OPG’s Arden O’Connor teamed up with Bill Messinger to highlight the facts and issues associated with chemical dependencies in the workplace. The article addresses signs and symptoms of dependency in employees and offers advice for potential courses of action that an employer may take to bring about a positive outcome for all parties involved.
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Scope of Problem
Chemical dependency can dramatically affect an employee’s ability to contribute to your company’s success. In economic terms, an addiction can lead to a drop in productivity, reduced product quality, increased absenteeism, and higher health care costs. In human terms, an addiction or substance abuse issue can lead to failed marriages, broken homes, severe emotional problems, and even death. Depending on the nature of the individual’s work, public safety can be jeopardized.
The following statistics help to define the scope of the problem :
• In 2007, of the 17.4 million current illicit drug users age 18 and over, 13.1 million (75.3 percent) were employed.
• Similarly, among 55.3 million adult binge drinkers, 44.0 million (79.4 percent) were employed, and among 16.4 million persons reporting heavy alcohol use, 13.1 million (79.6 percent) were employed.
• Of the 20.4 million adults classified with substance dependence or abuse, 12.3 million (60.4 percent) were employed full-time.
• An estimated 3.1 percent of employed adults actually used illicit drugs before reporting to work or during work hours at least once in the past year, with about 2.9 percent working while under the influence of an illicit drug
• An estimated 1.8 percent of employed adults consumed alcohol before coming to work, and 7.1 percent drank alcohol during the workday.
• Workers reporting heavy alcohol use or illicit drug use, as well as workers reporting dependence on or abuse of alcohol or illicit drugs, are more likely to have worked for more than three employers in the past year. Likewise, those workers are more likely to have skipped work more than two days in the past month.
• There is evidence that co-worker job performance and attitudes are negatively affected. Workers have reported being put in danger, having been injured, or having had to work harder, to re-do work, or to cover for a co-worker as a result of a fellow employee’s drinking
There are nuances between how companies manage substance use issues versus family members; while promoting recovery and health may be part of the motivation in both cases, companies have to consider a range of other factors including liability, impact on culture, and their role as the employer.
Signs and Symptoms of Substance Use Issues
Substance use issues can come to light in a variety ways within the context of a company- an individual can self-report a problem to HR, a supervisor may witness performance issues or a colleague could divulge suspicions to a management team member. Without an employee admitting to a problem, it can be difficult for employers to ascertain the existence and acuity level of a substance use issue, particularly if the individual has learned how to hide signs of use, or he or she is in a position of authority. Crises (ex. inappropriate behavior at a holiday party, a DUI) can be opportunities for employers to exert leverage and to rapidly engage in a specific course of action.
Below is a list of possible symptoms; some of the listed symptoms may be associated with issues other than substance abuse, however, the existence of multiple signs should cause an employer to become concerned.
Possible symptoms of substance abuse or addiction in the workplace:
1. Change in work attendance or performance
2. Alteration of personal appearance
3. Mood swings or attitude changes
4. Withdrawal from responsibility or contact with associates
5. Unusual patterns of behavior
6. Defensive attitude concerning the object of addiction
7. Rumors/reports of substance abuse by colleagues
It is possible that an individual may have several of the above symptoms and his or her behavior may deteriorate quickly (ex. lateness turns into absenteeism, late assignments turn into missed assignments). For other individuals, the impact of substance use gradually builds over time and may take a long time before a supervisor feels comfortable addressing it. Finally, there are “high functioning” substance users (typically alcoholics) who may be able to complete their assignments, but are still drinking outside normal limits (guidelines suggest 7 drinks per week for women; 13 for men) and exhibiting obsessive behaviors around substances, suggesting a problem.
Employers are also in the difficult position of having to assess whether it is appropriate to raise a concern, when to do so and how to frame the conversation. Some employers will wait until a substance use problem raises a financial, legal or ethical risk that the firm can’t afford to ignore. Smaller businesses, particularly family owned firms, may adopt a more proactive approach, potentially even involving family members.
Employers often worry about a range of issues that are quite different than family members. Employers are often more sensitive to confronting an individual without “evidence,” making the firm vulnerable to claims of slander. There are federal laws that protect individuals with certain conditions including addiction that must be considered during disciplinary action. Employers may worry about invading a person’s privacy and trying to “control” personal choices around use (ex. can a firm “prohibit” someone from drinking?). Finally, employers need high-performance employees; they have to require a certain level of accountability for any treatment plan to be effective and the employee’s role may not be conducive to recovery (ex. a salesperson who develops an alcohol issue may not be able to entertain clients in the same manner they could previously).
It is never easy to raise an issue around substance abuse, and the context of the conversation is important (ex. is this a colleague approaching a peer or a supervisor who is having performance issues with an employee). In general, firms fare best if they stick to specifics observed and don’t make accusations. An example of this would be a supervisor mentioning that an employee has been late three days in a row and has missed deadlines, versus saying “You are clearly drinking too much which is why you’re not performing well.” Like any other performance issue, the documentation of conversations is important. In some circumstances, the conversation may come from a group of peers (ex. partners at a law firm approaching another partner). In those circumstances, verbalizing compassion may be appropriate (ex. “I am concerned about your level of stress”). It is still important to mention specifics (versus make accusations) and offer help. A key part of the process is having a list of resources available so that a plan of action can be formed quickly.
It can be difficult for employers to develop a comprehensive list of potential resources for behavioral health challenges, given the economic, cultural and geographic diversity in an employee base. There are also challenges with the way traditional substance use treatment works:
• Episodic and crisis –driven (ex. 30 day treatment with limited follow up)
• Varied quality of inpatient and outpatient providers (ex. therapists without substance abuse expertise)
• Limited focus on a family systems approach
• High relapse rates
• Lack of focus on sustained recovery and continuous care
Employers should be aware that the best outcomes in the addiction industry are with licensing boards for pilots and physicians. A range of studies report the following outcomes:
• 92% of pilots remain sober at TWO years*. Similar results exist for physicians
• The physician and pilot outcomes contrast sharply with an average of 30% sustained sobriety rates quoted by the therapeutic community.
What are pilots/physicians doing that is different?
• Oversight and direction of treatment process
• Long-term monitoring, including drug testing for years
• Use license revocation as leverage to pressure compliance with treatment
• They MANAGE the recovery process
While this model may not be transferable to every employment situation, it is worth studying its components and attempting to adapt depending on the circumstance. Sample services for employers to consider implementing include the following:
• Intervention process (if applicable)
• Referral to inpatient or outpatient treatment
• Education on disease of addiction
• Case management and care coordination
• Continuing care plan implementation and compliance
• Assignment of therapist and/or psychiatrist
• Attendance at AA or other self-help groups
• Drug testing and/or alcohol monitoring
Transition Back to Work
If an employee agrees to address a substance abuse or addiction issue, one of the biggest challenges for an employer will be to create a return to work plan that meets both the firm’s and the individual’s needs. There are legal issues around “reasonable accommodation” to consider, as well as practical challenges around requirements of the position. For references purposes, there is a sample “Return to Work Contract” included at the end of the article that can be modified to address specific circumstances.
Employers must have a way to address substance use and addiction issues within the company context, given the economic costs of ignoring them. A variety of factors, including liability and privacy issues, make it difficult to have a “standard” solution. There are, however, models that can be adapted to increase the chances of long-term success.