EMPLOYERS

Helping Workers With Substance Use Disorders Start a Path To Recovery: A Guide for Employers

Problems with alcohol or drugs occur among millions of people who are employed.¹ To help address these problems in the workplace, companies can make an effort to be in touch with their employees and provide a supportive alcohol- and drug-free workplace. Companies that take such actions can see substantial corporate benefits. By taking a proactive approach and encouraging employees and corporate managers with these problems to seek help, employers actually can promote increases in employee performance, motivation, and morale, while also boosting customer satisfaction and financial savings.²

As you make plans to improve the productivity of your business and the company bottom line, it is important to consider what you invest to support managers' and employees' health, especially for people who have problems with alcohol or drugs. As many as 63 percent of Americans say that addiction to alcohol or other drugs has had an impact on them at some point in their lives, whether it was the addiction of a friend or family member or another experience, such as their own personal addiction.³ Overall, millions of Americans live with substance use disorders.

Substance use disorders encompass both dependence on and abuse of alcohol and illicit drugs. Dependence on and abuse of alcohol and illicit drugs, which include nonmedical use of prescription-type drugs, are defined using the American Psychiatric Association's criteria specified in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV). Dependence reflects a more severe substance problem than abuse; individuals are classified with abuse of a particular substance only if they are not dependent on that substance.⁴

Employers take note: in 2003 alone, 76.8 percent (14.9 million) of the adults who suffered from substance use disorders were employed.⁵ In fact, about 34 percent of admissions to treatment programs for sub­stance use disorders in 2001 included people who were employed full-time or part-time when they entered treatment, according to the Substance Abuse and Mental Health Services Administration's (SAMHSA's) Treatment Episode Data Set (TEDS).⁶ Addiction remains the most common problem for employees in most workplaces, accounting for 20 percent of voluntary employee-assistance referrals to treatment and 50 percent of supervisory referrals.⁷

Problems with alcohol or drugs can affect anyone, even your most valued employees.⁸ Fortunately, however, substance use disorders are medical conditions for which treatment is highly effective.⁹ Offered the opportunity, people in recovery from addiction can do meaningful work, contribute positively to their communities, and are productive, tax-paying members of society.

In fact, many people in recovery are outstanding employees precisely because they have faced obstacles and overcome enormous challenges.¹⁰

Yet large numbers of people who could be helped by treatment still do not receive it. Of the 1 million people surveyed in 2003 who felt they needed treatment for substance use disorders, 273,000 (26.3 percent) made an effort but were unable to receive the treatment they wanted.¹¹

Because so many people affected by substance use disorders are employed, employers play an important role in helping guide managers and employees toward recovery, and those employees and managers can continue working while receiving treatment. Employers can provide a supportive work environment through a comprehensive drug-free workplace program.¹²

These programs typically include:

• A clear company policy on substance use



• Employee education



• Supervisor training



• An employee assistance program (EAP)



• Drug testing (when appropriate)

Keep in mind that drug testing is only one part of a drug-free workplace program, and many state and local governments have statutes that limit or prohibit workplace testing.¹³ Some states have laws that offer companies certain discounts on workers' compensation insurance premiums if they establish drug-free workplace programs. The U.S. Department of Labor's Working Partners for an Alcohol- and Drug-Free Workplace Web site, which is available at www.dol.gov/asp/programs/drugs/said/StateLaws.asp, provides information on these laws for each state or territory, as well as other laws relating to drug-free workplaces. These laws pertain to drug testing, unemployment compensation, workers' compensation, and state drug-free workplace acts. Not all states or territories have a drug-free workplace-related law.¹⁴

Another way employers can help is by offering their employees private health insurance plans that cover treatment for substance use disorders at the same level that other medical conditions are covered.¹⁵ Additionally, they can take other steps to support workers in recovery. It is important for employers to understand the distinction between recovery and treatment. Recovery, the process of initiating and maintaining abstinence from alcohol or other drug use, frequently requires multiple episodes of treatment. For many, treatment involves multiple interventions and attempts at abstinence, and treatment can occur in a variety of settings, in many different forms, and for different lengths of time.^{16, 17}

Retaining managers and other workers who have substance use disorders may require some practical and creative efforts to aid their transition back to work and provide continued support for their recovery. But importantly, these efforts also can benefit the rest of your employees. A small investment of support can lead to a considerable reward: loyal, long-term employees.¹⁸

Some employers have already seen the corporate benefits of doing so. For example, Chevron Texaco found that from 1990 to 1996, three-fourths of the employees who entered the company employee assistance program with alcohol use disorders were able to keep their jobs, while nationally the turnover average is about 40 percent for employees with untreated alcohol use disorders. Providing an EAP is far more cost-effective than other responses to alcohol use disorders, such as automatic termination. It helps the company keep its experienced employees, saving training expenses-costs that are far higher than the cost of alcohol use disorder treatment.^{19, 20}

Other employers are using a variety of effective avenues to provide needed treatment for affected employees. Shell Oil took a straightforward step by establishing a position in its health services division dedicated to advocating for people with substance use problems.²¹ Employers such as American Airlines, Eastman Kodak, IBM, General Motors, Delta Air Lines, Pepsico, and AT&T have provided relatively generous private insurance packages for addiction treatment. Most use managed-care firms to control costs, an approach they determine to be cost-effective.²² By committing to a drug-free workplace and supporting substance use disorder treatment programs for employees, businesses can experience a variety of benefits, including performance improvements that can contribute to the company's success.

The costs and benefits of workplace policies are the primary considerations for businesses; no single solution will work for every organization. But reviewing various approaches to substance use disorder treatment and recovery will help employers make the right decisions for their businesses.

Estimating the cost of substance use disorders to businesses of a similar size can help employers find the best solution for their work environment. Through The George Washington University Medical Center, the Ensuring Solutions to Alcohol Problems initiative offers an alcohol cost calculator that companies can use to compute how much alcohol use disorders can cost their businesses. The calculator can be found at www.alcoholcostcalculator.org/business/, where businesses also can learn more about how to reduce the costs of alcohol use disorders.²³

Assessment and Referral

In the workplace, the tasks of recognizing a particular employee's need for treatment and referring that person to a treatment program can be done through corporate efforts that are backed by the support of all employees in the office. This ensures that employees who need treatment get to an appropriate treatment program. Employer support can begin by providing supervisors with training on how to recognize the signs of substance use disorders based on job performance, as well as guidance for intervening and making appropriate referrals. Employers also can educate all of their workers that alcohol and drug addiction are treatable diseases and treatment is effective.²⁴

In many workplaces, peoples' coworkers are often the first to notice a change in their behaviors or attitudes. Coworkers can help the personal problems of a fellow employee be identified and addressed in the early stages, before serious job performance problems develop.²⁵

Using EAPs to Assess and Refer Employees to Treatment

As an employer, you can offer employee assistance programs (EAPs) to help people who recognize they need help finding a treatment program. An EAP can provide confidential problem identification, short-term counseling, referrals to treatment, and follow-up services to help resolve employees' problems.²⁶

In the Worker Drug Use and Workplace Policies and Programs study by SAMHSA, people whose employers provided EAPs, as well as drug and alcohol information and written drug and alcohol policies, were less likely to abuse illicit drugs.²⁷ In addition to the many health and wellness benefits they offer employees, EAPs have been proven to save employers money. EAPs are increasingly seen as a way to keep workers productive and healthy.²⁸

There has been an explosive growth of EAPs in the past decade. More than 80 million Americans now have access to EAP services of some kind-a 247 percent increase since 1993.29 In 2000, 76 percent of full-time employees aged 18 to 49 reported that their workplace had written policies on substance use, and 53 percent were aware of EAPs at their workplace.³⁰

For EAPs to be successful, people need to feel comfortable enough to use them, which depends on the workplace environment. Currently, 89 percent of human resources (HR) professionals believe treatment is effective in helping employees fight the disease of addiction, but a quarter of HR professionals also say there is a belief in their companies that it is easier to terminate an addicted employee than to get him or her into treatment. Additionally, more than half say there is a lack of expertise in their companies to identify addiction.³¹

Reducing the stigma and changing these attitudes will require a concerted effort.³² One way to reduce the discrimination against people with substance use disorders is to provide comprehensive EAPs that are confidential. The Ensuring Solutions to Alcohol Problems initiative lists steps for employers to consider regarding EAPs, including assuring self-referred employees that accessing EAP services for help with an alcohol problem will be confidential and will not result in any job repercussions.^{33, 34, 35, 36}

Another issue to consider is whether the EAP is capable of focusing on the many facets of an employee's life. Employees who have children or aging parents have particular needs and concerns about their family members that can affect their everyday performance.³⁷ And 99 percent of HR professionals say they believe that employees who have children with addiction problems use an increasing amount of health care dollars.³⁸

These figures show how employers that recognize the need to include family members as well as employees in an EAP can promote a strong and supportive work environment. They also stress the importance of understanding employees' challenges and developing strategies to improve job satisfaction and productivity, while also looking to improve the organization's bottom line.³⁹

EAPs are cost-effective, and small employers can make EAP services available by joining with other companies in a consortium or cooperative agreement, or working with a local business or trade association to start an EAP for its membership. For those companies that have taken the time and effort to set up an EAP, the results have been worth it. EAPs can help a company save money in terms of less absen­teeism, fewer accidents, decreased use of medical and insurance benefits, savings in workers' compensation claims, fewer grievances and arbitrations, and fewer employee replacement costs.⁴⁰

Even without a formal EAP, workplaces can offer education and awareness programs for employees that include information on where to get help with alcohol and other drug problems.⁴¹

Access to Treatment

Employees with substance use disorders often turn to their employers for help in obtaining access to treatment, which employers may provide as part of their drug-free workplace programs. These programs are tailored by a company to promote a safe and productive workplace.

Such programs may include workplace policies that increase employees' access to treatment, along with EAPs that not only provide referral to treatment, but also offer employee education, supervisory training, and both short-term and continuing treatment services. These elements can help create an environment that encourages access to treatment, support for recovery, and the return of the employee to productive work. Employers can ensure that an employee who needs treatment experiences a smooth transition back into the workplace during and after receiving treatment by creating a supportive work environment.^{42, 43}

Employers should not worry that providing their employees with access to treatment will interfere with their ability to perform their jobs. Research shows that someone who is busy is much less likely to relapse and begin drinking or using drugs again than someone recuperating at home. Furthermore, intensive outpatient programs are effective and allow workers to stay on the job, seeking treatment outside of work. For example, someone who enters a weekend alcohol detoxification program could be back to work on Monday, provided they continue to participate in outpatient treatment and if they receive ongoing case management from appropriate treatment professionals.⁴⁴ As part of that ongoing care, employees in some states have access to specialized aftercare programs that can help in the long term by preventing relapse among people trying to maintain recovery from alcohol and drug addiction.⁴⁵

The following actions by employers help create not only a drug-free workplace, but a healthy environment that supports treatment and recovery:

• Offer flexible hours to allow people in treatment to attend meetings, support groups, and counseling sessions.



• Create a mentoring program for new employees to eliminate the anxieties that are typically present when starting a new job.



• Recruit workplace-recovery sponsors to help keep people on track. These workers can be a valuable resource for an employer.



• Offer life skills training for employees and supervisors. This can include stress and time management and communication skills. Such training often has a positive impact on overall job performance.



• When possible, offer health insurance to all employees. This can significantly relieve stress and may encourage someone with a substance use dis­order to enter treatment.



• Plan work-related social events sensitively and carefully, ensuring all employees are comfortable with the atmosphere.



• Always respect confidentiality. Employers must recognize and appreciate the delicate balance between wanting to help and an employee's need and desire for privacy.⁴⁶

Health Care Coverage

In addition to helping employees find treatment for substance use disorders, employers can offer private health insurance plans that cover a full range of treatments for employees and their families. This can be difficult with today's economy, where employers are trying to cut costs. Programs such as EAPs can be particularly susceptible to the financial pressures of the health care market, even though they have the potential to deliver vital services.^{47, 48} Such financial pressures are so common that they were noted in a speech by Tommy Thompson during his tenure as Secretary of the U.S. Department of Health and Human Services from 2001 to early 2005.

“Most corporations, as you know, offer their employees part of their compensation in cash, and part in the form of health benefits. And, if you talk to senior management of corporations in almost any industry about their biggest concerns, as I have, over and over you hear about rising health care costs. The more expensive health care is, the harder it is to compete with foreign competitors.That's why employer spending on prevention is a wise investment that pays off,” Secretary Thompson said, recognizing the concerns of employers about rising health care costs.⁴⁹

Experts expect the cost of providing employee health insurance coverage to double by 2007-prompting many employers to consider strategies to help control costs.⁵⁰ In an economy where employers look to cut costs, providing additional covered services may not appear cost effective. In the long term, however, the opposite is often true.^{51, 52} In some cases, integrating addiction treatment with medical treatment can cut the cost of medical treatment in half.⁵³

In fact, identifying and treating alcohol use disorders can be good business practices. Increasing access to substance use disorder treatments can help employers cut costs while improving their businesses' overall productivity, ⁵⁴ because alcohol use disorder treatments are known to reduce health care costs for most problem drinkers, with even higher savings seen among younger problem drinkers.^{55, 56, 57, 58} Recent data now reveal that providing private insurance coverage for treatment services is not only effective in helping people return to work, it also reduces health care costs overall. This is clearly a benefit for employers, who are likely to invest in treatments that save money while strengthening their workforce, as well as a benefit for private insurers.^{59, 60}

Employers can adopt various levels of private insurance coverage for substance use disorder treatment depending on their corporate environment. Through private insurers, employers are now beginning to cover more treatment services because they recognize the value of treatment. In fact, many large employers have dropped day and visit limits on treatment. However, lifetime and episode-of-care caps remain in place.⁶¹

In deciding how much private insurance coverage to purchase for employees, companies can consider ways to make the most of their money. Providing coverage for certain services, such as screening and motivationally based interventions at the time of a traumatic episode involving alcohol or drugs, may be advantageous as these services directly lead to a reduced use of substances and prevent further injuries. These strategies also have the potential to save $327 million in nationwide direct medical costs over 5 years, so services such as screening should be encouraged.^{62, 63}

Several sources can help employers learn about insurance laws in their state, which can help determine the type of insurance to purchase for employees. To find out more about laws in your state, you can contact your state (or county) office for services related to substance use disorders and ask if they have a workplace specialist or advisor. (A list of single-state agencies is provided in the “Resources” section of this planning toolkit.)

Another tool for employees seeking financial assistance for treatment is President Bush's Access to Recovery (ATR) grant program, which is administered by SAMHSA. By providing vouchers to people in need of treatment, the grant program promotes individual choice for addiction treatment and recovery services. It also expands access to care, including access to faith- and community-based programs, and increases substance use disorder treatment capacity.

More information about the Access to Recovery initiative and grant program, including a list of states where the program has been launched, is available from SAMHSA at www.samhsa.gov.

Another SAMHSA grant program, the Recovery Community Services Program (RCSP), provides support services to those seeking recovery from substance use disorders. In RCSP grant projects, peer-to-peer recovery support services are provided to help people initiate and/or sustain recovery from substance use disorders. Some RCSP grant projects also offer support to family members of people needing, seeking, or in recovery. Peer support services are not treatment or post-treatment services provided by professionals, but rather support services from people who share the experiences of addiction and recovery. Peer-to-peer services help prevent relapse and promote long-term recovery, thereby reducing the strain on the overburdened treatment system.⁶⁴

Making a Difference: What Can I Do?

1. Set the tone. Establish a comprehensive drug-free workplace to demonstrate your company's commitment to an environment and community free of alcohol and drug use. Start by contacting some of the “Workplace Resources” listed at the end of this document.



2. Make it easy to get help. Smaller businesses that cannot afford in-house resources should refer employees with substance use disorders (and any co-occurring conditions), and employees impacted by a family member's disorder, to a ppropriate local mutual support organizations and professionals, including certified substance use disorder counselors and therapists. Resources also are available to assist people within a particular field. For example, a law firm may refer an attorney with a substance use disorder to Lawyers Concerned for Lawyers, the American Bar Association Commission on Lawyer Assistance Programs, or its bar association's lawyer assistance program.



3. Hire people in recovery. Recruiting and hiring people in recovery helps them regain control of their lives and reduces the stigma of substance use disorders by sending a positive message that people in recovery can become productive members of society. The National Association on Drug Abuse Problems, Inc., (NADAP) has smoothed the transition from treatment to employment for nearly 10,000 men and women through its business and labor partnerships. For more information, call 212-986-1170 or go to www.nadap.org.



4. Provide health insurance coverage. The cost of treatment for substance use disorders can be a barrier to receiving treatment.⁶⁵ Many people in recovery who have private health insurance often find that coverage for treatment for their disorder is limited or non-existent. To fill this void, a business can negotiate coverage of behavioral health services, including substance use disorder treatment and counseling, with its health insurance company.

Making a Difference: How Can I Contribute to Recovery Month?

Each September, National Alcohol and Drug Addiction Recovery Month (Recovery Month) is celebrated by hundreds of organizations across the country to highlight the importance of treatment for substance use disorders. Your company can make a difference by taking part in outreach efforts to promote and observe Recovery Month.

1. Educate your employees. The most important audience you can reach with information about substance use disorder treatment is your workforce-and employers can also reach their employees' family members by mailing information to them at home. Provide them with facts on the signs and symptoms of substance use disorders, treatment options, and the company's policy on supporting employees in recovery. Deliver Recovery Month information through the company intranet, internal newsletters, e-mails, paycheck inserts, and/or bulletin boards in common areas throughout the office.



2. Act locally. Make a financial donation (if donations are accepted), coordinate a volunteer effort with a group of employees, sponsor a Recovery Month educational or publicity event, or offer pro bono company services to a local provider of substance use disorder recovery services.



3. Go public. Distribute a press release to the local media about your company's Recovery Month activities, highlighting the company's drug education program as well. Or write an article for placement in a business publication that expresses your opinion about substance use disorders in the workplace and what can be done to help remedy the problem. Support your position with relevant statistics or scientific study results (which can be found through the resources at the end of this document), personal anecdotes, or references to recent news events. Celebrate employees in recovery (with their permission) by highlighting their accomplishments in the company publication, or by posting their success stories in common work areas.



4. Evaluate your efforts. Survey your employees to obtain feedback on your company's workplace drug education program and determine what elements are not effective. Ensure confidentiality of their responses, and use the findings to make decisions regarding any modifications to the program.