Assessing employment limitations in the context of addictions: A question of equity
(Re)entering the workforce and maintaining employment is a major challenge for people undergoing medical treatment for an opioid use disorder. These people therefore often turn to financial assistance programs, which can be increased by 57% if a medical report documenting functional limitations results in a recognition of severe work disability. However, the evaluation of these limitations is a complex medical act, particularly for patients with drug or alcohol use disorders. The case study conducted in an opioid addiction treatment center aimed to document: 1) the criteria used by professionals involved in the assessment; and 2) the experiences of applicants. The data collected came from interviews with seven professionals and 18 service users and from two focus groups with about 20 professionals. The thematic analysis shows that five types of criteria are used by the professionals: 1) medical and psychosocial factors; 2) the person’s employability; 3) his or her credibility; 4) the potential impacts of recognizing work disability and of access to enhanced benefits; 5) their individual values. Five main themes also emerged from the interviews with users: 1) anxiety about the medico-administrative process; 2) the difficulty of accepting the refusal to recognize work disability; 3) the anticipated or felt impacts of access to enhanced benefits, which tend to show the strong potential of interventions on income; 4) the great value placed on work and the relief of having their employment difficulties recognized; 5) the variability of users’ reactions to the formalization of a diagnosis. Some ideas are proposed for the evaluation of employment limitations from a health promotion perspective. These include an interdisciplinary perspective as a facilitator for taking into account the social determinants of health in the evaluation.