Risks and rewards – the challenge of worker wellbeing in the AOD sector

July 2021

The role of the frontline alcohol and other drugs (AOD) worker is crucial to effective and sustainable service delivery. The work itself can be very meaningful and rewarding, and can also be very demanding with a high risk of stress and burnout for many workers [1].

Much of the research on AOD worker wellbeing has focused on chronic stress and burnout. For example, a large multi-site study found that one-third of AOD workers in European treatment services report burnout [2, 3]. Whilst these statistics raise serious concerns, it is also important to recognise that AOD workers also demonstrate high levels of resilience, dedication and commitment. For example, a recent Australian study observed that 70% of Australian NGO workers reported high engagement with their work characterised by energy and enthusiasm [4].

Our understanding of alcohol and other drug use has become increasingly sophisticated over time, as we recognise substance use as a complex phenomenon that may involve a range of states and experiences. A similar evolution of our understanding is needed with regard to how we view and respond to AOD worker wellbeing. This more sophisticated and nuanced view of wellbeing recognises that AOD workers may simultaneously experience a variety of states including feelings of exhaustion and cynicism (i.e., burnout) perhaps from high workloads, alongside feelings of dedication and commitment to high quality service delivery for clients.

Within the research literature burnout and engagement are recognised as states that can be experienced concurrently [5], most likely in complex situations that are both demanding and rewarding such as AOD work [6, 7]. Other examples of such complex work situations include teaching and nursing roles.

A recent NCETA study applied this new perspective on wellbeing to AOD work, exploring whether AOD workers may experience burnout and engagement concurrently, and examining the implications this complex state may have for job satisfaction and other outcomes.

Using data from NCETA’s 2019-2020 AOD National Workforce Survey, we found that around one quarter of AOD client service workers reported high levels of both burnout and engagement. We labelled this group over-extended – the enthusiastic but exhausted. Around 16% of workers were burnt out (with low engagement), two thirds were engaged (with low burnout) and 16% were neither burnt out or engaged (i.e., indifferent).

Of particular interest is the observation that over-extended workers (enthusiastic but exhausted) were comparable to burnt out workers (exhausted and without enthusiasm) on poor health outcomes. The enthusiasm of over-extended workers also did not overcome their high levels of burnout with regard to sustaining job satisfaction – this group had job satisfaction equivalent to their indifferent colleagues (low engagement and low burnout).

This more nuanced view of worker wellbeing has important implications for strategies to support AOD workers. Highly motivated yet exhausted employees may struggle to sustain their commitment and dedication over the longer term in the face of ongoing demands, and risk transitioning to being simply burnt out [8].

It is crucial that AOD managers, leaders and clinical supervisors understand that an enthusiastic but exhausted worker is a professional at risk, and still requires active intervention in the same way that a burnt out colleague requires support.

More detailed findings are available from Skinner, N. and Roche, A.M. (2021), ‘Very demanding. Extremely rewarding’: Exploring the co-occurrence of burnout and engagement in alcohol and other drug workers. Drug Alcohol Rev.. https://doi.org/10.1111/dar.13250

NCETA has produced a range of resources and guides on worker wellbeing which can be downloaded from our website.

This study was supported by funding from the Australian Government Department of Health.

  1. Butler, M., et al., Wellbeing and coping strategies of alcohol and other drug therapeutic community workers: a qualitative study. Ther Communities, 2018. 39(3): p. 118-128.
  2. Volker, R., et al., Burnout, coping and job satisfaction in service staff treating opioid addicts - from Athens to Zurich. Stress Health, 2010. 26(2): p. 149-159.
  3. Oyefeso, A., C. Clancy, and R. Farmer, Prevalence and associated factors in burnout and psychological morbidity among substance misuse professionals. BMC Health Services Research, 2008. 8(1): p. 39.
  4. Duraisingam, V., et al., Predictors of work engagement among Australian non-government drug and alcohol employees: implications for policy and practice. Int J Drug Policy, 2020. 76: p. 102638.
  5. Mäkikangas, A., K. Hyvönen, and T. Feldt, The energy and identification continua of burnout and work engagement: developmental profiles over eight years. Burn Res, 2017. 5: p. 44-54.
  6. Dweck, C.S. and E.L. Leggett, A social-cognitive approach to motivation and personality. Psychological review, 1988. 95(2): p. 256.
  7. Shirom, A., Feeling vigorous at work? the construct of vigor and the study of positive affect in organizations. Research in organizational stress and well-being, 2003. 3: p. 135-165.
  8. Schaufeli, W.B. and T.W. Taris, A critical review of the Job Demands-Resources Model: implications for improving work and health, in Bridging occupational, organizational and public health: a transdisciplinary approach, G.F. Bauer and O. Hämmig, Editors. 2014, Springer Netherlands: Dordrecht. p. 43-68.