The Career Trajectories and Outcomes in Substance Use Recovery: A Scoping Review

This scoping review provides a comprehensive overview of the reported trajectories and outcomes of individuals in recovery from substance use disorders (SUDs). Database searches of PsycINFO, Medline, and ERIC were conducted, resulting in 33 relevant studies. Thematic analysis was used to identify the themes that emerged in the literature. The key themes that emerged from the studies fell under two main categories: trajectories (the role of work, characteristics of working in recovery, and education and aspirations) and outcomes (employment status and long-term recovery and career success). The results of this scoping review offer several suggestions for the career trajectories and outcomes implicated in substance use recovery and career development concepts and theory applicable to the needs of this population; this also includes the need to continuously support clients who are in recovery with their career development.

With rates of substance use problems continuing to climb in the U.S. and Canada (Health Canada, 2018;SAMHSA, 2019), it is imperative to understand the course and trajectory of problematic substance use.It has been estimated that over 20 million individuals in the U.S. each year meet diagnostic criteria for a substance use disorder (SUD; SAMHSA, 2019).Additionally, it is estimated that 20% of Canadians will meet diagnostic criteria for an SUD during their lifetime (Health Canada, 2018).Researchers in both physical and mental health disciplines continue to explore the underlying causes of substance use problems and possible explanations for their course and trajectory.More recently, the dominant understanding of substance use problems has shifted from an acute to chronic disease model.Substance use problems are now considered a lifelong process to be managed, similar to how recovery for other chronic health conditions is viewed in mental health (Costello et al., 2020;Dennis & Scott, 2007).The frequency of relapse in recovery from substance use problems further supports the chronic disease model.According to the National Institute on Drug Abuse (2022), about 40%-60% of those with a history of problematic substance use will experience a relapse, comparable to rates of relapse for chronic health disorders such as hypertension and asthma.
Due to its chronic nature, substance use problems have a significant and often negative impact on various aspects of an individual's life.Substance use problems often manifest as failing to meet major obligations at work, school, and home (Di Maggio et al., 2021;Martinson et al., 2021).Specifically, it is important to note the relationship between substance use problems and poor employment outcomes.In the literature, it has been found that substance use problems have been found to increase the likelihood of unemployment and decrease the chance of finding and maintaining employment (Compton et al., 2014;Henkel, 2011).Upon receiving treatment and preparing to re-enter the workforce, there are several barriers to successful work re-integration.These barriers are not limited to but may include a lack of career goals, low self-esteem about work-related abilities, poor social skills, and previous work experience unrelated to desired future employment (Di Maggio et al., 2021;Magura & Marshall, 2020;Martinson et al., 2021).This highlights the paramount importance of attending to the employment trajectories and outcomes of individuals with past substance use problems in order to support the recovery of these individuals.This is especially critical due to the connection between economic disadvantage and increased risk of drug use and death from drug overdose (Nicholson, 2022;Pear et al., 2019).
Despite the pervasive nature of problematic substance use, including previously cited poor outcomes, there stands evidence that recovery from substance use problems is possible.For example, in a nationally representative sample of adults in the United States, 10% of the sample reported a history of substance use problems that they considered to be "resolved" (e.g., no longer problematic; Kelly et al., 2017), and over 75% of adults with a prior substance use problem report being in recovery (Jones et al., 2020).These rates provide promising evidence that although substance use problems are a chronic condition, individuals can reduce their problematic substance use and achieve stable recovery and overall well-being.
The most common outcome measure of recovery is reduction in substance use, with abstinence being the most reported indicator (Costello et al., 2020;Neale et al., 2014).In a broader sense, however, recovery encompasses more than just abstinence.Recovery includes improvements in quality of life, personal health, and citizenship or community (Neale et al., 2014).The American Society of Addiction Medicine (2018) defines recovery from problematic substance use as "an active process of continual growth that addresses the biological, psychological, social, and spiritual disturbances inherent in addiction."The Society recommends that language and terminology be adopted to reflect the ongoing care required to manage the chronic nature of addiction.
Though recovery from problematic substance use is a process that numerous individuals undergo in their lifetime, we know little about the trajectories and outcomes of these individuals in long-term recovery.To date, few attempts have been made to review the existing research on the trajectories and outcomes of individuals in recovery, including their attempts to return to work.A review of the literature on this topic could prove useful in highlighting the recurring themes relevant to positive trajectories and outcomes in returning to work, as well as barriers, plus identify supports that help and hinder the career development of the individual in recovery.While considering how recovery is a unique experience for each individual, the definition of recovery likewise reflects these variations (Best & Nisic, 2022;Costello et al., 2020).This review attempts to highlight the diverse trajectories and outcomes of people who are in recovery from substance use problems, including employment and education.This paper reports on a scoping review conducted by a research team at the University of British Columbia, who consolidated the published research on the career trajectories and outcomes of individuals with a history of substance use who have sustained recovery.The objective of this scoping review is to understand the career and occupational trajectories and outcomes for individuals in recovery; this includes employment rates, experiences of stigma, and success stories.This review also hopes to yield important implications for enhancing practice and research in this area, specifically related to the career processes experienced by individuals in recovery from substance use and the relevant career development theories for this population.

Method
A scoping review was chosen as the framework for this review.Scoping reviews are a type of evidence synthesis that identifies the scope or coverage of a particular topic, providing a broad and detailed overview of the available research (Munn et al., 2022;The Joanna Briggs Institute, 2015).A scoping review allows for identification of the type of research being conducted on the career trajectories and outcomes of individuals in recovery, plus key characteristics of such experiences.For this review, the Joanna Brigg's scoping review protocol was utilized, due to its eminence among scoping review protocols (The Joanna Briggs Institute, 2015).
The key concepts that comprised the basis for this research included addiction, recovery, and career trajectories and outcomes; these concepts informed the development of the research question.At the onset of the review, the research question was, "What literature exists on the career experiences of individuals in sustained recovery from substance use disorders?".However, during the review of the literature, the research question emerged and was revised to be, "What are the career trajectories and outcomes of people in recovery?".

Data Sources and Search Strategy
An initial literature search for articles was conducted in January 2022 in three databases: Medline, PsycINFO, and ERIC.The search strategy was developed with the support of the education research librarian.Search terms included iterations of "substance use," "recovery," and "career" in various combinations, including title, abstract, subject terms, and general searches.

Inclusion Criteria
Study Design.Included were published empirical studies (qualitative, quantitative, and mixed methods), as well as dissertations.Studies had to have been published and accessible in English.The search excluded studies published earlier than the year 2000 and concluded with studies published in January 2022.
Population.The population of interest comprised of individuals who had a history of substance use and who either self-identified or were identified by authors as being in recovery.For this review, "substance use disorder" (SUD) was defined as significant impairment due to the recurrent use of alcohol or drugs, including cannabis, opioids, sedatives, hallucinogens, stimulants, and tobacco (American Psychiatric Association, 2013).Studies included indicated participants had a history of substance use, either by formal definition or self-reported use."Recovery" is understood by the definition from American Society of Addiction Medicine (ASAM, 2018) which includes the following factors: (1) Improved quality of life as identified by the individual; (2) pursuit of abstinence from substances or behaviors that pose a risk in the future; (3) relief from symptoms, including craving; (4) improvement of behavioral control; (5) enrichment of interpersonal relationships and social connectedness; and (6) improvement in emotional self-regulation.In this review, studies were included if they defined their population as being in recovery from an SUD, no longer receiving active treatment for the disorder, and included at least three of the factors from the ASAM definition.
Concepts.The concepts of interest in this scoping review are studies that included career trajectories and outcomes of individuals in recovery.This included but was not limited to employment status, job satisfaction, level of education, income, job discrimination, occupational interests, and work attitudes.

Exclusion Criteria
Abstracts, case studies, and review articles were excluded from this review.Studies that primarily focused on recovery from a co-occurring mental health disorder (i.e., psychosis and bipolar disorder) in addition to substance use were excluded from this study.Studies where participants were identified as being "in recovery" while actively enrolled in a treatment program were excluded, in order to avoid conflating experiences in treatment with experiences of being in general recovery.Similarly, follow-up studies on particular substance use treatment programs were excluded, due to the focus being on lived experiences in recovery rather than program outcomes.Longitudinal studies of individuals with a history of substance use in general were excluded if they did not separate outcomes of individuals in recovery from those in active addiction.

Study Selection
Identified studies based on the search strategy were uploaded into RefWorks and subsequently uploaded into Covidence.Covidence is a screening and extraction tool that streamlines title and abstract screening, full-text screening, and data extraction.Covidence identified and removed duplicates.In Covidence, two reviewers independently screened titles and abstracts for inclusion criteria and made the initial selection of articles to move to full-text review.Next, both reviewers screened the full text of the selected studies for inclusion in the study.Studies were included if both reviewers agreed that they met inclusion criteria.If there were disagreements in whether a study was included, the disagreement was resolved by both reviewers.Then, the reviewers independently extracted the data from the included articles, including publication information, population descriptions, and careerrelated outcomes.The reviewers met to resolve disagreements in the extraction process and subsequently met and agreed on the emerging themes to reduce researcher bias.A quality analysis was not conducted, in line with the scoping review methodology (The Joanna Briggs Institute, 2015).Finally, the reviewers conducted a thematic analysis to uncover major themes, implications, and gaps presented from the review.Evidence from each article was organized into related categories through a memoing process by the first author using an inductive coding and theme development process, working "bottom up" from the data to develop codes (Terry et al., 2017).Codes were developed beginning with the semantic, "surface" level content and later emerged as latent codes of the underlying meaning and concepts present in the literature.The organization of categories and themes was developed in consultation and confirmed by the second author.

Results
The search resulted in 1230 hits (Medline: 641; PsycINFO: 541; ERIC: 48).Removal of duplicates (290) resulted in 939 articles for title and abstract review.A total of 85 were included in full-text review.Thirty-three articles met the inclusion criteria.Forty-three articles were excluded for the following reasons: included individuals in active addiction (20); reported on a specific intervention (15); primary focus was co-occurring mental health disorders (5), not empirical article (e.g., reviews; 2); did not report on career-related outcomes (1).

Study Characteristics
The included studies were published between 2000 and 2022.More than two-thirds of the studies were conducted in the United States (n = 23), followed by the United Kingdom (n = 5), Italy (n = 1), Norway (n = 1), South Africa (n = 1), Zimbabwe (n = 1), and a combined study from the United Kingdom, the Netherlands, and Belgium (n = 1).A total of 41,968 individuals in recovery were included across 14 quantitative, 15 qualitative, and 4 mixed-methods studies, with sample sizes ranging from 3 to 25,349.
Substances represented in this review included alcohol (n = 26), heroin or other opiates (n = 18), cocaine or crack (n = 13), cannabis (n = 12), methamphetamine or other stimulants (n = 8), benzodiazepines or anxiolytics (n = 3), ecstasy or other club drugs (n = 3), tobacco (n = 3), hallucinogens (n = 1), and inhalants (n = 1).Four studies did not specify the substances used by their sample but stated that their population were individuals in substance use recovery; while other studies listed alcohol and "drugs" as the substances used by their sample, rather than specifying the nature of drug use (n = 7).
All 33 studies surveyed adults (≥18 years of age).One study sampled only young adults (aged 18-24; Dawson et al., 2006), and one study sampled only older adults (aged 47-52; Vegeris & Brooks, 2022), while the other 31 sampled individuals from young adulthood (≥18 years of age) to older adulthood, up to age 80 as reported in one study (Drury et al., 2003).Four studies sampled only women (Campagna et al., 2015;Gorvine et al., 2021;Sinakhone et al., 2017;Suiter & Wilfong, 2021), and two studies sampled only men (Hunter & Jason, 2021;Nhunzvi et al., 2019).Of the remaining 27 studies, 11 sampled a majority of men, 3 sampled a majority of women, 7 sampled equally men and women, and 6 did not report the gender identities of their sample.Only 1 study included an "other" option besides male or female for gender (Asabigi, 2009).
Participant time in recovery generally ranged from about one year to over 40 years (Stokes et al., 2018).Almost half of the studies sampled only individuals with a year or more in recovery (n = 15), with four studies sampling those with more than 8 years in recovery (Best et al., 2008;Drury, 2003;Izzard, 2014;Kelly et al., 2021).The remaining studies (n = 18) included some participants with less than one year of recovery, with one outlier study that included participants in recovery for as recent as three days (Crutchfield & Guss, 2019).

Themes: Career Trajectories and Outcomes
The key themes that emerged from the studies fell under two main categories: trajectories, which includes three subthemes: the role of work in early recovery, characteristics of working in recovery, and education and aspirations; and outcomes, which includes two subthemes: employment status in recovery and positive long-term outcomes in recovery.A summary of included studies with country of origin, sample size and description, aim of the study, time in recovery, and career-related trajectories and outcomes of the sample is provided in Table 1.-Diani, 2000;Best et al., 2010;Cebulla et al., 2004;Dawson et al., 2006;Hunter & Jason, 2021;Irish et al., 2020;Laudet & White, 2010;Nhunzvi et al., 2019;Sinakhone et al., 2017;Vegeris & Brooks, 2022;Veseth et al., 2022).Some studies reported that participants felt a sense of urgency to find a job (Alpert-Diani, 2000), while others reported obtaining employment was a high priority (Laudet & White, 2010;Sinakhone et al., 2017).Other studies found participants cited employment as the most important reason for successful recovery (Best et al., 2010;Veseth et al., 2022).The importance of employment to recovery varied by primary substance, as reported by only 21.1% of former heroin users, compared to 44.6% of former alcohol users (Best et al., 2010).In another study, importance of work did not change markedly by length of recovery, though it was mentioned more often by respondents in the 6-18-month group, than those with less than 6 months of recovery.These findings suggest that employment becomes increasingly important after immediate recovery effort is already underway (Laudet & White, 2010).
Reasons explaining why employment was cited as important composed of having the ability to help provide structure and return to a "normal" life pattern (Cebulla et al., 2004), as well as offering an outlet to fill time (Sinakhone et al., 2017), while having the opportunity to establish new roles (Dawson et al., 2006;Vegeris & Brooks, 2022).Dawson et al. (2006) found that employment was a transitional life event in recovery, and that those who initiate recovery within three years of their first full-time employment are more likely to remain in recovery.However, this effect is only applicable for first full-time employment and only within the first three years of initiation.Contrary to these results, two studies did not find that employment was important to successful recovery (Bacchus et al., 2000;Best et al., 2008), with one study reporting that it ranked low on the priorities of those in recovery (Asabigi, 2009).In another study, 76.5% of former heroin users denied that work opportunities were a reason to stop using heroin, and only 29% reported that having a job was a reason for successfully sustaining abstinence (Best et al., 2008).

Subtheme: Characteristics of Working in Recovery
Barriers to Career Development in Recovery.Six studies mentioned barriers to career development in recovery, including difficulty balancing work and recovery, discrimination and stigma, and limited resources (Baldwin et al., 2010;Gorvine et al., 2021;Hunter & Jason, 2021;Irish et al., 2020;Sinakhone et al., 2017;Suiter & Wilfong, 2021).Individuals in recovery experience ongoing struggles and challenges to obtain employment, and there are a variety of barriers which contribute to this struggle (Gorvine et al., 2021;Sinakhone et al., 2017;Suiter & Wilfong, 2021).Studies of women in recovery found that balancing work and recovery was a common theme and required a tremendous level of ongoing effort (Gorvine et al., 2021;Sinakhone et al., 2017;Suiter & Wilfong, 2021).
Three studies mentioned discrimination and stigma as a barrier to employment (Baldwin et al., 2010;Hunter & Jason, 2021;Irish et al., 2020).One study found that persons without a history of substance use had significantly lower rates of job loss in the previous year than persons with a history of SUDs (Baldwin et al., 2010).One study found that men in recovery who were employed reported lower average scores for discrimination than men who were not employed; similarly, men who were unemployed reported feeling that they were treated differently than others due to their substance use, compared to men who were employed (Hunter & Jason, 2021).In the third study, cultural capital (e.g., discrimination and addiction stigma) was found to be a barrier to developing positive physical capital (e.g., employment, income, and transportation) for those in recovery (Irish et al., 2020).
Two studies discussed the limited resources available to individuals in recovery, including low work compensation, a lack of health insurance, and no retirement benefits (Sinakhone et al., 2017;Suiter & Wilfong, 2021).Women in particular reported the barriers they face in employment during recovery including a lack of employment benefits, precarious or unstable work hours, and limited financial resources (Sinakhone et al., 2017;Suiter & Wilfong, 2021).Perception of Self.The connection between perception of self and work was mentioned in 10 studies (Alpert-Diani, 2000;Barbieri et al., 2016;Campagna et al., 2015;Cebulla et al., 2004;Drury, 2003;Eddie et al., 2020Eddie et al., , 2021;;Irish et al., 2020;Stokes et al., 2018;Suiter & Wilfong, 2021).Self-confidence, self-esteem, self-efficacy, and feelings of self-worth were found to increase with gainful employment (Alpert-Diani, 2000;Cebulla et al., 2004;Eddie et al., 2020;Irish et al., 2020), and achievements in career were found to be associated with increases in feelings of self-esteem, as well as improved sense of quality of life and greater amounts of recovery capital (Eddie et al., 2021).Moreover, self-esteem was related to career adaptability (Drury, 2003).Work locus of control (WLC), defined as a construct which predicts employment attainment, satisfaction, and outcomes, was related to the self-esteem of women in sober living homes; this explains for 15.7% of the variance in WLC (Campagna et al., 2015).WLC was also related to age, in that older women had lower scores of WLC, likely due to lifelong experiences with systemic barriers and societal stigma related to their identities as older women (Campagna et al., 2015).
In one study by Cebulla et al. (2004), work appeared to provide a sense of identity to former users.In other studies, work also appeared to offer a sense of purpose and meaning and a general feeling of pride in their accomplishments (Stokes et al., 2018;Suiter & Wilfong, 2021).87.5% of individuals in one study felt that they were responsible employees and upstanding members of their communities (Alpert-Diani, 2000).In one study, women reported fears that they lacked the skills to adequately perform the duties associated with their jobs; at the same time, they reported excitement at the prospect of developing new skills and increasing their work-related knowledge (Suiter & Wilfong, 2021).Lastly, perceiving oneself as being more engaged at work was positively linked to resilience, hope, future time perspective, and performance (Barbieri et al., 2016).
Satisfaction and Quality of Work.The satisfaction and perceived quality of work for individuals in recovery was found to be mixed, with three studies discussing job satisfaction and quality of work (Alpert-Diani, 2000;Cebulla et al., 2004;Suiter & Wilfong, 2021).Work conditions were considered important for the individual's satisfaction and perceived quality of work.Another area considered important for work satisfaction was a strong match between the individual's abilities and their current stage of recovery (Cebulla et al., 2004).Four studies reported on satisfaction in work environments, which had relatively adequate or good incomes (Alpert-Diani, 2000;Hymes, 2015;Sinakhone et al., 2017;Veseth et al., 2022).Compared to other areas of life (e.g., personal healthcare), working lives were described as hands-on, direct, and honest-qualities which were of particular importance to participants in the study by Veseth et al. (2022).Two studies reported on the frustration of individuals in poor working conditions (Sinakhone et al., 2017;Suiter & Wilfong, 2021).Participants in one study, for instance, commented that they struggled in positions that were lower in status than their previous work experiences in active addiction, with only 5% of participants having access to a job that had benefits and adequate pay (Sinakhone et al., 2017).Only 5 out of 19 women in one study reported that they had worked a job that was not a low-wage job, with 15 of the women having a history of engaging in sex work (Suiter & Wilfong, 2021).In one study, former drug users reported more frequently taking up unskilled or semi-skilled work (e.g., retail assistant, cleaning shop security, and barista), while alcohol users aspired to return to the same work they had left due to their addiction (Cebulla et al., 2004).Suiter and Wilfong (2021) found that individuals in recovery reported that their ideal work environment was an environment that supported their health and development and allowed them to participate in the health and development of others, as well as do work that was meaningful and challenging and that they could have some control over their schedules.
Social Support.The workplace emerged as a critical element in the support of individuals in recovery, including via interactions with employers and co-workers.Individuals in recovery reported a need for community, workplace, and household support (Sinakhone et al., 2017).Social support and a sense of community were found in one study to have an indirect positive effect on job performance and work engagement (Barbieri et al., 2016).In another study, men who were employed had significantly higher social support scores than men who were not employed, highlighting the correlation between social support and employment (Hunter & Jason, 2021).
Two studies reported on the positive impacts of the workplace on recovery (Stokes et al., 2018;Suiter & Wilfong, 2021).Stokes et al. (2018) found that a supportive work environment played a major role in sustaining recovery.In the second study, participants in the sample reported excitement about developing relationships with fellow employees when starting work after recovery (Suiter & Wilfong, 2021).Meanwhile, some studies found that workplaces provided more barriers than opportunities for successful recovery.
Six studies reported negative impacts of the workplace and relationships on recovery (Alpert-Diani, 2000; Boeri et al., 2016;Gorvine et al., 2021;Hunter & Jason, 2021;Hymes, 2015;Sinakhone et al., 2017).Some reported that they felt under pressure from their employers once they returned from treatment and had to face their employers and co-workers who knew or suspected why they had taken time off from work, some even choosing to hide their treatment from their family, friends, and employers (Alpert-Diani, 2000; Gorvine et al., 2021;Hunter & Jason, 2021).The majority of men in one study agreed or strongly agreed that they did not need to reveal that they were in recovery to their employer, while one-third of the participants agreed that they would be honest with potential employers about being in recovery (Hunter & Jason, 2021).Some reported that their former workplaces had rampant drug use and that their relationships at work were primarily developed around drugs (Boeri et al., 2016).In this same study, workplaces were reported to not facilitate linking or bonding opportunities for individuals in recovery (Boeri et al., 2016).
Employers were reported to not understand the demands related to recovery (Sinakhone et al., 2017).In some instances, former users wished that their employers would be more receptive to recovering users and appreciate that they had overcome their addiction or were working at overcoming it (Cebulla et al., 2004) and reported a desire to be respected by employers (Suiter & Wilfong, 2021).There was a desire for employers to allow them to continue receiving treatment if necessary during the workday (Cebulla et al., 2004).
Subtheme: Education and Aspirations in Recovery.Of the 33 studies included in the review, 20 studies reported the education level of their sample.The studies varied broadly on how they reported the education level of their participants, with some studies reporting the average years of education (Drury, 2003;Laudet, 2012;Laudet & White, 2010).Most of the education-related information was reported as percentages, but how they reported their percentages differed.Two studies only reported the percentage of participants that had completed high school (Suiter & Wilfong, 2021: 52%;Sinakhone et al., 2017: 90%) and one reported only who had completed college (Eddie et al., 2020: 53%).The variance in reporting methods made a synthesis of the education levels in the studies difficult.
One study reported percentages of those who had completed some education and divided them into three separate groups: not recovered, abstinent recovery, and non-abstinent recovery (Dawson et al., 2006).They found that those with abstinent and non-abstinent recovery had higher percentages of individuals who had completed some education (90.9% and 88.7%, respectively) than those who were not recovered (79%).
Eight studies mentioned the role of education in relation to work and recovery (Alpert-Diani, 2000; Cebulla et al., 2004;Eddie et al., 2020Eddie et al., , 2021;;Hymes, 2015;Laudet, 2012;Laudet & Hill, 2015;Laudet & White, 2010).To start, two studies found that being employed was associated with a higher level of education (Eddie et al., 2020;Laudet, 2012).One study reported that education buffered against employment risk (Eddie et al., 2020).Two studies reported that sustained recovery was associated with efforts to further education, either due to needing to relearn knowledge that was forgotten or to learn new advances in their fields (Alpert-Diani, 2000;Hymes, 2015).There were varied reports of individuals pursuing education in recovery, with percentages ranging from 16.8% (Eddie et al., 2021) to 78.1% (Laudet & Hill, 2015).The participants in one study reported that training and credentials were essential to securing job stability and the potential for career advancement in recovery (Hymes, 2015).
Career Aspirations in Recovery.Five studies reported on the career aspirations of individuals in recovery (Cebulla et al., 2004;Hymes, 2015;Laudet & White, 2010;Suiter & Wilfong, 2021;Veseth et al., 2022).Three studies mentioned that participants expressed aspirations of working in the field of addictions recovery (Hymes, 2015;Laudet & White, 2010;Stokes et al., 2018).In a study of peer recovery coaches, there were contrasting views regarding desired career trajectory; however, there was a consistency in progressing toward better work opportunities in the future (Hymes, 2015).Despite this, the type of work described in these studies was diverse and reflective of diverse resources and interests.The kinds of work reported included retail, politics, sciences, trades, hospitality, social services, and teaching (Veseth et al., 2022).In one study, none of the participants (all women) reported desires to become wealthy, famous, or highly influentialinstead, they reported the importance of being able to support themselves and their families (Suiter & Wilfong, 2021).
Three studies reported on employment disparities in minority groups.Larger employment disparities were found to be reported among those in marginalized populations, including for Black or Hispanic participants, and women (Baldwin et al., 2010;Eddie et al., 2020;Laudet, 2012).One study found that an individual's primary substance had an impact on employment status.Individuals who reported alcohol as their substance of choice were more likely to be employed than individuals who reported that cannabis or amphetamine were their substance of choice (Eddie et al., 2020).One study found that age was associated with employment status; younger age predicted greater likelihood of employment (Laudet, 2012).One study found that individuals who identified as being in substance use recovery beginning in young adulthood (18-29 years old) were more likely to be employed than those who identified as being in substance use recovery beginning in older adulthood (age >30 years).This finding did not change when considering the age of the individuals at the time of the research study (Kelly et al., 2021).

Subtheme: Positive Long-Term Outcomes in Recovery
Time in Recovery and Positive Career Outcomes.Eight studies found that time in recovery was associated with positive career outcomes, including employment (Asabigi, 2009;Crutchfield & Güss, 2019;Dawson et al., 2006;Drury, 2003;Eddie et al., 2020Eddie et al., , 2021;;Laudet & Hill, 2015;Martinelli et al., 2020).However, the strength of the reported relationships varied, with weak correlations reported by some (Asabigi, 2009) and strong correlations reported by others (Eddie et al., 2020).An active occupational situation, referring to individuals with obtained employment or education, was found to be more common in later recovery stages (Martinelli et al., 2020).One study found that individuals had higher incomes once they left sober living homes (Jason et al., 2009).
Another study found that career adaptability was correlated with time in recovery and selfesteem (Drury, 2003).However, this relationship was not found in three studies (Drury, 2003;Hunter & Jason, 2021;Laudet, 2012).In one study, substance use indicators such as lifetime severity of use, past year use, and abstinence duration were not statistically significant predictors of employment status (Laudet, 2012).Additionally, some studies found no significant differences between individuals who were unemployed and the time spent in recovery (Hunter & Jason, 2021).One study found that participants in earlier stages of career development were typically earlier in recovery time (Drury, 2003).
Career Achievements in Recovery.Three studies reported on the self-improvements and career achievements of individuals in sustained recovery (Crutchfield & Güss, 2019;Eddie et al., 2021;Laudet & Hill, 2015).One study found that one's self-improvement was correlated with the number of years in substance use recovery (Eddie et al., 2021), and vocational/educational achievements were a significant predictor of days in recovery (Crutchfield & Güss, 2019).Since starting recovery, 26% of one sample reported that they had gotten a new job and 15.5% had received a promotion in their old job, with 80.1% of the sample reporting at least one achievement in a life domain (Eddie et al., 2021).Additionally, one's self-improvement was positively correlated with beginning substance use earlier in life.However, it was not associated with demographic characteristics (e.g., gender and ethnicity), mental health history, substance use treatment completion, or 12-step affiliation or attendance (Eddie et al., 2021).One sample reported that 82.5% had received positive job-related performance evaluations (Laudet & Hill. 2015).Laudet and Hill (2015) found significant differences in life experiences between individuals in recovery who sought treatment for substance use compared to those who had not sought treatment.The differences were found to be the most pronounced in their employment trajectories and outcomes during active problematic substance use compared to during recovery.For example, individuals who did not receive treatment for their substance use had better employment outcomes while they were still in active substance use than individuals who received treatment, which likely reflects the severity of substance use problems (i.e., individuals with less severe substance use are less likely to receive treatment).However, the group of treated individuals made significant employment-related gains during substance use recovery, making up the difference apparent during active use.The only statistically significant difference was the greater percentage of untreated individuals who started a business after beginning recovery, relative to their treated counterparts.In the no treatment group, 9% restored their occupational or professional license, compared to 19.4% in the treatment group.Only 10% reported being fired/suspended at work, compared to 50.9% in active problematic substance use, and merely 4.4% reported frequently missing work or school, compared to 61.1% in active problematic substance use.As few as 1.4% reported losing an occupational license, and 3.5% reported dropping out of school, which is significantly less than those in active problematic substance use (Laudet & Hill, 2015).

Discussion
To date, this review presents an overview of the key themes across studies focused on the careerrelated trajectories and outcomes of individuals in recovery from substance use.The key themes that emerged from the studies fell under two main categories: trajectories, which included three subthemes: the role of work in early recovery, characteristics of working in recovery, and education and aspirations in recovery; and outcomes, which included two subthemes: employment status in recovery and positive long-term career outcomes in recovery.This review is the first of its kind to synthesize the research on individuals in recovery and their career-related trajectories and outcomes, as well as provide insight into the struggles and achievements experienced by this population.
Overall, the literature suggests that many people with a history of problematic substance use experience a negative impact on their working lives (Boeri et al., 2016;Burton, 2013;Cebulla et al., 2004;Izzard, 2014;Laudet & Hill. 2015;Nhunzvi et al., 2019;Veseth et al., 2022).These results fit within the dominant narrative of negative career outcomes for those with a history of substance use (Di Maggio et al., 2016;Martinson et al., 2021).These negative experiences include being fired, frequently missing work, losing professional licenses, dropping out of school, and low employment rates (Laudet & Hill, 2015).These career difficulties do not appear to end once the recovery process begins, with many people in recovery reporting that they are unemployed or unable to work due to disability, often due to the physical and psychological impacts of substance use (Asabigi, 2009;Bacchus et al., 2000;Cebulla et al., 2004;Eddie et al., 2020;Gorvine et al., 2021;Laudet, 2012;Laudet & White, 2010;Martinelli et al., 2020).Other difficulties reported included the struggle to balance returning to work and recovery needs, discrimination and stigma, plus limited resources (Baldwin et al., 2010;Gorvine et al., 2021;Hunter & Jason, 2021;Irish et al., 2020;Sinakhone et al., 2017;Suiter & Wilfong, 2021).With a few exceptions (Asabigi, 2009;Bacchus et al., 2000;Baldwin et al., 2010;Best et al., 2008;Laudet, 2012), work was reported to be a critical aspect to beginning and sustaining recovery, and improvements in work were associated with longer time in recovery in a majority of the studies.Providing structure and new roles during the transition into recovery was one reason why work was cited as being important for participants.Surprisingly, financial reasons were not often listed as the primary reason why work was important to recovery, although some studies mentioned financial barriers as issues in early recovery.This suggests that a good job provides more than just financial benefitsit provides a sense of purpose and meaning to life that was otherwise preoccupied by substance use.Employment takes space and occupies time, leaving less time to act on cravings or associate with substance-using peers.However, some studies did not find that employment was a priority in early recovery and even was denied as being important to recovery by some (Best et al., 2008).There was also significant support for the relationship between employment and recovery, with the majority of studies finding that length of recovery was associated with employment.Good or better employment was reported to increase as time in recovery increased (Alpert-Diani, 2000), and educational/vocational achievement was correlated with time in recovery (Crutchfield & Guss, 2019).This could also be explained by the fact that individuals with longer times in recovery could likely not be in the workforce due to retirement or disability (Eddie et al., 2020).Nonetheless, other studies did not find that individuals with longer lengths of time in recovery were in the establishment stage of their career, implying that not everyone in early recovery is necessarily in the early stages of their career development (Drury, 2003).
It seems evident that the career processes which are important to navigating the career challenges experienced by individuals in recovery are career adaptability and career self-efficacy.Career adaptability is widely considered an essential trait as modern careers become increasingly uncertain and subject to change (Borgen & Edwards, 2019), but career adaptability appears especially important for individuals in recovery.Adaptability was only explicitly studied by Drury (2003), but the theme of adaptability emerges from the accounts of people in recovery.For example, Laudet and Hill (2015) reported that 19.4% of individuals who received substance use treatment restored their occupational or professional license in recovery, demonstrating the need to be adaptable and resilient in the face of career challenges.Adaptability is key to recovering from career challenges faced by substance use.Related to career adaptability is the need for career selfefficacy (e.g., one's belief in the ability to successfully perform tasks and achieve goals related to their career outcome).It seems likely that individuals in recovery have low career self-efficacy after experiencing setbacks in their careers due to substance use.In the literature from this review, career self-efficacy was consistently related to increases in gainful employment (Alpert-Diani, 2000;Cebulla et al., 2004;Eddie et al., 2020;Irish et al., 2020).Individuals with increased career adaptability and career self-efficacy appear more likely to remain resilient in the face of career barriers posed by their previous substance use.
Although adaptability and self-efficacy are likely important to foster successful return-to-work outcomes, there are clear systemic barriers that hinder the career trajectories and outcomes for individuals in recovery, namely discrimination and lack of career resources.Discrimination may result in a lack of career choice, and the necessity to attend substance use treatment can result in significant employment-related gaps.One framework that could be used to understand systemic barriers faced by individuals in recovery is the Psychology of Working Framework (PWF; Blustein et al., 2008).Unlike traditional career choice theories, which have been criticized for being primarily applicable to upper-or middle-class and privileged individuals pursuing traditional career paths and possessing the necessary resources to develop and execute their career plans, PWF emphasizes the career development needs of individuals whose work experiences have been predominantly characterized by survival (Blustein et al., 2019;Cadenas & McWhirter, 2022).The core assumptions of PWF are supported by the literature in this review, including that work is an essential aspect of life and component of mental health (e.g., recovery) and that work fulfills the fundamental human needs of survival, connection, and self-determination (Blustein et al., 2008).The need for self-determination was highlighted by the study by Suiter and Wilfong (2021), in which the participants emphasized that work was important in being able to support themselves and their families but did not emphasize the desire for wealth or fame.In PWF, an emphasis is placed on decent work, which includes physically and interpersonally safe conditions, hours that allow for free time and rest, organizational values that complement family and social values, and adequate compensation and access to healthcare (Blustein et al., 2008).Decent work was implicated in the literature in this review under Theme 1, focusing on the characteristics of the work in recovery, which was often reported as including poor working conditions and low wages with limited access to healthcare (Sinakhone et al., 2017;Suiter & Wilfong, 2021).Duffy et al. (2016) proposed the Psychology of Working Theory (PWT) in tandem with the PWF, arguing that social and economic factors are the forefront of securing decent work.According to PWT, proactive personality, critical consciousness, social support, and economic conditions moderate the paths from economic constraints and marginalization to volition, adaptability, and decent work.From this review, social support emerged as crucial to gaining employment, job performing, work engagement, and sustaining recovery in work for many (Barbieri et al., 2016;Hunter & Jason, 2021;Sinakhone et al., 2017;Stokes et al., 2018;Suiter & Wilfong, 2021).A lack of social support was discussed as negatively impacting the working lives of people in recovery (Alpert-Diani, 2000;Boeri et al., 2016;Gorvine et al., 2021;Hunter & Jason, 2021;Hymes, 2015;Sinakhone et al., 2017).To our knowledge, the PWF has yet to be deductively tested with individuals in recovery.However, it has been recently applied as a framework for a qualitative exploration of the working lives of veterans with co-occurring mental health and substance use (Stevenson et al., 2023), showing promise for future research on PWF and individuals in substance use recovery.

Limitations
There are several notable limitations both in the included studies and in the current research design.Of the 33 studies, 23 were conducted in the United States.Only two studies were conducted in countries outside of the United States or Europe (both from Africa; Nhunzvi et al., 2019;Stokes et al., 2018), and no studies were found available in English from Asia or South America.As a result, the themes and findings may not be applicable when considered on an international scale.The employment statistics and career trajectories and outcomes may also differ for individuals in recovery from non-Western countries, and the conceptualization of successful recovery may be different for individuals from non-Western countries, including refugees and immigrants with histories of substance use.
Secondly, the definition of recovery used in this study included abstinence from substance use.However, there is a substantial disagreement on how to measure recovery and whether abstinence is a key outcome indicator of recovery (Neale et al., 2014).Several studies have been conducted to evaluate whether the definition of recovery can be extended to individuals with alcohol use disorder who still consume alcohol (Witkiewitz et al., 2019(Witkiewitz et al., , 2020;;Witkiewitz & Wilson, 2021).Two latent profiles of high functioning individuals emerged (heavy drinkers and infrequent nonheavy drinkers), both with high levels of psychological functioning regardless of their level of alcohol consumption (Witkiewitz & Wilson, 2021).These results challenge whether or not only individuals who achieve total abstinence can consider themselves to be "in recovery" and whether the results of this scoping review are applicable to individuals with non-abstinent recovery.As such, due to the unique experience that is recovery and the multiple pathways in which individuals achieve recovery (Best & Nisic, 2022), the trajectories and outcomes highlighted in this review may not apply to every individual in recovery and perhaps do not encompass all trajectories and outcomes of individuals in recovery during the course of their career development.Studies in this review also had varied criteria for defining recovery, with individuals in one study only having three days of recovery time (Crutchfield & Guss, 2019).One would anticipate that the career trajectories and outcomes of individuals with three days of recovery time are likely different from those with more than 40 years of time in recovery, and therefore the overarching trajectories and outcomes presented in this review may not be applicable to individuals at different points in their recovery journey.
Lastly, this review did not include articles that were career intervention studies, due to a desire to provide an overview of individual trajectories and outcomes in recovery, rather than reporting on the effects of specific interventions on employment trajectories and outcomes.For this reason, this review cannot identify whether specific treatments improve or hinder employment and career trajectories and outcomes.With regards to this current review, a scoping review methodology does not include a quality analysis of the studies included.Therefore, the quality and rigor of the methodologies of the included studies was not examined.As research is continued to be conducted in this subject area, a systematic review would elucidate the quality of the research being conducted.Future researchers should consider a systematic review of the research as the literature in this area continues to develop.

Implications and Recommendations for Future Research
The current review examined the trajectories and outcomes of individuals in recovery from problematic substance use in relation to their work and careers.The themes discussed in the review provide a greater understanding of the career development difficulties experienced by individuals in recovery as well as their successes and strengths.
Future research would benefit from looking at specific career-related constructs for individuals in recovery, specifically career adaptability and career self-efficacy.The majority of included studies did not include standardized measures of employment outcomes and often assessed for employment by asking whether the participant was employed with a "yes" or "no" question.Only three studies in this review included standardized measures of career assessment: the Adult Career Concerns Inventory (Drury, 2003); the Work Locus of Control Scale and Barriers to Employment and Coping Efficacy Subscales (Campagna et al., 2015); and the Work Climate Questionnaire and Utrecht Work Engagement Scale (Barbieri et al., 2016).Future studies would benefit from including validated career assessment psychometric measures, two examples of which include the Career Adapt-Abilities Scale (Savickas & Porfeli, 2012) and the Career Decision-Making Self-Efficacy Scale (Betz & Luzzo, 1996).In addition to utilizing standardized career measures, future research would benefit from utilizing modern career theories (such as the Psychology of Working Theory; Duffy et al., 2016) as a lens to guide the development of research questions and methods, as well as potential career interventions for individuals in recovery.
There also emerged a lack of consensus on what constitutes "career success" beyond employment.Future studies could explore further the concept of career success for individuals in recovery, including the broader concept of quality of life and well-being as a way of measuring career success.There is also a need for vocational research with specific subpopulations of individuals in recovery, including individuals with comorbid physical and mental health disorders, specific ethnic groups, members of the LGBTQIA+ community, and women.Most of the research conducted has been done with men, with a particular sub-focus on men in the criminal justice system.SUDs are diagnosed among all groups of people, regardless of racial, gender, religion, or cultural background (Richardson & Epp, 2016), and therefore the focus of research should include these individuals and the ways in which their career development is impacted by their SUD.This review included a mix of qualitative and quantitative studies, with fewer studies that focused on mixed methods designs (n = 4).Future researchers may consider the benefits of utilizing both quantifiable and subjective data.The qualitative studies in this review provided a rich depth of information on the lived experiences of individuals in recovery, while the quantitative research validated these findings as they applied to a wider number of participants.
Recurring messages surrounding difficulty interacting with co-workers and supervisors during treatment and upon returning to work were raised, with evidence that social support from supervisors is key to early recovery success also being highlighted (Barbieri et al., 2016).This has implications for employers, supervisors, and policy makers who seek to make the pathway back to work more accessible for individuals in recovery.A policy that encourages employers to hire individuals in recovery and provide support to them in the workplace is the Recovery Friendly Workplace Initiative (Bernstein, 2018).It is a program that was developed by the state government of New Hampshire, with 30 states and one province in Canada having registered to become a part of the Recovery Friendly Workplace Community of Practice (Bernstein, 2018).This initiative encourages businesses and employers to adopt policies and practices that support employees in recovery from SUDs.Another example is The Colorado Consortium for Prescription Drug Abuse Prevention, which developed a toolkit for workplaces interested in the initiative.This involves an assessment of the organization's current health and safety practices regarding SUDs and implementation of recovery-friendly practices, while also maintaining an open dialog about substance use problems, reducing gossip, protecting dignity, changing the language used to discuss addiction, and treating SUDs as a health condition.When considering individuals in recovery during the hiring processes, an organization should also be creating wellness programs, being alcohol-conscious, participating in recovery-focused community events, and building a working relationship with recovery organizations (Colorado Consortium, 2022).These kinds of initiatives directly respond to the call from employees in recovery for greater understanding, patience, and support from their employers as they continue the process of recovery from SUDs.
The evidence found by the studies in this review provides an initial understanding of the broad impacts of substance use recovery on career development.It is imperative that future research acknowledge the areas that can be expanded upon as noted in this review and continue to engage in research with this population of individuals, in particular the subgroups who have been understudied in the literature and marginalized by society.

Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Table 1 .
Final Included Studies (n = 33) and Career Trajectories and Outcomes.

Table 1 .
(continued)Theme 1: Career Trajectories in Recovery Subtheme: Centrality of Work to Recovery.Eleven studies discussed the centrality of work to the recovery process (Alpert