By KATHLEEN MITCHELL, HealthCareNews.com
Rene Pinero says antiquated beliefs persist about individuals who become addicted to alcohol or drugs, despite recent headlines and ample evidence to the contrary.
“People think they’re homeless, don’t work, and have a low level of education,” Pinero, clinical director for Outpatient Behavioral Health at the Center for Human Development (CHD), told HCN. “If you ask someone to describe an addict, they may paint that picture, but they don’t realize it can happen to anyone, and they don’t think about professionals such as doctors and lawyers.
“Addiction is a medical condition, like diabetes or hypertension,” he went on. “And well-educated people who have good resources are able to hide their problems better than those who don’t.”
Amy Royal agreed. “There are high-functioning people with addiction problems who are really good at concealing it,” said the founding partner of Royal, P.C. in Northampton, whose law practice deals exclusively with employment law and representing businesses.
But whether addiction is obvious or goes unnoticed for a long period of time, it has a profound effect on the workplace. Studies show addiction costs employers roughly $250 billion annually in lost productivity, absenteeism, attrition, safety issues, workers’ compensation claims, and hidden healthcare expenditures.
The National Business Group on Health reports that employees with substance-abuse issues often fail to fulfill major work obligations at work, home, or school; use substances in situations where it is physically hazardous to do so, which can include operating or working on machinery and driving company vehicles while impaired; and have recurrent legal or financial problems. In addition, they continue to abuse substances in spite of persistent or interpersonal difficulties.
Related statistics are certainly eye-opening. The American Council for Drug Education reports that 70% of substance abusers are employed, and 75% of workers have used drugs within the past year.
Although the belief persists that people are responsible for their addiction and can choose to stop their drug or alcohol use at any time, experts say people with the problem often suffer from a mental illness and initially try to alleviate symptoms with drugs or alcohol. However, as their tolerance to alcohol or the drug rises, they need to use more and more to combat their troubling symptoms, which causes side effects such as hangovers and depression.
“The majority of clients we see with an addiction problem also have a mental-health problem,” said William Davila, vice president of clinical services for CHD, the Springfield-based social-service agency that boasts 70 programs, many of which focus on the broad issue of substance abuse in some manner.
Pinero agreed, noting that, when clients come to CHD’s Pine Street Clinic in Springfield, it’s not uncommon to find that life situations led to their addiction. “Many have a co-occurring disorder and are dealing with anxiety, depression, or a past trauma. It’s rare to see someone who only has a problem with substance addiction.”
For example, someone with post-traumatic stress disorder who suffers from anxiety, depression, frequent nightmares, or disturbing memories may self-medicate so they can stop thinking about these issues, while a person with undiagnosed bipolar disorder may try to cope with the mood swings that accompany it by using alcohol, marijuana, or cocaine purchased on the street, or medications that have been prescribed for them.
“It’s a more severe form of what occurs when someone says they had a bad day at work and need a stiff drink,” Davila said. “These people are looking for a way to alleviate stress, exhaustion, or fatigue, and many times they start with one drink or one pill, and it snowballs. The problem is often magnified when someone has a mental-health issue.”
Pinero agreed. “A lot of the clients we see are trying to cope with serious issues and are at the point of desperation,” he said, adding that many fear admitting to the problem due to the stigma associated with substance abuse and fear that they will lose their job if anyone finds out.
But they are often unable to focus while they are work due to their preoccupation about how or when they will be able to use the drug again and whether people will notice their condition.
“It adds pressure, and the increase in stress can actually cause the person to use more,” Pinero said.
For this issue, HCN wades into the tide of addiction, what employers need to know, and how they can equip themselves to cope with this issue.
Dose of Reality
Massachusetts has initiated a so-called State Without Stigma campaign in response to statistics showing that about four people in the Commonwealth die every day as a result of their addiction to opioid painkillers. The goals of the initiative include creating new pathways to treatment, reducing the stigma that prevents people from seeking help, acknowledging addiction as a chronic medical condition, and a host of concrete measures.
“If someone fell and broke their leg on the way to work, they would not be embarrassed to seek medical treatment,” Pinero told HCN. “But people with an addiction problem think they have to keep it under wraps. Eventually, it starts to consume their life.
“And if they don’t get the support they need, they are absent from work more often, late more often, and can engage in unsafe behavior,” he went on. “People with addictions are five times more likely than their co-workers to have an injury at work or injure others.”
Davila said signs that indicate an employee may have an addiction problem are many and are usually recognizable to those who know what to look for. They include unexplained absences, mood swings, changes in attitude, difficulty relating to others, a decrease in productivity, lack of focus or concentration, and work that fails to meet expectations.
On the other hand, there are people who drink excessively during lunch or during the workday and are skilled at hiding it. “By the time it’s discovered, many people have been using for months or years,” he explained.
An Opioid Task Force was created in Greenfield to cope with growing numbers of people in the Franklin County and North Quabbin regions of Massachusetts who are addicted to heroin and opiates, and it’s an example of what’s being done in many regions and cities.
The list of participating agencies and healthcare groups is lengthy, but the mission is clear: to prevent heroin and prescription-drug addiction and help people who are already hooked.
And there are many reasons to help people with addiction issues, starting with the fact that employers care about the people who work for them and value them for what they are — real assets, but also human beings.
“Employers want to do the right thing and support someone who is having a tough time,” Royal said. “There really is a desire to preserve employment, especially if someone has been a good employee and is well-liked.”
There are financial considerations as well, specifically the large investment employers have made in searching for, selecting, and training personnel.
But, since they know being under the influence at work presents liabilities and potential exposure to lawsuits, employers must conduct a delicate balancing act as they attempt to both help their employee and protect themselves from liability.
Royal cited a case in which a nursing home was sued after something went awry with a resident due to an employee’s irresponsible behavior. After the incident occurred, other employees told the family they had observed the person working in an altered state in the past, and, as a result, management was found negligent because it failed to do something about the problem.
“It can be a dilemma,” Royal explained. “An employer may really like the employee and want to help, but they need to weigh that against the risk of liability.”
She added that, in an office setting, concerns manifest themselves that have less to do with safety and more with the company’s reputation or the way it is perceived. For example, a receptionist who slurs his or her speech and has glassy eyes can be detrimental to interactions with the public or with clients.
However, the main concern for many employers is safety, which can be critical in a factory where machinery is involved, or when the person works for a nonprofit and engages in one-to-one care with a vulnerable population, as in the example of the nursing home.
Addressing the Issue
Royal gets a lot of questions about when, if ever, to insist that an employee undergo drug testing, but she says Massachusetts does not have a drug-testing statue.
“However, there is a privacy statue that is very broad and is utilized in the employment context,” she noted, explaining that mandating a drug test can be considered an invasion of privacy. However, the courts have implemented a balancing test where they weigh privacy against legitimate business interests.
Safety is considered a legitimate reason to test, but Royal noted that any employer who mandates a drug test needs objective criteria it can present to a court if it is challenged.
“I suggest that front-line supervisors document their observations in a concrete way,” she told HCN, adding that evidence cannot be subjective, and she has worked with clients to prepare a checklist of behaviors that include odor, the way someone walks and speaks, erratic behavior, shakiness, and whether the employee’s eyes appear glassy. “But first, I try to find out what an employer’s concerns are and whether or not they want to preserve the employee.”
Regardless of their goal, it’s important to provide supervisors with training regarding the legalities of what constitutes suspicious behavior.
“A supervisor needs to be able to recognize and document it, and a company shouldn’t assume the person is armed with these skills without some type of training,” Royal went on. “The supervisor also needs to understand that their role includes being accessible and present in the workplace.”
If an employer decides to confront an employee, Pinero said, they should be understanding and tell the person they want to do whatever it takes to help them keep their job and address their addiction.
“One of the best things employers can do is to establish a policy and an employee-assistance program to handle these problems,” he told HCN, adding that employers should emphasize that any information shared with employee-assistance counselors is confidential.
Davila has been a manager for many years, and says there have been times when he suspected something was wrong with an employee. But he added that erratic behavior does not always result from addiction.
“The employee may have suffered a loss in their family, have financial problems, or problems with housing that can be as distracting as addiction,” he said. “Employers don’t want to police their staff, but they need to be vigilant and proactive so they can help.”
He suggests explaining to an employee that changes have been observed in their behavior that can include mood, self-care, or asking colleagues for money. “Tell the person you are concerned, there is a program that can help, and you recommend they try it,” he advised. “You should also emphasize that you are happy to talk to them about any of their concerns.”
However, experts admit that addiction can be a lifelong struggle, and in some cases, the person isn’t ready to admit they have a problem.
Bottom Line
Addiction in the workplace is a complex issue, and despite all the media attention focused on it, outdated notions persist.
“People with addictions are not held in high esteem,” Royal said. “But it is a disease, not a conscious choice, even though people may perceive it that way.”
And there are definite benefits to helping someone recover.
“It’s a win-win situation for the employer, the person’s family, and the community,” Pinero said. “Some people start with outpatient services or peer-support programs, while others have to go to a detox program to deal with the physical aspects of addiction. But recovery is a process, and they will continue to need treatment.”
Which means employers need to be alert to potential problems and deal with them in a manner that is caring, but also addresses issues of liability.
“Just don’t be judgmental,” Pinero suggested. “Most people with an addiction want treatment, but often feel ashamed, and are waiting for someone to ask them to get help.”
