Meaningful Work as Medicine
Updated: Nov 11, 2022
by Geoffrey Morrow
The Substance Use Support and Employment Program operates around the theory that employment is one way to enhance stability and manage substance use goals, along with an increase in other positive health outcomes. This theory is supported by multiple lines of evidence that includes research conducted by the British Columbia Centre for Substance Use, The Health Foundation, and the lived experiences of peers involved in SUSEP.
Meaningful work is identified as work that makes one feel fulfilled and socially connected. Peers in SUSEP often use the word “purpose” to describe the fulfillment they find through meaningful work, and there’s an excellent example of this in a previous SUSEP blog article called “Jason’s Story.” Jason is a peer worker on the Downtown Eastside who, through meaningful work as a Chinatown Steward and SUSEP Peer Worker, was able to cut his fentanyl use in half before stopping altogether. Jason found purpose in his work helping other people, and the community that formed around Jason through his work became much needed structure and social support that helped him discover a career and a life without substance use.
Jason’s story highlights an important experience with meaningful work that contradicts a common myth that people cannot make responsible decisions while using drugs. This myth creates stigmas associated with drug use and creates barriers to finding work, but once SUSEP participants break through these barriers and obtain meaningful employment there is a noticeable increase in their self esteem and an understanding of what they are capable of. This opens up a world of opportunities and internal research conducted by the SUSEP team finds that once peers begin work that is meaningful, their drug use decreases because drug use becomes an impediment to work. Participants stop engaging in crime to survive and instead they earn money doing work that they actually enjoy doing.
These findings underscore research conducted by the British Columbia Centre for Substance Use that showed an inverse relationship between employment and the initiation of injection drug use.  The UK organization, The Health Foundation, has also noted strong links between employment and positive mental health outcomes.  If employment is the doorway to a healthy and productive life free from addiction, then meaningful work is the key that unlocks this door for people who struggle to find employment. This is why the SUSEP team values meaningful work as an important component of the program and the completion of positive goals around substance use.
Richardson, Lindsey et al. “Employment and risk of injection drug use initiation among street involved youth in Canadian setting.” Preventive medicine vol. 66 (2014): 56-9. doi:10.1016/j.ypmed.2014.05.022
Destigmatizing Addiction Through Unconditional Positive Regard
By Geoffrey Morrow
There’s a common saying in recovery groups that goes something like, “You know an addict is lying because their mouth is moving.” Many people who have gone through an addiction have heard this saying before and experienced the stigma of being labeled a liar because they use drugs. This stigma is unfair, and, ironically, untrue. To challenge these unfair stigmas towards people who use substances, SUSEP utilizes harm reduction strategies so people who use drugs can feel safe and respected when seeking help.
One of the most impactful tools to help people with their substance use is the person-centered therapeutic technique of unconditional positive regard. SUSEP case workers use unconditional positive regard by reminding clients of their successes and continually affirm their positive choices. "Don's Story" is a great example of the impact unconditional positive regard can have on a recovering person. After relapsing following nine months of sobriety, Don connected with SUSEP and worked with the SUSEP case manager who used unconditional positive regard. Don made significant progress with this approach and completed his goals around substance use, got his driver's license, obtained employment, and received a promotion shortly after being hired. An important component of Don’s success was the SUSEP team who did not assume he was lying because he was a drug user. In Don’s own words, "I had people who believed in me and that gave me confidence."
The progress Don made through unconditional positive regard demonstrates the importance of social support because people who struggle with substance use are accustomed to hearing negative stereotypes about themselves. While speaking with the SUSEP case manager it was apparent that most of the SUSEP participants carry a lot of shame and guilt for using drugs. Participants may not yet have the tools to support themselves, so identifying the successes each participant has made can reframe the negative thoughts associated with their drug use. Over time, participants begin to see themselves differently and recognize those positive changes in themselves. This process of unconditional positive regard radically changes the core beliefs of shame and guilt that is caused by stigmatizing drug users who are more than capable of being honest with themselves and finding success in the face of difficult challenges.
Geoffrey Morrow is a staff member of EMBERS Eastside Works, the drop-in space from which SUSEP operates. He has watched SUSEP evolve since May, 2021, and referred many people to the program.