‘I am somebody now’—exploring meanings and experiences of gaining employment among people in substance use disorder treatment

Many individuals with severe Substance Use Disorders (SUD) want to work. This study explores the experiences of what gaining employment represents for patients receiving Individual Placement and Support (IPS) early in their SUD treatment. Semi-structured interviews were conducted among 17 patients in specialized SUD treatment who received IPS through participating in a randomized trial. Interviews were thematically analyzed in an interdisciplinary group. The analysis generated three main themes: <i>Employment promoting positive change in self-experience,</i> where employment was described as improving well-being, confidence, health stability and awareness of personal challenges; <i>Employment as a bridge for reconnecting with society</i>, where work was experienced to enable social participation, feelings of usefulness and identity reconstruction; and <i>Employment as a risk factor for destabilization and relapse</i> showing how employment could have negative impacts, and potentially trigger substance use. Gaining employment during SUD treatment can support both personal development and social integration but may also involve risks. Tailored employment support that responds to the complexities of SUD and is delivered through interwoven collaboration between health care and employment support services may improve treatment outcomes. This has important implications for future policy and service development and warrants further exploration.

许多罹患重度物质使用障碍（Substance Use Disorders, SUD）的群体均有就业意愿。本研究旨在探究在物质使用障碍治疗初期，接受个性化安置与支持（Individual Placement and Support, IPS）的患者对就业意义的切身体验。研究通过一项随机对照试验，招募了17名在专科物质使用障碍治疗机构接受IPS服务的患者并开展半结构化访谈，随后由跨学科研究团队对访谈资料进行主题分析。分析结果提炼出三大核心主题：其一为**就业助推自我体验的积极转变**，该主题下就业被描述为可提升幸福感、增强自信心、稳定健康状态并提升对自身困境的觉察能力；其二为**就业作为重归社会的桥梁**，此主题中患者认为工作能够助力社会参与、赋予自身价值感并推动身份重构；其三为**就业可能成为状态失衡与复吸的风险因素**，该主题则揭示了就业可能带来的负面影响，甚至有可能诱发物质使用行为复吸。
在物质使用障碍治疗期间获得就业机会，既有助于个体发展与社会融入，但也可能伴随相应风险。结合物质使用障碍的复杂特性，通过医疗保健与就业支持服务的深度协同所提供的定制化就业支持，或可改善治疗效果。该研究结论对未来的政策制定与服务优化具有重要参考价值，同时也有待开展更深入的探索。