Drugs and youth: an international perspective on vocational and social reintegration
Vocational rehabilitation and employment
Job counselling and guidance
Therapeutic function inherent in vocational rehabilitation
International trends and innovative approaches
A municipal project
Helping both addict and community
Drug dependence and the disabled
Occupational drug abuse and alcoholism programmes
Author: E. SACKSTEIN
Pages: 33 to 45
Creation Date: 1981/01/01
Deputy Chief, Vocational Rehabilitation Branch, Training Department, International Labour Organisation, Geneva, Switzerland
Despite the negative attitudes of the general public and even of professionals concerning the potential of drug-dependent youth to reintegrate socially and to be employed, there is ample and growing evidence for a more positive outlook. This paper describes the vocational rehabilitation process which can serve as a basic tool for most drug rehabilitation programmes. The author illustrates a number of interesting and innovative approaches, both public and private, which have all demonstrated some measure of positive outcome. Mention is made of the need for and great value of direct involvement of the community in the rehabilitation and re-integration process. Programmes for employed drug-dependent persons are also cited as a preventive and highly effective approach.
The term "drug addict" generally conjures up in one's mind an image of a depraved, amoral youth who is not only dangerous to society but who is also incapable of changing his ways or of being helped. Fortunately, this image is far from the truth. And yet, all too often, national policies and programmes for the drug dependent are formulated in ways which strongly reflect this stereotype and prejudice. As a result, and almost as a self-fulfilling prophecy, drug rehabilitation programmes have been notoriously plagued by low success rates.
If drug addicts can, in fact, become productive members of their community then why, one must ask, has the experience in many parts of the world been so generally discouraging? This paper takes a closer look at the problems concerning vocational and social integration of drug-dependents, ventures to identify a number of the main difficulties and explores several encouraging and innovative trends.
In recent years, the world has seen important technical and social progress and has simultaneously experienced increasingly greater social and political turmoil. With little from accepted traditions and values to guide it, the younger generation, and particularly youth from the more rapidly changing and industrialized countries, has found itself in a position of having to seek more relevant values and has had to structure a way of life that corresponds more to current realities. This is a profound challenge to confront an entire generation that had cut its eye teeth in a society of potentially unlimited prospects for achievement, and young people are proving to be least well prepared to cope with stress or to be truly adaptable to rapid change. The causes of drug-taking behaviour are certainly complex and may vary widely from culture to culture and country to country. Nevertheless, one tends to find that mental illness is on the rise and occurs at an increasingly earlier age; suicide and violence are more prevalent; socially deviant behaviour (delinquency, prostitution, criminality etc.) is spreading; and the use of substances (drugs, alcohol etc.) to relieve anxiety and for recreation is intensifying.
Seen in this perspective, drug taking is but one of many symptoms of social ferment. It reflects self-destructiveness but may also demonstrate a form of noncompliance with what are felt to be unacceptable social alternatives. Drug taking is therefore more a human, personal and social problem than a legal or medical one.
This point is fundamental; if it were accepted, its implication for policy and programme development would be of evident importance in setting strategies at international and national levels.
With the spread of the drug abuse phenomenon the image of the typical drug taker has become more diverse and broader. The average age of substance abusers has considerably lowered in recent years. Both drugs and alcohol are being taken in combination, with the result that poly-drug use is increasingly common. Substance abuse is neither the exclusive domain of either the rich or the poor, of the employed or the unemployed, of the young or the not-so-young. Nor is it a phenomenon unique to either industrialized or developing countries. One thing is true, however, of all drug takers. Their drug-taking behaviour is universally seen as deviant and as a fundamental threat to the stability and future of society.
Professionals in a number of countries have explored a wide range of experimental approaches in their efforts to tackle many of the thorny problems inherent in trying to persuade addicts to refrain from using drugs and to find a meaningful place for themselves in their families and communities. The results have been extremely varied - from discouraging to very hopeful. Any measure of success depends to a large extent upon the definition of these terms and on how they are measured. In this context there have been great differences, not only from country to country, but also among programmes within the same country.
The more statistically successful programmes are often eyed sceptically by other rehabilitation professionals. One should not under-estimate the extremely destructive influence that negative attitudes, on the part of the general population as well as of rehabilitation professionals themselves, can have on the outcome of rehabilitation efforts. Even the best-conceived assistance can result in failure if people are not convinced that it can work.
It is also probable that some of the failures in helping ex-addicts back to life in their communities, particularly in Western cultures, are due to the fact that the help may not sufficiently encourage their voluntary participation or that it does not correspond to their personal needs or to the hard realities of the labour market.
Employment is universally considered as vital; it gives individuals a certain identity and a place in society. It provides them with evidence that they are needed by others and that they have something of value to contribute. Work is an important determining factor in one's social integration and plays a significant role in personal relations with others. Work also performs the function of organizing and structuring one's daily life.
It is generally recognized that addicts face serious discrimination problems in the job market. In both the public and private sectors, addicts have to overcome employment barriers; this includes those addicts who have been through treatment and rehabilitation programmes. These barriers are often difficult, if not sometimes impossible to surmount by the ex-addicts themselves, unless they Choose to conceal their former dependence from prospective employers. Special assistance is therefore needed to overcome the many difficulties that lie in the path towards social integration.
For this and other reasons the majority of the more successful drug rehabilitation programmes have an important vocational element. Vocational rehabilitation, a process that has proven its effectiveness for many years in preparing the physically and mentally handicapped for economic independence, has proved to be particularly relevant in assisting the ex-addict. International Labour Organisation (ILO) Recommendation No. 99, 1on the vocational rehabilitation of disabled persons, lays down international guidelines for services in this field.
It has been our experience over the years that the meaning of the term "vocational rehabilitation" is not generally understood. It may be defined as a continuous and co-ordinated range of activities which aim to provide vocational services. These include vocational evaluation, job counselling and guidance, job preparation, vocational training, selective placement and follow-up. These services are designed to enable the ex-addict to secure and retain suitable work.
1. ILO, Recommendation No. 99 concerning the Vocational Rehabilitation of the Disabled, Geneva, 1955.
Vocational evaluation systematically utilizes work, whether real or simulated, as the focal point in the vocational development and career planning of an individual. Psychological, social, educational and vocational data are gathered to assist in this process.
Job counselling and guidance consist in helping a person to learn about relevant opportunities for education and training. Standardized tests may be used to ascertain an individual's abilities. Job counselling and guidance can also involve helping individuals to understand better what suitable and realistic job opportunities may be available to them once they are ready to enter the labour market.
Job preparation aims at (re)acquainting a person with the conditions and demands of the work world and environment. This can include training with different materials, tools, machines and methods of working, as well as the promotion of the standards expected at work, It should also include the development of those personal factors that can enhance an individual's employability, e.g. work habits, physical or emotional tolerance of work, and appropriate inter-personal skills. This type of assistance to ex-addicts who have never worked before can be of crucial importance in adapting to their first jobs. Lack of preparation could easily spell failure for reasons that are not related to the person's former addiction.
Vocational training should take into consideration both the persons' abilities and their interests. Training must be based on realistic employment opportunities in the current labour market. This point cannot be overemphasized in view of today's increasing unemployment. Solid job training can put a former drug-dependent person in a more competitive position in an increasingly competitive and tightening labour market.
The techniques of selective placement can be extremely effective in assisting individuals to find employment that is suited to their experience as well as their physical, mental and other characteristics. It involves good knowledge of the job seeker's positive attributes and skills, knowledge of the job and its requirements and, finally, matching the candidate to the job. A trained placement counsellor usually makes direct, on-the-spot contacts with personnel departments and managers in industry, with businessmen and labour representatives, for the purpose of identifying prospective job openings. This direct approach also serves the important function of trying to overcome the inevitable prejudices that employers might have in engaging a former drug dependent.
This type of service can be provided within the rehabilitation programme itself. However, those programmes that lack the placement expertise or manpower can sometimes benefit from special services that are set up specifically for that purpose.
It is worth mentioning in this context that in a demonstration project undertaken in the United States which developed strong placement services for exdrug abusers, participating employers were questioned about their experience after having employed a client from the programme. The majority of the clients (71 per cent) had been involved with heroin or heroin and cocaine. Over 69 per cent had been using drugs for over two years, with 47 per cent having used drugs for over four years. With regard to overall job performance, 77 per cent of the employers rated the programme clients as the same, or better than regular employees. With regard to punctuality, 79 per cent of the employers rated clients the same or better than regular employees. Approximately 86 per cent of the clients were rated the same or better than regular employees concerning attitudes towards their job and their ability to relate to co-workers. On the subject of absenteeism, clients were rated by 66 per cent of the employers as the same or better than regular employees. Most programme clients were placed in entry-level positions. Their occupation distribution is shown in table 1.
Table 1 - Occupation distribution of ex-drug abusers (Percentage)
Distribution of all total placements
The last phase of the vocational rehabilitation process, the follow-up, is not, as many believe, a statistical, head-counting exercise to determine how many ex-addicts benefited from their rehabilitation. Instead, follow-up aims to ascertain for given individuals whether their placement in a job or social adaptation has proved to be satisfactory. It also serves a second, preventive, function in that it attempts to detect and rapidly resolve difficulties or obstacles to satisfactory adaptation to work so that these would not unnecessarily lead to dismissal.
In organizing a vocational rehabilitation programme many professionals question whether such services would be suitable for those detoxified addicts who have previously had vocational training and work experience. It can readily be seen that the rehabilitation process corresponds to a wide range of vocational needs of former drug-dependent youth. Programmes should be sufficiently flexible to assist clients according to their individual needs, and not unnecessarily require them to fit into a predetermined set or sequence of services.
In the event that programme clients have had previous employment training and experience, it may be unwise to require them to undergo job training unless they want to redirect their vocational future. Nevertheless, a rehabilitation programme can provide an important therapeutic function in that it can assist someone in readjusting to a work environment and all that this may entail. A certain number of addicts have only poorly developed the emotional resources needed for appropriate social and vocational functioning. This fact alone, regardless of whether or not one is drug-dependent, can account for failure or chronic difficulties in holding a job and in becoming a responsible member of society.
For this reason residential programmes such as therapeutic communities, halfway houses, drug rehabilitation centres etc. are created. They provide a new environment within which one can be helped to learn more suitable ways of behaving and working with others. Such programmes generally offer a well-structured range of activities. Vocationally oriented programmes, that is those which have real work activities, can do much to prepare the addict to meet the demands of a normal work situation. For example, all employees are expected to accomplish certain tasks within a given period of time and to meet certain standards of quality. They must be able to maintain acceptable relationships with colleagues and supervisors. They must put in a minimum number of hours each day, and so forth.
Rehabilitation professionals should, therefore, not view the work activities within a rehabilitation programme as merely a way of occupying the time of the recovering addict. Unfortunately, however, this grave error is often made and may frequently contribute to the detoxified addicts' feelings of anxiety or boredom, and may result in them running away and to a sense of futility about their future.
In recent years a growing number and variety of rehabilitation approaches have been developed that incorporate these vocational preparation and therapeutic components. A few of the more representative examples which prove effective and encouraging efforts are being undertaken today are as follows:
Created in New York City in 1972, Wildcat is a drug rehabilitation programme that was conceived as a corporation which provides services to local communities. The corporation employs ex-addicts or ex-offenders to provide these services and bas shown that through supported work these people can break out of the pattern of drugs and crime. By offering them meaningful jobs and salaries on which they pay taxes, Wildcat has demonstrated that they can become self-sufficient, contributing members of society. Wildcat was designed to provide a structured environment in which ex-addicts can be encouraged and supported in their adjustment to employment through group work, peer supervision, "feedback" and rewards for good performance. Most Wildcat projects perform public services for the city, although there are some projects undertaken for non-profit community agencies. Crews are assigned to about one hundred job sites which include clerical, social services, maintenance and construction work. The main programme goal is to provide a transition from. subsidized to competitive employment. There were as many as 1,400 clients within the programme in 1975, prior to New York City's financial crisis. An analysis was made of 149 clients who left Wildcat before the end of three years (see table 2).
Table 2 - Post-Wildcat employment experience in third year by length of time at Wildcat
Length of time at Wildcut (weeks)
Fraction working full-time at end of third year (percentage)
Average length of time worked in third year (weeks)
1 - 26 ( n = 45)
27 - 52 ( n = 38)
53 - 104 ( n = 45)
Flexible work policies have been developed to deal with the work problems of employees while they are within the programme's supported employment. These policies relate to punctuality, attendance and time off. This flexibility does not mean that there are no regulations but rather that the (ex-drug abusers) workers may temporarily be permitted some margin for deviating from norms of work conduct with the understanding that they will eventually have to comply with these. This therapeutic approach can often help ex-addicts make the personal and crucial adjustments that are essential to their being able to function socially and at a place of work.
Grupo Abbele developed in Italy. It was created by a young priest to respond to some significant social problems within the industrial city of Turin. In addition to drug abuse, these included delinquency, alcoholism, prostitution, lack of recreational activities for Turin's youth and a lack of assistance for its older population. Situated in a residential facility (a renovated old building on a sizeable tract of land) within the city limits, the Grupo Abbele employs young people who suffer from various problems to assist in the upkeep and maintenance of the building, and to raise animals and vegetables for sale as well as for their own use.
The Grupo also organizes activities that respond to important needs within the community. In so doing, its programme aims at changing those social conditions that may be the cause of the difficulties of its clients. For example, the lack of recreational activities for the city's youth can be an element contributing to delinquency. The young people are directly involved in these community improvement projects. In this way, they develop certain vocational skills. The significance of the responsibilities they are given cannot be underestimated, for none can deny that their work has a socially useful function.
The clients are not encouraged to stay longer than necessary. Employment assistance is offered when needed. The Grupo is not a closed institution. Rather, its uniqueness and originality come from it being open and sensitive to the quality of life and needs in the community around it. It may be worth emphasizing that the Grupo does not cater to any one category such as the drug-dependent or the public offender.
The Government of Burma has requested technical assistance from the ILO, financed through the United Nations Fund for Drug Abuse Control, in the formulation of a national strategy and the development of a national programme of vocational rehabilitation and social reintegration services for drug-dependent persons. This assistance is part of a multi-sectoral international programme including, among others, crop replacement, preventive education, and treatment.
In line with government policy, the Department of Social Welfare is seeking to create a network of rehabilitation services (i.e. craft training centres and social support centres) for drug-dependent youth throughout the country. These services are being set up in relatively small facilities within and near the affected towns and cities. The most unique feature of this programme is, perhaps, the use of what are known as volunteer social workers. These are young people who have recently terminated their education, and are engaged at the local level in identifying, registering and bringing known addicts for treatment and rehabilitation. After a short introductory course and, later on, a refresher course, these volunteers work in close collaboration with village and community leaders.
As the programme develops the youth workers gather practical knowledge and insight into the causes of drug abuse. They learn how the addicts and their families can be assisted, and what solutions can be developed with regard to job training, placement and employment. Some have taken the initiative, for example, in contacting prospective or former employers for the purpose of placing an addict or convincing a reluctant employer to take back a formerly drug-dependent worker. As a result, the ILO has been increasingly encouraged to seek the advice and guidance of this corps of youth volunteers in finding solutions to questions concerning the further direction and development of this experimental programme.
This joint project is only at the midpoint of its work and it is, therefore, not possible to evaluate its results at this stage. However, the ILO is quite hopeful that the present pragmatic and community-oriented approach will bear fruit.
The therapeutic community (TC) as a system of rehabilitation is extensively developed in various parts of the world. This approach was developed at a time when it was realized that out-patient treatment and hospitalization had little impact on an addict's remaining drug free. Therapeutic communities have tended to be somewhat controversial internationally in that, while some have succeeded in getting their members to conform to the subculture of the community, the ex-addicts were often unable to make an adequate transition and adaptation back into the regular mainstream of society. Those therapeutic communities became more or less permanent substitutes for drug dependence.
Fortunately, this is not true of all therapeutic communities, among them the Centre du Levant. This may be due, at least in part, to the fact that greater efforts were made to get the addicts to conform to the more realistic demands of the work environment and of society at large.
The Centre du Levant is a fairly traditional type of TC at Lausanne, Switzerland, which offers a residential programme to some 20 ex-drug abusers. Like many, it has a strict, regulated, three-phased, one-year programme that promotes the evolution of the individual in terms of group participation and responsibility, vocational preparation and eventual reintegration within the traditional community. Members must be involved in some form of vocational training and activities. These include the upkeep and maintenance of the residence, cooking and kitchen work, as well as performing services within the neighbouring community. For those members who, at the completion of their one-year stay, are not ready for full social reintegration, a farm activity outside Lausanne has been created. The final objective of the Centre du Levant, however, is the return of the ex-addict to a useful social and economic role.
With regard to the general outcome of TC programmes, a 1976 review of experience in the United States showed that half or more of the graduates of traditional therapeutic communities were employed in drug treatment or social service activities. The proportion of addicts that returned to employment in the usual sense appears small.
New Orleans, in the southern United States, has a local government municipal project for socially disadvantaged youth, including the drug-dependent, but it has no residential facility as its base. Rather, its main emphasis is on the economic sector of the community. In a dynamic and aggressive approach, local managers and businessmen are contacted with a view to enlisting their participation. This consists in agreeing to provide on-the-job training to a detoxified youth for a determined period of time. A subsidy may be offered to the employer during this period to compensate for the lower productivity of the trainees during their stay. It is understood that the participating employer is under no obligation to engage the trainee at the termination of the programme.
However, many employers were quite willing to offer regular employment to trainees once they were convinced that their prior drug dependence was no obstacle to the performance of their job.
These few examples of vocational and social rehabilitation programmes are presented as evidence that drug-dependent youth can be helped and that a significant part of that help involves their preparation for employment, their placement and social participation. One important commonality among most of the programmes cited is their involvement of and with the local community. Some have extended their target population to include other socially disabled or disadvantaged groups. Most, in their efforts to assist their clients, have at the same time turned towards trying to solve some of the problems facing the neigh-bouring community. Thus, Wildcat employees have cleaned up empty city lots to provide playgrounds for ghetto children or have renovated decaying city houses to provide more suitable housing accommodation; Grupo Abbele members have developed some services for Turin's senior citizens and some recreational activities for the city's youth, and so forth.
Drug abuse, like delinquency, mental illness, disability etc., is a community problem. This writer submits, therefore, that the community should not only be concerned about these problems but it should also directly contribute to seeking out suitable solutions and to participating in their implementation. "Community" in this context is defined in its broadest sense, i.e. all public and private organizations, voluntary groups and concerned individuals. There exists an enormous potential in terms of financial resources, manpower, services, locales and equipment. Community participation usually means there is less need to rely on institutions, which can be costly, and which often merely serve to further isolate the troubled persons from their family and collectivity. In the case of the detoxified drug-dependent, this separation is not always necessary or desirable.
Finally, community involvement increases contact with ex-addicts. This will generally result in greater understanding of their difficulties and needs and in fewer destructive, negative attitudes. As with the physically and mentally disabled, their greatest handicap is not so much their disability but the negative attitudes of others towards them. These attitudes result in job and social discrimination, social isolation, reduced access to services that are available to the regular population etc.
Among other recent trends are the following:
As recently as May 1980 a six-point Federal Initiative was formally created by the US National Institute on Alcohol Abuse and Alcoholism to develop treatment services for drug-dependent and alcoholic persons with additional physical or mental disabilities. This development will provide an opportunity to strengthen the relationship between drug and alcoholism treatment programmes and the rehabilitation field in meeting the needs of these neglected persons.
Not all substance-dependent persons are unemployed. However, if they do not receive appropriate and well-timed assistance, they are likely to lose their jobs. Interestingly, a high proportion of persons with drinking problems is employed, perhaps as much as 65 - 70 per cent. Estimates of drug abuse are less readily available but are probably considerably lower.
Industry is understandably concerned at the extent of substance abuse among its employees. It is not financial loss alone that is worrisome but rather the components of such loss (absenteeism, illness, work accident, lower productive capacity, decreased quality of work, personnel turnover, thefts, and difficulty in working relationships). Equally distressing is the loss in human potential. Once dismissed, the substance-dependent persons will be at a distinct disadvantage in seeking other jobs. In general, most employers will not readily hire someone who is identified as an alcoholic or drug addict. In today's shrinking labour market, job loss in most countries can turn into chronic unemployment for even the non-drug abuser.
Only a small number of occupational drug abuse and alcoholism programmes have been developed in countries in North America and Western and Eastern Europe. This is somewhat surprising in view of the great potential of these programmes. For example, in the United States some firms that had dismissed as many as 95 per cent of their alcoholic employees before instituting special services, were able to claim up to 80 per cent recovery and retention of this group as the direct result of having set up these services. Occupational drug abuse and alcoholism programmes, therefore, have a highly preventive function.
A more recent development within this field has occurred in Canada and may well mark an important new stage. The Canadian Labour Congress, a trade union, is setting up services that aim at the spectrum of behavioural problems that impair job performance. In this way they will not concentrate only on the alcoholic or drug-dependent employee, for it can be observed that work performance may also be seriously affected by a range of psycho-social problems other than substance dependence. Known as "employee assistance" or "employee recovery" programmes, such generalized services are considered more effective in that they do not cater for any one group and, in so doing, do not place the stigma or label of "alcoholic" or "addict" on those seeking help.
We have briefly reviewed several recent and innovative trends in helping drug-dependent youth to reintegrate in their communities. Training for employment has proven to be of enormous therapeutic and practical value to help ensure a more favourable outcome for their re-entry and their attempt to survive in an increasingly competitive and complex world. National planners, treatment and rehabilitation personnel and the general public must all be better informed about the nature, objectives and usefulness of vocational rehabilitation. It should also be stressed that a vocational component in rehabilitation should not and cannot be used merely to help pass the time in the addict's daily schedule. In order to develop a realistic vocational service, personnel with experience in training, placement, employment and the business world are absolutely essential.
When setting up rehabilitation services for youthful drug abusers, it is equally important to bear in mind that this group has generally little or no job training, work experience or survival skills. The present world-wide economic downturn makes these factors even more crucial. These individuals' opportunities for and abilities in obtaining jobs on their own are limited, particularly if they are from socially disadvantaged groups. If our efforts to reintegrate former drug-dependent youth fail, perhaps we should not hasten to put the blame on their shoulders. We should ask ourselves two questions: "Where have we missed the boat?" and "How can we do something differently, and respond more effectively to the problems of those we are responsible for helping?"
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