women reporting a high prenatal intention to breastfeed, exclusive breastfeeding at hospital discharge postpartum was low. Breastfeeding was associated with a decreased likelihood of pharmacological treatment for neonatal opioid withdrawal syndrome.

Substance abuse treatment as a preventative tool for opioid use: A cautionary tale

ABSTRACTObjective. Using a large panel sample of men who have been released from prison, the current study seeks to explore whether substance use treatment before and after release from prison helps reduce opioid use.Methods. To explore how pre-release and post-release substance abuse treatment might restrain opioid use, we estimate a two-level mixed-effects model which regresses opioid use at several waves of data onto both treatment measures and control variables.Results. Pre-release substance use treatment is not related to opioid use after release from prison. Although post-release substance use treatment is statistically significant, the direction of the post-release substance abuse treatment effect demonstrates that increased odds of opioid use are found among those who participated in treatment programs.Conclusions. Substance use treatment does not appear to have the desired effect on opioid use for those coming home from prison. Instead, it appears to gradually increase opioid use over time. Due to the possibility that returning persons may establish deviant peer ties in substance use treatment programs, there is a strong substantive need to better understand the implications of substance abuse treatment programs on opioid misuse and abuse.

Employment services and substance abuse treatment

This qualitative study of over 800 participants focused on the employment experiences of consumers of substance abuse treatment programs to provide a better understanding of what employment services are offered and what needs treatment agencies have in the area of employment services, examining barriers and facilitators from both the consumer and provider perspectives. Data were collected via a mixed research methodology of focus groups and surveys from July 2015 through June 2016 in a large Midwestern U.S. state. Employment is a challenge for persons with substance use disorders. Only a quarter of this study’s large sample of substance abuse treatment consumers reported being cur­rently employed; and of those consumers who reported no current employment, greater than half reported that their current unemployment was due to their substance use. Persons receiving substance abuse treatment face many challenges in obtaining and maintaining employment. Treatment providers identified several barriers to implementation of employment services. They named an array of resources as needed, including increased funding for supportive employment programs and staff appropriate to the delivery of employment services. Some providers believed employment services to fall outside of their scope of practice. Data generated through this study may inform policy to invest resources in employment services within substance abuse treatment settings.