“The client has changed.” Representations of social workers specialized in the care and occupational rehabilitation of individuals with substance use disorders.

Since the late 1970s, the Third Sector has been entrusted by Italian institutions to provide treatment and promote the social inclusion of individuals with substance use disorders (SUDs). However, significant changes have occurred in society, in services, and in the field of addiction since then. This study involved a social cooperative that focuses on the treatment and rehabilitation of individuals with SUDs. The therapeutic program, which incorporates work as a therapeutic tool, begins in a therapeutic community, continues in a semiresidential rehabilitation facility, and concludes with a low-intensity educational program in apartments, where clients reintegrate into the workforce. To understand the representations of their clients by social workers, 12 semi-structured interviews were analyzed with NVivo following an inductive thematic analysis approach. Three main themes emerged: 1) Changed client: Clients are increasingly severe, often presenting psychiatric issues and in indigent conditions. 2) Differential progress: Clients who succeed in occupational rehabilitation show strong vocational skills but have difficulties in relationships. Conversely, those who struggle in the program underestimate reintegration difficulties and aim for social buffers rather than occupational rehabilitation. 3) Anxiety, fear, and worry about the future were commonly noted by social workers among service clients. If unacknowledged, these emotions are seen as contributing to self-sabotage. Given the changing clients and the increasing challenges they face in integrating the workforce, social workers emphasize the risk of therapeutic communities being assimilated into extensions of psychiatric care, highlighting the need to strengthen additional services to support individuals with SUDs (e.g., "housing first", high-intensity apartments).