Executive summary 

This report explores the labour market integration in the Nordic countries of individuals with substance use problems (including alcohol, illicit drugs, and prescription medications). The remit covers Denmark, Finland, Greenland, Iceland, Norway, and Sweden. While labour market integration of vulnerable groups has received significant attention in the Nordic region, there is a dearth of research focusing exclusively on individuals with alcohol and substance use problems. The primary aim of this report is to share Nordic experiences and foster a deeper understanding of the integration of these individuals. Specifically, the report seeks to identify successful methods and interventions for labour market integration and to single out lessons for organising and delivering these services. The report addresses several key research questions, including labour market intervention regulations, service organisation, and specific integration interventions in each jurisdiction. These dimensions guide the country profiles.

Individuals with substance use problems are defined as struggling to be included in the labour market due to their substance use, whether or not they have a formal diagnosis and whether or not they are currently in treatment. While not traditionally classified as a disability, substance use problems can significantly impact daily life and working capacity.

Methodologically, the report employs a mix of approaches, including literature reviews, legal statute analysis, expert knowledge, practitioner insights, and interviews with key informants. We acknowledge in the absence of a systematic literature search that the interventions discussed are not exhaustive. To facilitate the analysis, we have used a case-oriented comparative approach, delving deeply into select cases to uncover commonalities and distinctions among the Nordic countries. The objective is to unveil core themes, mechanisms, and factors influencing the labour market integration of individuals with alcohol and substance use problems, and to identify successful interventions and organisational settings for service delivery in this context.

The analysis showed that while statutory rights to employment services are indeed extended to individuals with substance use problems in all Nordic countries, specific rights tailored to their unique needs are lacking. Despite the aim of providing comprehensive and personalised services, fragmentation issues persist in most Nordic countries, hindering effective assistance to this vulnerable group’s labour market integration. Reforms in Nordic countries have aimed to address fragmentation, enhance service comprehensiveness, and personalise services. A primary consequence of these reforms has been an increased emphasis on welfare conditionality: for individuals to receive benefits or services, they need to fulfil certain behavioural or activity requirements. The effectiveness of welfare conditionality measures remains debated, particularly concerning individuals with substance use problems. Thus, the authors recommend cautious implementation of such measures when applied to individuals with problems of substance use.

Despite the reforms’ intended goal of enabling a more comprehensive service approach, there are persistent challenges related to fragmentation among service providers. Effective coordination is crucial for the labour market integration of individuals with substance use problems. While evaluations of Norway’s NAV reform (integration of several service institutions) have yielded mixed results, they indicate that one-stop shops can be a step in the right direction. Nonetheless, comprehensive services vary, and further research is needed to determine effective approaches for their implementation.

Privatisation of employment services has emerged as a significant trend in the Nordic countries, contesting the traditional welfare model. Some Nordic countries, such as Sweden and Denmark, have embraced privatisation, but others, such as Norway, Finland, Iceland, and Greenland have maintained a stronger focus on public control. The involvement of private providers has sparked debates regarding innovation and efficiency versus further service fragmentation and inequity. Balancing the roles of private and public providers in employment services poses a challenge and requires careful consideration of potential benefits and drawbacks. Robust regulatory frameworks are essential to protect the interests of individuals with substance use problems and uphold the principles of the Nordic welfare model in this evolving landscape.

The results reveal a myriad of interventions currently applied to individuals with substance use problems. However, the results also highlight significant overlap of interventions, many of which are implemented locally and lack nationwide coverage. They could and should also be evaluated more rigorously. There is a notable shift from train-then-place to place-then-train interventions, with a focus on swift integration into mainstream workplaces. Knowledge regarding their implementation and effectiveness in the Nordic countries is limited. The report thus underscores the need for further research and evaluation to enhance the comprehensiveness and efficacy of interventions in this field. There is also a need for a greater emphasis on service innovation, with new projects and services specifically tailored to individuals with substance use problems. In turn, such projects can be evaluated to form a more robust knowledge foundation for service design.

The Nordic interventions for individuals with substance use problems have been divided into five main categories: train-then-place, individual placement and support (IPS), low-threshold jobs/activities, peer support/activities, and coordinative/organisational interventions. For example, Iceland’s Grettistak train-then-place programme aims to restore participants’ full work capacity through an 18-month process of increasing their recovery capital index. Similarly, Sweden’s Employment Service is increasingly pairing unemployed individuals with education opportunities leading to employment.

Place-then-train programmes such as individual placement and support (IPS) are currently employed in several Nordic countries. While evaluations outside the Nordic region have shown promising results, Nordic evaluations are limited. However, the few Nordic evaluations do point to positive outcomes of IPS, which appears to be one of the most effective measures. Other interventions with promising results are pay subsidy, applied in most Nordic countries; the Danish interventions JobFirst and social free pass; work capacity coordinators in Finland; and Atvinnu- og virknimiðlun (AVM) in Iceland. 

The observed scarcity of evaluations of the various interventions is particularly problematic given that much of the innovation of interventions occurs locally in Nordic countries. Thus, the capacity for knowledge acquisition and sharing is hampered. In this regard, the Finnish Centre of Expertise for Social Enterprises (established in 2021), which collects, evaluates, and disseminates good practices for promoting employment, is a venture to follow. It is still too early to assess its impact, but such expertise centres might indeed serve as a model for other Nordic countries, too.