The goal of this clinical trial is to evaluate whether an integrated medico-psychosocial vocational support program (ADD'Pro) can improve employment outcomes in adults with substance use disorders receiving care at a specialized addiction day hospital.
The main question it aims to answer is:
\- Does participation in the ADD'Pro program increase the rate of competitive employment (at least one day worked in the open labour market) at 6 months compared to standard employment services?
Researchers will compare participants enrolled in the ADD'Pro program to participants referred to conventional employment services (France Travail or Cap Emploi) to see if structured, dual medico-psychosocial support leads to higher rates of vocational reintegration, better employment preparation, improved quality of life, and reduced physiological stress reactivity.
Participants will:
* Be randomly assigned to either the ADD'Pro program or standard employment services * If assigned to ADD'Pro: receive immediate individualised support from a vocational counsellor (CIP) at the CeCler Association, running in parallel with their hospital addiction care, with no fixed end date * If assigned to standard care: be referred to conventional employment services with monthly follow-up interviews at the hospital, and the option to join ADD'Pro after 6 months * Complete structured interviews and validated questionnaires at inclusion, 3, 6, and 12 months * A sub-sample of up to 50 participants will additionally take part in a simulated job interview stress test (adapted TSST) with salivary biomarker collection and heart rate monitoring at inclusion and 6 months
Adult of working age (18 years or older)
Diagnosed substance use disorder receiving medical care
Unemployed or on sick leave with a vocational reorientation project
Motivated to work in the competitive labour market
Medical care provided under a court-ordered treatment obligation
Previously included in the ADD'Pro program
Residing outside the Puy-de-Dôme with no plan to work in the department
Under legal guardianship (tutelle, curatelle, or sauvegarde de justice)
Parallel
ADD'Pro Program
BehavioralADD'Pro is a structured medico-psychosocial vocational support program delivered in four phases: (1) a group awareness workshop on employment held at the addiction day hospital (HDJA); (2) a comprehensive individualised vocational assessment covering professional history, aspirations, barriers, and work readiness; (3) active dual support combining ongoing addiction care at the HDJA with personalized accompaniment by a vocational counsellor (CIP) from the CeCler Association, including job search preparation, employer outreach, workplace immersions, and skills development; (4) open-ended post-placement follow-up by the CeCler Association with no fixed end date, continuing beyond the hospital care period. Coordination between the clinical and vocational teams is ensured by a dedicated psychologist-doctoral researcher through regular joint meetings. The program runs in parallel with standard addiction care and is initiated from the patient's first care sequence at the HDJA.
Standard Care (in control arm)
BehavioralParticipants assigned to the standard care arm are referred to conventional employment services available under French law: France Travail (formerly Pôle Emploi) for general job seekers, or Cap Emploi for individuals with disabilities. Registration with the relevant service is facilitated at the HDJA if not already completed. Participants receive the employment support services routinely provided by these organizations, without any additional vocational guidance from the ADD'Pro program or the CeCler Association. In parallel, monthly follow-up interviews are conducted at the HDJA by a member of the research team to monitor employment-seeking activities and collect study outcome data. Standard addiction care at the HDJA continues unchanged throughout the study period. Participants in this arm have the option to access the ADD'Pro program after the 6-month primary endpoint assessment.
Rate of competitive employment (at least 1 day worked in the open labour market, expressed as a percentage)
Number of individual sessions with a vocational counsellor
Number of telephone sessions with a vocational counsellor
Number of group workshops attended
Number of workplace immersions
Job placement adequacy
ob placement adequacy will be assessed through a structured qualitative evaluation of the alignment between individual job preferences, competencies, and employment outcomes. This evaluation will be conducted by the investigator, a member of the research team, and/or a vocational integration counsellor using predefined criteria, including job type, skill match, and consistency with the participant's initial vocational goals. Assessments will be performed at 3, 6, and 12 months.
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