Residential addiction treatment providers: Identifying the role of social context in worker health and turnover

• Published in: Social science & medicine (1982) Vol. 314; p. 115462
• Main Authors: Stelson, Elisabeth A., Sabbath-Clayton, Lauren L., Sorensen, Glorian, Kubzansky, Laura D., Berkman, Lisa F., Sabbath, Erika L.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-12-2022
• Subjects: Addiction treatment; Behavior, Addictive; Conceptual model; Counselor; Humans; Massachusetts; Qualitative; Quality of Life; Reproducibility of Results; Residential Treatment; Social Environment; Substance use; Total worker health; Working conditions; Substance use; Substance use disorder; Massachusetts Office of Health and Human Services; Counselor; Massachusetts; Total worker health; Working conditions; Residential treatment; Qualitative; Conceptual model; Addiction treatment
• ISSN: 0277-9536; 1873-5347
• DOI: 10.1016/j.socscimed.2022.115462

Increased lethality and availability of addictive substances has strained US addiction treatment services, further exacerbating workforce shortages in these settings. The emotional and physical health toll of providing treatment may contribute to shortages. This community-initiated qualitative study aimed to identify conditions that affect provider health and turnover in residential addiction treatment from a Total Worker Health® perspective. Providers (direct service, supervisors, leaders) working in nonprofit residential treatment facilities in Massachusetts were recruited by role and geography to participate in interviews and focus groups. NVivo12 facilitated coding and analysis. 25% of transcripts were double coded to assess interrater reliability and coding consistency (mean Kappa = 0.82). Providers (N = 49) participated in 33 interviews and 4 focus groups. Many participants reported personal addiction histories. Analysis revealed how socio-contextual factors originating outside of residential facilities were dominant influences on “downstream” working conditions, worker health, staff turnover, and by extension, client care. Four primary socio-contextual themes surfaced:1) Changes in type and potency of substances and client need not reliably accompanied by shifts in treatment practices; 2) challenges balancing state requirements and state-provided resources; 3) influence of structural discrimination and addiction stigma on pay and professional advancement; and 4) geographic location of facilities shape work and quality of life. Results were used to develop a conceptual model for residential addiction treatment to illustrate pathways by which ecological factors interact to affect provider health and turnover. Findings indicate that protecting health and wellbeing of providers—many of whom are in addiction recovery themselves— is integral to improving addiction treatment. From this workforce's perspective, recent changes in socio-contextual factors have intensified already challenging working conditions (job demands, pay, advancement), negatively impacting worker health, turnover, and client care. Any interventions to improve treatment outcomes or working conditions in nonprofit addiction facilities must consider larger socio-contextual factors influencing these organizations.
•Contextual factors heavily effect working conditions in residential addiction treatment.•Substance lethality, client needs, and facility location affect worker job demands and quality of life.•Inadequate state funding contributes to low wages, poor worker health, and turnover.•Stigma and increased qualifications structurally discriminate against workers in recovery.•Improving addiction care requires addressing contextual factors affecting addiction treatment work.