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"The Chemical Dependency Care Package," by Peggy Stuart, copyright June 1991. Reprinted with the permission of PERSONNEL JOURNAL, ACC Communications, Inc., Costa Mesa, California; all rights reserved.
by Peggy Stuart
He's on drugs. He snorts it several times a day... and he's on your payroll.
Dealing with alcohol and drug use in your work force may be one of the most difficult problems you have to face. How you deal with this problem may have a profound influence on the success of your company.
The combined cost for psychiatric and chemical dependency care will increase by 47% in 1991, according to the Foster-Higgins 1990 Annual Report on Managed Care. In spite of this enormous expense, 85% to 90% of chemically abusive employees currently get no treatment.
True, treatment is often expensive, but consider the expense of employees who don't receive clinical assistance. If your organization is typical of U.S. companies, 10% of its employees use drugs in the workplace. This results in time lost due to dysfunctional work relationships; absenteeism, turnover and inefficiency. Additional losses occur on the job from injuries, breakage of equipment, and "inventory shrinkage" (more commonly known as theft). Costs don't end in the workplace, however. If expenses for workers' compensation, medical and surgical claims, and disability are examined closely, many are revealed to be alcohol- and drug-related.
In some industries, such as health care and transportation, even casual drug or alcohol use can result not only in increased costs, but also in lawsuits and loss of life.
Even if the employee isn't chemically dependent, a spouse or family member using drugs or alcohol can mean missed work, extensive personal phone calls and increased dependent medical benefits.
This situation may sound hopeless, but it's not. According to Bob Belichick of California Psychological Health Plan of Los Angeles, 75% to 80% of substance abusers entering a complete treatment program through their employers can be helped to abstain for one year or more. After this length of time the chances are good for continuing recovery.
Some company-sponsored treatment programs have an even higher success rate...but some are much less effective. What makes a successful chemical dependency program?
Richard Kunnes, chief operating officer for U.S. Behavioral Health in Emeryville, California, which manages chemical dependency and mental health for The Travelers, maintains that successful treatment requires a complete "continuum of care" including the major components of prevention, assessment, treatment and aftercare. The aim is to provide quality care, produce cost-effective outcomes, reduce inappropriate use of health services and keep people productive on the job. Often elements of the continuum are missing or there's "significant non-integration" among these four critical areas. Staff members responsible for implementing the program may unknowingly work at cross-purposes to each other.
Prevention and aftercare are the two weakest links in most programs, according to Barbara Lambert, director of training, education and consultation for U.S. Behavioral Health. Companies may provide good assessment and treatment services, but fail to provide an environment for their workers that's conducive to a drug-free work force.
Most chemical dependency experts agree that prevention begins with a clear corporate drug policy. Management must send a clear message to its work force that substance abuse isn't acceptable. Belichick says the Drug-free Workplace Act of 1988, which applies to organizations receiving federal funding, is a useful guide to use when writing a corporate drug policy statement. This statement should include an explanation of the different types of testing used by the company:
Many organizations have a strong policy statement, which they think is enough. "It isn't enough. It gives the employee too much responsibility," says Lambert.
Take a look at your workplace. Do your managers discuss business over a three-martini lunch? Do you serve wine at meetings? Is alcohol served at company parties? Lambert says management often sends a mixed message to employees. If alcohol is condoned but drugs aren't, alcohol quickly becomes the drug of choice. Your corporate culture must match your drug policy.
She states that chemical dependency training and awareness should be provided for all supervisors so they'll know the warning signs and how to respond. Education also should extend to the work force. "We've learned that workers trust the education they receive from their employers," says Lambert. Management is in a position to have a real, positive impact on people's lives and contribute to the bottom line.
Amazingly enough, few companies follow these guidelines. Many feel that if they address chemical dependency directly, it's admitting that they have a problem. Lambert says that we all—the company, the community and the country—have a problem. There's hardly an organization in existence that hasn't been impacted directly or indirectly by chemical dependency.
Let's assume your well-written company drug policy is in place; management has taken steps to send a clear message and to provide education to the employees. What's your next step?
You don't have to provide the care yourself, but you do need to be able to identify the chemically dependent worker. It may be brought to your attention through a reduction in productivity or punctuality. The employee may exhibit a change in personality or a disheveled appearance. You may have a positive drug test already. Get the assistance of legal and treatment professionals before proceeding.
You also must be able to refer him or her to a treatment program with a proven success rate, says Belichick. A multi-disciplinary approach is required, because chemical dependency isn't simply one problem. In adolescents, for example, it's almost always a combined physical and psychological problem.
Kunnes points out that 30% to 40% of addicts have psychological problems and the same percentage of people with emotional problems are chemically dependent, so both mind and body must be treated for a program to be successful.
There also are differences according to culture and age group. For instance, people younger than 50 may use heroin, cocaine or other hard drugs with or without alcohol, whereas older people often prefer alcohol or prescription drugs. Differences exist between cultures, as well. Drugs of choice gain and lose popularity over time. Amphetamine use, for instance, has increased in the last few years.
Health coverage for chemical dependency must be generous and comprehensive enough to encourage easy access and early assessment, and to provide the most appropriate level of managed care for employees and their dependents, according to Kunnes. The appropriate treatment isn't always an inpatient, four-week program, he says. Inpatient care often is unrealistic and doesn't prepare recovering alcoholics and addicts for life in the real world. The chemically dependent person not only has his or her work interrupted, but then goes back into the same stresses that contributed to the problem in the first place.
If you have a good prevention program in place, you may be identifying the addict at an earlier stage in the progression of the disease, when outpatient treatment can be successful, says Maureen Whitmore of Occupational Health Services in Larkspur, California.
Belichick also points out that detoxification and outpatient care are not only much less expensive but often are all that's required. Lifetime benefits should provided a minimum of $25,000 to $50,000 for treatment, which allows for either inpatient or outpatient care and repeated treatment, if necessary.
According to Whitmore, outpatient care generally runs $1,500 to $4,000 in the U.S. Inpatient care for a four-week program can cost $14,000 or more.
Outpatient care may not be feasible for workers on swing shifts or night shifts, because many of the programs are provided only in the evening. There may not be the support at home to make outpatient treatment possible. In such cases inpatient care may be the only choice, according to Whitmore.
Traditionally, however, insurance for chemical dependency outpatient care carries a 40% to 60% copayment, as opposed to 0% to 20% for inpatient treatment. This encourages patients to choose the more expensive inpatient program, whether or not it's appropriate for them. It costs them less, but the benefits program pays more.
Risk rating—assigning a lower insurance premium rate to a group at lower risk—can be an important part of prevention for the employee who's willing to take part voluntarily in drug testing, according to Kunnes. How can you get your employee into a treatment program? Fortunately, an approach to motivate a person to accept treatment—called intervention—is quite successful. Health care providers and treatment programs can refer you to a specialist who can walk you through the process.
The old adage, "You can't help an alcoholic (or addict) unless he's willing to help himself," isn't necessarily true. If you wait for the chemically dependent person to ask for help, you may be waiting a long time. Most people who are dependent on drugs or alcohol aren't motivated to quit; it's part of the addiction.
There's another old adage: You can lead a horse to water but you can't make him drink. "That's true," says Whitmore, "but if you add salt to the oats, you can make sure he's thirsty."
By the time you realize your employee has a problem, his or her family life already may have broken down. As the employer, though, you are in a position to provide tremendous incentive for accepting treatment, as well as providing emotional support afterward, because the job usually is of extreme importance to the addicted individual.
Once you've invested time and money in treating a person, how can you be sure he or she won't "fall off the wagon?" You can't. There are some things you can do, however, to increase the likelihood that your recovering employees will continue to recover.
Offering this kind of support for the recovering alcoholic or drug addict also contributes to prevention by involving other potentially addictive people during the early stages of their own substance abuse.
If you see the warning signs in one of your recovering employees (increased absenteeism and personal phone calls, irritability or passivity and so on), what should you do? The answer depends on whether the employee knows you're aware of the problem. If he or she thinks you don't know, don't bring it up. Instead you might say something like: "Six months ago your performance wasn't acceptable, but then you improved. Lately things seem to be slipping again. Is something going on? Have you talked with the EAP? That's what he's (she's) there for."
If the employee is open about his or her treatment, your approach would be different: "How is aftercare going? What can we do to help you in your recovery? Would you like to attend AA meetings during the day?"
Keep in mind that outpatients often don't get the same attention during aftercare that inpatients receive. The alcohol or drugs provided relief from stress for your employee. Alternative stress relief must be found. Prompt attention from you at this point can prevent a relapse.
Some people are beyond help, says Belichick. Others need to go back into treatment periodically, the way an executive visits the gym. If you've tried your best and the chemically dependent worker returns to drugs or alcohol, don't blame yourself. Instead, enjoy your successes...and there will be successes. Encourage your recovering employees to share their experiences with co-workers. Often they'll want others to know, says Lambert. These people can be a walking advertisement for your program and encourage other employees to get help. "After treatment, former chemically dependent individuals are often the best employees and spokespersons for your program," she says.
The challenge is to get companies to acknowledge the problem, Lambert points out. There are many obstacles to overcome: psychological, economic, political and corporate barriers.
Few, if any, people come from homes without problems. Some of your employees may have had alcohol- or drug-dependent parents. People tend to re-create in the workplace what went on in their families, says Whitmore. This generates institutional co-dependency.
This same re-creation of family in the workplace allows you to provide a corrective experience for your employees. Through education, firm but fair policies, consistent corporate culture, and caring support during intervention, treatment and aftercare, you can break the cycle of dependency and co-dependency in your company and assist many of your workers to have a chemically independent future.
For further help
Books on Intervention:
Johnson, Vernon E., Intervention. Minneapolis, Minnesota: Johnson Institute Books, 1986.
Ketcham, Katherine and Gustafson, Ginny Lyford, Living on the Edge. New York, New York: Bantam Books, 1989.
To find a professional interventionist, or a local treatment program call:
Betty Ford Center, Rancho Mirage, CA, 1-800-392-7540
Hazelden Foundation, Center City, MN, 1-800-262-5010.
Peggy Stuart is assistant editor for PERSONNEL JOURNAL.
The kind of testing you choose to use depends on the type of drug and alcohol use you're trying to uncover and the legal ramifications to your organization. Before putting a testing program into practice in your company, have your legal department advise you on the laws in your state. Generally, however, testing is legal if it's administered fairly and employees are informed of policy beforehand.
Maureen Whitmore of Occupational Health Services in Larkspur, California says the test most often used is the NIDA (National Institute for Drug Abuse) Certified Drug Test. Alcohol, cocaine and some other drugs aren't detectable using this test, however.
If your company is a provider of health care, public safety or transportation, you may want to identify the casual user who may endanger lives. In this case, random testing is preferred, Whitmore says. Users often pick up a pattern in random testing and test clean. To be sure your tests are useful, break up the schedule. Back-to-back tests can trip up the person trying to beat the system. Use an NIDA-certified collection site or have the collection witnessed to prevent cheating.
It's a waste of benefits to put every casual user into a four-week program, says Richard Kunnes, chief operating officer of U.S. Behavioral Health, which manages chemical dependency and mental health for The Travelers. There's no improvement in behavior because there's no disease. Non-random testing will identify the individuals truly unable to confront their drug usage: the company announces drug testing of all employees on a certain date, usually several weeks in the future.
This separates the casual drug user—who may be breaking the law but doesn't create a problem in the workplace—from the addict. Although the true addict may attempt to abstain from drug use before the test date, he or she will be unable to do so and will produce a positive test result.
"There's no case law, but there's less likely to be a constitutional challenge to non-random testing," says Kunnes. That's because it's a lower-level invasion of privacy. "If you announce a party at your house at 7:00 and people show up at 3:00, that's an invasion of privacy, but if they come at 7:00, it's not," he says. Few employees are actually in favor of drug testing, but there's less likely to be an employee backlash with non-random testing.
Function testing—testing the employee to see if he or she can complete the assigned tasks properly—is certainly allowed and is effective. The employer has the right to demand that the worker be able to complete job-related functions on a timely and accurate basis. Workers who fail function testing may then be given a urine drug test, as part of the company's policies and procedures.
Whatever your testing policies are, use professional assistance.
Susan, one of your salespeople has tested positive for cocaine. You also have noticed a change in her ability to concentrate on her work recently, which has led to poor performance with significant errors. She often comes to work late or leaves early. You know your next step is crucial in helping Susan overcome her drug problem.
If you call her into your office and threaten to fire her unless she gets help, it's likely she'll refuse treatment and quit. Even if, in the shock of confrontation, she gives in, it's a good bet she'll become indignant later and refuse to follow through.
Intervention is crucial to the ultimate success of any chemical dependency program. Statistics show that as many as 90% to 94% of those individuals confronted by intervention actually accept treatment. Of those, 97% stay in treatment, which is a much higher rate than the percentage of individuals who seek treatment individually. After rehabilitation, 70% of the intervention subjects remain drug- or alcohol-free.
Although the success rate for solving chemical abuse in the workplace using the intervention method is high, fewer than 25% of personnel managers who investigate this treatment follow through and actually implement it, mainly because it's a time-consuming and uncomfortable process. For those people who are able to overcome these issues, the rewards are well worth the effort.
The first step is to identify a professional interventionist. Although there are some good books explaining this method, it's wise to seek the advice of a professional. Because surprise is a key element in eliciting a positive response by a potential client, a failed attempt may ruin your chances for good. Unless the situation is an emergency, take the time to lay your groundwork thoroughly. It's not unusual for the planning stage to take several weeks.
The interventionist will ask you to form a group of eight to 10 people who are important in the client's work life. If the spouse has discussed the problem with you and you feel he or she would be an asset, you may want to include him or her on the committee. It's considered unwise, however, to contact a spouse who hasn't asked for help. Family members are often enablers and would consider such action on their part disloyal. You could end up losing that surprise element.
Good committee members are usually the employee's supervisor, carefully-selected co-workers who have witnessed the problem and the employee assistance plan (EAP) manager. Individuals who are at the subject's level should be identified: staff colleagues, team members, friends at work. Consider who the most influential people are in this person's work life. To whom does he or she go for advice?
The day before the intervention meeting, it's likely the interventionist will want to hold a preparation session, which all committee members must attend. During this session participants will learn how the intervention will be conducted. They'll prepare their statements to the individual and rehearse. Before the next day, they'll write letters to the subject, in which they outline their perception of the problem and express encouragement and support. A photo of the group may even be taken. The letters and photo will accompany the subject when he or she goes to the treatment program.
All arrangements for treatment must be made before intervention proceeds, so the subject can begin immediately. This will entail making treatment program and travel arrangements, if any, and packing, if the family is cooperating.
When the subject arrives at the intervention meeting the supervisor or another management member expresses the organization's appreciation for his or her performance in the past, and acknowledges that there appear to be some problems, but that the company is willing to provide the help necessary to return him or her to the same level of usefulness.
For instance, you might open a meeting with Susan this say:
"Susan, you've been a great salesperson. You've brought us some of our best accounts. Lately, though, your sales have been slipping and we've noticed that you're having some other problems. We know this is related to your drug use and we want to help you. You're important to us and we would hate to lose you, because you really are valuable. Not only do we care about you as a colleague, but as a friend, too. It upsets us to watch what you're doing to yourself, and we need you to get help."
Others on the committee will express their concern and affection, and give specific examples of the behavior they've observed. This meeting could take anywhere from 30 minutes to several hours. It may be a good idea to make a tape recording if you can, in case the individual forgets some of the meeting's revelations later, or disputes them.
The subject's job is of such economic importance that intervention is usually more successful among employees than family members seeking the same type of treatment. As soon as the employee agrees to treatment, he or she should be taken physically and put on the plane or taken to the facility before there's time to think about it. Committee members must be firm in their resolve as well and not buckle, even though the experience may be painful to watch firsthand. If properly conducted, however, the subject often leaves the meeting with increased self-esteem and a genuine desire to beat his or her problem.
What if the drug user is the CEO, or another member of upper management? Intervention still can be successful, but great care must be taken. In this case, because only individuals superior to or on the subject's level would attend, the HR manager won't take part in the actual intervention and may have to look outside the organization to find committee members. The treatment may be paid for out of other funds rather than the company health insurance to protect the individual from exposure through the human resources department. In this case, an interventionist who has had experience dealing with upper management should be consulted.