Everyone agrees the opioid crisis is a problem, but the number of proposed solutions is virtually without end. Among the most common refrains is that wage labor should be an avenue of recovery for those with opioid use disorder. As a Washington Post reporter recently argued, a steady job can give recovering people not only an income and health insurance but also more abstract benefits like “meaning,” “purpose,” and “the sense of being part of a team.”1 But does work actually work? Its role in recovery has often been unclear. Can wage labor help someone recover, or is it a measure that someone is in recovery? Historically, the connection between work and recovery has been counterproductive when its primary focus is the demands of the market, not the needs of the person.
During the 1970s, America battled another opioid crisis — heroin.2 A large component of that earlier struggle was the use of methadone maintenance, a precursor to today’s medication-assisted treatment (MAT), which prescribes methadone or buprenorphine to treat individuals with substance use disorders through substances that will mitigate withdrawal while allowing them to function day-to-day. Politicians often oversold methadone as an easy solution to complex public health and societal issues, including crime. By doing so, methadone’s effectiveness became measured not necessarily by its effects on the health of patients, but by whether there was a reduction in urban crime. This illogical and unrealistic benchmark set methadone up to fail, and set the stage for the return of punitive approaches to people who used drugs during the 1980s.3
1970s New York. Not its best look. (Camilo J. Vergara, “Honeywell at 178th St. S. Bronx, 1970,” Library of Congress.)
Proponents of methadone also believed that its use would enable heroin users to get and keep jobs. A 1970s U.S. federal government manual on methadone maintenance claimed that those addicted to heroin couldn’t hold down a job, but “a methadone patient, in contrast, can and often does get and hold a job. The result can be a stabilization of his whole life pattern.”4 Without this stabilization in wider society, many officials feared former addicts would slide back into drug use. At a 1974 New York conference on drug use and the workplace, one prominent banker argued that “we must accept the doctrine that an ex-addict without employment is an ex-addict without cure.”5 In practice, however, merging work and recovery proved complicated.
In the 1970s, just as now, people living with and recovering from substance use disorders faced prejudice and mistreatment at the hiring stage and in the workplace itself. There were no legal protections against being fired or not hired because of receiving methadone treatment. At a 1973 national conference on methadone, Joan Randall (a patient advocate and co-chair of the Methadone Coalition for Equal Opportunity) called out employers like Macy’s and the New York City Transit Authority for their refusal to hire methadone patients, although she claimed they were already employing hundreds of methadone patients they didn’t know about.
Nurse dispensing methadone medication (Warren K. Leffer, 1971, Library of Congress).
In contrast, some New York firms did make special efforts to hire methadone patients, including Citibank and Chemical Bank. Randall charged, however, that many “liberally oriented” employers were only hiring methadone patients on a token basis and subjecting them to employment discrimination, including longer probationary periods at lower pay and more drug testing.6
Treatment programs and employers themselves were also often dissatisfied with these initiatives. The summary of the aforementioned 1974 conference on drug use in the workplace reported as such. Those on the treatment side thought employers were reluctant to give patients a chance. Employers thought the treatment people underestimated what it took to be ready to hold a job. It was a vexing question: what exactly were workplace programs for? Was a job part of someone’s treatment or an aspect of a new, recovered life? Conference participants were divided: “The concept of on-the-job readiness is simultaneously simple and elusive. There is a tendency for employers to want cured applicants while the treatment programs may view work as part of the rehabilitative process.”7
In 1971, the New York City criminal justice reform–centered Vera Institute launched Pioneer, a program of supported work to help people with addiction issues or criminal records get and retain employment. It viewed work as a supplement to recovery, not recovery itself. Pioneer was quickly renamed Wildcat; as wildcatters looked for oil in unpromising locations, so the program searched for human potential “among those whom society would deem incapable of being productive.”8 Federal grants and waivers got the program going, but it would largely support itself through city contracts for services and direct grants. In Wildcat, participants worked together in crews, and the focus was on building job readiness, not specific workplace skills. It ran a messenger service, landscaping and cleaning crews and more surprising work placements: banks, off-track betting offices, and even the evidence rooms at police stations. For Valentine Lopez, a recovering addict and Wildcat supervisor, this meant “after so many years running from [police], there we were right in the middle of them.”9
Two Wildcat workers (Manpower Magazine).
Controlled studies showed that Wildcat participants, over time, were more often employed and more likely to be supporting families, although it is not clear whether supported work affected drug and alcohol use. Notably, money invested in Wildcat returned $1.25 in labor value, taxes on economic activity, and reduced incarceration, for every public dollar invested.10 A magazine piece on the program pointed out that Lopez had “his own kind of bookkeeping: ‘Before this I was 12 years on drugs. Now I’m working. Now I can go home at night to my family. I pay taxes. I’m self-supporting. I love Wildcat.’”11
Wildcat’s approach had its critics though. The Methadone Coalition for Equal Opportunity released a statement claiming supported work programs “create[d] the image of a handicapped population, incapable of competing in the labor market.”12
Wildcat worker (Manpower Magazine).
Criticism like that shortsightedly rejected the possibility for solidarity with the Americans with disabilities. Another critique of supported work programs like Wildcat is that they focused on people who used drugs who had not been able, for whatever reason, to get or keep jobs. It offered little to those workers who were able to maintain employment while still using drugs, but faced negative consequences to their health or career if their drug use continued or was discovered.13 Despite the criticisms, Wildcat survived, and still works with thousands of New Yorkers annually.
For methadone patients, however, and others recovering from substance dependence, programs such as Wildcat were rare. Fear and stigma endured, and even increased during the Reagan administration. The consequences have been deadly. A 2017 Vox article claimed that despite strong evidence of MAT’s effectiveness, it remains underused in large part because of the belief that it is just a different form of addiction. Drug and alcohol historian William White similarly argued that “the person enrolled in methadone maintenance has never received full status as a ‘patient,’ and the methadone clinic has yet to be viewed as a place of healing on par with hospitals or outpatient medical clinics.”14
In my research, I am investigating what role employers may have played in the stigmatization of MAT. Did a desire for “clean” employees mitigate against MAT being used to its full potential? Certainly, restrictions on where patients can use medication, and how much medication they can receive at a time, have been onerous and placed recovery and employment at cross-purposes for too many. Substance abuse policies and politics are usually presented as arising between governments and citizens. I have found, however, that employers played a far larger role than most people think in determining what is defined as addiction, how people are identified as having a problem, what kind of treatment people receive, and what is defined as recovery.
Today, people using drugs and recovering from drug use remain a vulnerable, stigmatized population whose labor is easily exploited. This leads to employment abuse, recently exposed by Reveal’s reporting on the malfeasance of groups like Christian Alcoholics and Addicts in Recovery, who put people to work at a dangerous chicken plant and stole their pay; and Recovery Connections of North Carolina, who placed recovering people in nursing homes, working 16-hour days with no training and no actual rehabilitative treatment.15
Like Wildcat and the Methadone Coalition For Equal Opportunity, many organizations today like Retrofit Careers and Recovery Friendly Workplace are addressing the workplace barriers facing recovering people.16 The complicated history of the workplace as a recovery plan teaches us that we always need to ask what purpose the work experience is supposed to serve for recovering people, and remember that their best interests must always come first.
- Lenny Bernstein, “One Of The Biggest Challenges of Kicking Addiction Is Getting and Keeping A Job,” Washington Post, Nov. 27, 2018.
- See Eric Schneider, Smack: Heroin and the American City (Philadelphia: University of Pennsylvania Press, 2008); Claire Clark, The Recovery Revolution: The Battle over Addiction Treatment in the United States (New York: Columbia University Press, 2017); Julilly Kohler-Hausmann, “‘The Attila the Hun Law’: New York’s Rockefeller Drug Laws and the Making of a Punitive State,” Journal of Social History (Sept. 2010): 71–96.
- Claire Clark, “Chemistry Is the New Hope: Therapeutic Communities and Methadone Maintenance, 1965–1971,” Social History of Alcohol and Drugs (Summer 2012): 192–216.
- U.S. Department of Justice, Methadone Treatment Manual (Washington: US Government Printing Office, 1973), 3.
- “Drug Use Among Workers: Developing Policies and Guidelines,” Box 42.1, File 61, Harrison Trice Additional Papers, Kheel Center for Labor-Management Documentation and Archives, Cornell University, Ithaca, N.Y., 13.
- Joan Randall, “Employment Description of the Methadone Patient,” 5th National Conference on Methadone Treatment (March 1973): 52–55; L. Robert Ciotta, “Employment Discrimination Against the Methadone Maintained Individual: The New York Experience,” 5th National Conference on Methadone Treatment (March 1973): 49–51.
- Randall, “Employment Discrimination,” 53; “Drug Use Among Workers,” 28, 54.
- Timothy Larkin, “Wildcatting on the Sidewalks of New York,” Manpower (Feb. 1974): 3–9.
- Samuel Roberts, A Kind of Genius: Herb Sturz and Society’s Toughest Problems (New York: Public Affairs, 2009), 130–155; Larkin, “Wildcatting,” 6.
- Vera Institute of Justice, “Employment Patterns of Ex-Addicts: Impact of Supported Work on Long-Term Employment” (1976), 30–32; Roberts, A Kind of Genius, 135–136.
- Larkin, “Wildcatting,” 9.
- Ron Bayer, “Confronting Discrimination Against Methadone Patients: Statement by the Methadone Coalition for Equal Opportunity,” 5th National Conference on Methadone Treatment (March 1973): 1423.
- “Drug Use Among Workers,” 51.
- William White, “Long-term Strategies to Reduce the Stigma Attached to Addiction, Treatment, and Recovery within the City of Philadelphia” (Philadelphia: Department of Behavioral Health and Mental Retardation Services, 2009).
- Amy Julia Harris and Shoshana Walter, “They thought they were going to rehab. They ended up in chicken plants,” Reveal, Oct. 4, 2017.
- Harris and Walter, “They thought they were going to rehab”; Recovery Friendly Workplace, “Initiative”; Nina Feldman, “New Job Hope for Adults in Drug and Alcohol Recovery,” NPR, Dec. 16, 2018.
