Managing Addictions in the Workplace

Dec 5 2:50 pm Infonex Whitehorse

Chris Hylton, MACG Hylton & Inc.

800 449-5866 chris@hylton.ca

Agenda

• Developing a drug & alcohol policy and communicating it to staff

• Accommodation issues surrounding addictions in the workplace

• Dealing with addiction-related misconduct• Drug and alcohol testing in the workplace• Recognition, intervention, and support:

employee, employer, and community involvement in rehabilitation, recovery, and the reintegration process

3

Do you have any workplace issues we can try and solve for you in this session?

Types of mental health : Addictions

Definition: being abnormally tolerant to and dependent on something that is psychologically or physically habit-forming

Examples: alcohol, drugs, gambling, shopping, eating, etc

What is Mental Health?

• World Health Organization defines mental health as "a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community”

5

What is Mental Health?

People learning and able to cope with:

Stress– Changes in life and the workplace– Demands in the workplace– Home life – Work life

6

What is this?

7

Freud

8

Love and work are the

cornerstones of our humanness

http://www.freud.org.uk/

and you wonder why we work?

9

• “No other technique for the conduct of life attaches the individual so firmly to reality as

the emphasis on work; for his

• work at least gives him a secure place

in a portion of reality,

in the human community”

“Therein we have one of the fundamental paradoxes we face today:

Work is good for your mental health and work can make you crazy”

Out of the Shadows at Last: Transforming Mental Health, Mental Illness and Addiction Services in Canada (2006), Standing Senate Committee on Social Affairs, Science and Technology, Honourable Michael J. L. Kirby, Chair

10

Presenteeism

Absenteeism

Extended Health Claims

Disability Claims

Lost Productivity

Effect at work

11

Mental Health – Overlapped by Addictions

25% of adults in a year have anxiety, phobias, panic attacks,

depression, bipolar/manic depression, OCD, ADHD,

schizophrenia, or suicide, with half having multiple MH

conditions at same time

45% of mental health cases also have medical conditions –

pain, heart disease, COPD, diabetes, asthma, hypertension,

cancer, sleep problems 1 in 3 mental health cases also have substance or other

addiction problems at the same time

12

Abusers in Past Year as Percentage of Adults (Canada)

20 19 15 14 2

Alcohol Tobacco Medications Marijuana Illicit Drugs

Source: Attridge & Wallace (2009), MacMillan et al. (2009)13

Behavioural Addictions Increasing

14

Addiction Rate in Adult Population

Historical Trend

Gambling 5% problem; 2% pathological

Increasing

Sex 3% to 6% Increasing

Food / Eating 5% women, <1% men Increasing

Internet Use 1% unknown Increasing

Workaholism 1% unknown Increasing

Addictions are in the Workplace

15

Most people with addictions have jobs and are actively in the workforce

Alcohol and drug use tends to be higher among smaller size employers and in certain industries: ◦ construction and oil/gas mining◦ transportation ◦ installation, maintenance and repair◦ arts, entertainment and recreation◦ accommodations and food services◦ retail service occupations

Workplace Demographics

16

It Starts Young. Younger age workers are most at risk for

developing mental health and substance abuse problems,

as these often start in the teens and early adulthood. This

age group is most relevant for prevention activities, early

screening and brief interventions.

It Gets Complicated. Older age workers may experience

declining health status due to the cumulative effects from

undertreated mental health and addiction problems. This

age group is most relevant to integrated care approaches.

Alcohol and Drug Addictions Costs to Society: Canada

17

Combined costs of: health care law enforcement work productivity disability premature death

Average $1,267 per every citizen

Source: Single et al (1996); Rehm et al (2006)

Other Workplace Consequences

18

Majority of all addiction related costs (61%) are in area of diminished on-the job work productivity and unscheduled work absence.

Addictions also are also associated with higher health care costs, worker injuries, disability claims, workgroup morale problems, job turnover, and company risks for safe work environments, equipment loss and lawsuits.

Source: Attridge (2008), Attridge (2009)

Why is the problem to difficult and complicated?

19

ANY IDEA WHAT CAUSES ADDICTIONS?

Various Theories

20

Moral Model – only a “bad person” gets addicted and can’t quit

Disease Model – what are the genetic and neurobiological factors involved?

Behavioural Model – what is rewarding to the person about their addiction?

Early Environment Stress – what kinds of toxic stress (abuse, trauma, low SES) was experienced as a youth or in past?

How does someone get addicted

21

Traditional Continuum Model of Progression Toward Substance Abuse (Alcohol/Drug):

Source: Attridge & Wallace (2010)

Epigenetic Neuroscience Research

22

• “This is an extraordinary moment in the science of mental disorders. The intellectual basis of psychiatry is shifting, from reliance on psychological principles and theory to research findings and understanding the brain through neuroscience.”

Dr. Thomas Insel, Director of the National Institutes of Health (NIH – US) (Journal of Clinical Investigations, 2009)

New Research - Epigenetics

23

Links Addictions to a Combination of Genetic and Biological Factors that Interact with Early Child Development Experiences

The Greek prefix epi- in epigenetics implies features that are "on top of" or "in addition to" genetics; thus epigenetic traits exist on top of or in addition to the traditional molecular basis for inheritance.

24

development in utero and in childhood, environmental chemicals, drugs and pharmaceuticals, aging, and diet

Results in cancer, autoimmune disease, mental disorders, or diabetes among other illnesses. National Institute of Health

Source Wikipedia: National Institute of Health

25

Care and Prevention

26

• Can the problem be treated or prevented?

Range of Treatments

27

self-help (often many failed attempts) = weak group-based peer-support programs (AA) = modesttalk therapy - cognitive behavioral therapy (CBT) =

best evidencebrief residential detox with counseling = good

evidence for severe casesRx medications and general medical care = mixed

evidenceharm avoidance programs = emerging good evidenceScreening and Brief Intervention = best evidence

What Treatments are you Familiar With?

• Have they worked?• What is the cost?• What about the relapse?• How was the return to work monitored?

Addiction is a Life-long Condition

Source: Cleck & Blendy (2008)

The Addiction Cycle Often Repeats Over Time, Even with Treatment and Can Worsen

29

Solution

30

• Screening• Brief intervention• Referral for treatment• Study by Institute for Health Economics

and Alberta Health last year• Organizational Interventions for the

prevention of Workplace Stress Jan 2009 http://www.ihe.ca/documents/Interventions_for_prevention_of_workplace_stress.pdf

Overview from “35,000 Feet”

Alcohol Screening, Brief Intervention and referral to Treatment (SBIRT) is the leading way to help employees and businesses to

reduce the impact of unhealthy alcohol use.

Screenings

Brief Intervention

Referral to Treatment and Follow-Up

SBIRTScreeningUse a valid, brief (5 minutes or less)

standardized questionnaire about quantity,frequency and consequences of alcohol use.

Referral to Treatment and Follow-up Linking your client to specialized

addiction treatment and staying with the client to support sustained success.

Brief Intervention A behavior change strategy focused

on helping your client reduce or stop unhealthy drinking.

Four Patterns of Alcohol Use

5%

20%

35%

40%

High Risk

Low Risk

Moderate Risk

No Risk

No Risk:Those who never drink alcohol.

Moderate Risk:Those who regularly exceed one of the recommended daily, weekly or occasion limits for alcohol consumption.

Low Risk:Drinkers who never exceed the recommended daily, weekly and occasion limits for alcohol consumption.

High Risk:Those who regularly exceed 2 or more of the recommended daily, weekly or occasion limits for alcohol consumption.

High Risk5%

20%Moderate Risk

35%Low Risk

40%No Risk

*Backgrounder | 2008 | The Case for Low-Risk Drinking Guidelines for BC | www.heretohelp.bc.ca

How do you know you are an alcoholic?

• Any ideas?

Alcoholism, also known as alcoholdependence, is a disease with four

primary symptoms:

• Craving − A strong need or compulsion to drink.• Loss of control − The inability to limit one’s drinking on

any given occasion.• Physical dependence − Withdrawal symptoms, such as

nausea, sweating, shakiness, and anxiety occur when alcohol use is stopped after a period of heavy drinking.

• Tolerance − The need to drink greater amounts of alcohol over time in order to get the desired effect.

Source: US Nat’al Institute on Alcohol Abuse & Alcoholism

Workplace Solutions - Morale

• Make the work place a positive place!– Celebrate birthdays– Celebrate holidays– Team building exercises: staff day at the

movies, staff day in the park, etc

• Sit fighting co-workers down and help solve the issues between them

• Teambuilding workshops• Have a zero tolerance policy

35

36

• Performance Appraisal• Make it employee focused• Career path• Training• Tools they need• Job description updated

Workplace Solutions – HR Forms

• NO BULLYING!

• Bullying any co-worker on or off the workplace is still an offense

• Creates low self-esteem and toxic work environment

37

Workplace Solutions – HR Policies

• Absenteeism Management

• Establish average absentee rate

• Place those x% above, in an Absenteeism Management Program

38

Workplace Solutions – HR Policies

Policies are only as good as their communication

Managers need support on how to act and react

Workplace Solutions: Manager Training Agenda

What do substances look like? What do they do?

Enabling, Privacy, Rights

ER and EE Obligations

Treatment, Support, Accommodation

Performance Management

Prevention, Recognition, Response Skills

39

40

What is an “Employer of Choice”?

• Any employer of any size in the public, private or not-for-profit sector that attracts, optimizes and retains top talent… because the employees choose to be there

Work Life Balance

• It is important to find the balance in life: family, work, school, and any other side projects or important aspects of your life

• Canadian workers spend about 60% of their waking hours at work

Workplace Wellness

“Research shows that most employees believe the workplace is an appropriate and effective place to promote health and well-being

issues.”

Solution: Prevention!

Planned action to stop the development of addictive behaviours, and promote health enhancing behaviours

Physical Solutions

• Prevent physical illnesses by offering employees time to stretch, walk, exercise, etc

– For example: offer gym memberships

• If one person is sick in the office, send them home! One person sick is better than everyone being sick.

Workplace Solutions

• Make the work place a positive place!– Celebrate birthdays– Celebrate holidays– Team building exercises: staff day at the movies,

staff day in the park, etc

• Sit fighting co-workers down and help solve the issues between them

• Have a zero tolerance policy

Management Support

• Wellness programs

• Have an open door policy

• Listen to your staff and make sure they’re happy where they are

Workplace Wellness

• Does anyone have any programs they wish to talk about please?

Trend #2 - Health and Wellness Programs

48CG Hylton 48

Why? Employee Productivity

• Absenteeism• Presenteeism• Stress• Chronic Disease

CG Hylton 49

Common Chronic Disease Risk Factors

High Blood Pressure

Type 2 Diabetes

High Cholesterol

COPDLung

Cancer

Respiratory Disease

Cancer of Pancreas, Bladder, Kidney

Colon Cancer Breast

Cancer

ProstateCancer

Cancer of mouth, pharynx,

larynx, esophagus, liver

Heart Diseas

eMental

Disorders

Overweight/ Obesity

TobaccoSmoking

Unhealthy Diet

Physical Inactivity

AlcoholConsumption

Musculoskeletal

Renal Disease

Source: Ontario Ministry of Health and Long-term Care

CG Hylton 50

Employee Health Today

Most individuals are stuck in the “pre or contemplation” stage, High risk individuals will change health behaviors given the right coaching. Challenge for Employers: Engage employees who want to make this change

ContemplationPreparation

ActionMaintenance

Completion

Pre-contemplation

Risky Behavior

Permanent Behavior Change

Source: Mike Humphrey and Erika Van Flein of the University of Alaska.

51CG Hylton 51

What is an EAP?

• Mental health assistance for EEs and their families

• So EEs may concentrate on work• Short service model• Coordinates response to critical incidents

in the workplace• Deals tangentially with addictions

52

53

Typical Reasons for Calls to EAP

Substance Abuse

Family

Stress

Depression

Alcohol

Workplace

25%

22%

25%

18% 8%

54

Reasonable Cost

• EAP costs fraction of average medical or dental plan

• $200 per ee per mo for Dental insurance• $5 per ee per mo for EAP

What Price?

55

Stitch in time

• If mentally, employees believe “I am disabled” is their natural state = difficult to cure

• “I am temporarily having some difficulties that I with help of the EAP I will be able to overcome!” = easy to cure

• Prevention key

EAP Cost

• Our EAP• No cost to set up• $125 per hour cost

• Less expensive than programs that charge a set amount per ee per month

56

Cost Comparison

• 100 ees• 5% use plan• 3 sessions each• 15 sessions x 125 = $1,825

• vs 100 x $4.50 x 12 = $5,400

Case Study - Jack

58

Safety-sensitive, oilfield construction

Knee surgery due to work accidentseveral years before

Military Veteran, previous treatment for PTSD

Missing work — leaving early, coming in late, called in sick, spoke to YOU

Expressed suicide wish, disclosed drug use, asked for help

Response to Jack

59

Immediate appointment toassess safety and stabilize

Immediate EAP or substance abuse specialist

Employer input to counsellor

• Observations of behaviour• Performance• Previous assessments/testing• Any other pertinent work history

• In cooperation with EAP Program

• Set schedule of counselling appointments over 24 months

• Monitoring of compliance with substance abuse recommendations, e.g. inpatient treatment, abstinence, & 12-step programming

• Regular reporting of attendance

• Option to coordinate on-going substance testing

2 Year Relapse Prevention Program

60

61

Drug & Alcohol Testing

• Discrimination rules• No pre-employment

testing• No random drug

testing• No alcohol testing

for non-safety sensitive positions

• Safety sensitive position is one where impairment due to drug or alcohol use could result in injury to self or others

When Can you Test?

63

When can you test?

• Random alcohol testing for safety sensitive positions ok

• Drug or alcohol testing for “reasonable cause” or “post-accident” is ok

How nice should you be?

64

Consider: Is it better to fight discrimination suit than injury or death claim caused by a drunk or impaired employee?

Disclaimer: I am not a lawyer

Face to face Therapy

Research conclusively shows that traditional face-to-face (FTF) psychotherapy is generally effective for mental health issues

Mental health and addiction problems are common to the workforce, overlap with many medical conditions and have negative consequences for the person and the company

Source: Lipsey & Wilson (1993), NICE (2008), Seeling & Katon (2008)

65

Access not always possible

But, access to and use of FTF treatment is problematic. Less than 1 in 3 people affected get quality care FTF care also is not uniformly effective for

all patients even when received

66

67

•Telephonic therapy for mental health has been tested in more than 30 research studies.

·The general conclusion is that telephonic therapy is effective or at least promising in most of the empirical tests conducted. Cognitive Behavioral Therapy (CBT) has been the most commonly used form of intervention.

·Telephonic therapy services are effective for many conditions: Anxiety, depression, panic disorders, substance abuse, trauma, PTSD, and others.

Summary of Research Internet Counselling

68

• Internet-based forms of psychotherapy (e-mail andweb tools) also shows initial support in over 20 research studies; many with RCT study designs.

·Online therapy services and tools appear to work best for certain kinds of patients, when used to support other ongoing therapy, and for use as self-care and relapse prevention.

·Positive clinical outcomes have also been obtained with therapist use of the Internet to interact via e-mail for patients with depression, anxiety, social phobias, PTSD, eating disorders, and panic disorder.

·Source: Griffiths & Christensen (2006), Reger & Gahm (2009)

Summary of Research Internet Counselling

69

Conducted in UK by Kessler et al. (Lancet, 2009)

It used an online, real-time CBT intervention for 113 patients, compared to 97 cases with care as usual by a general medical practitioner.

In-person assessment of diagnosis and symptom severity, followed by a series of ten hour-long sessions of online text-based (e-mail) interaction with a mental health therapist.

After treatment, more patients recovered from depression in the online treatment group (38%) than in the control group (23%). This effect also was found at 8-month follow-up (42% and 26%).

Source: Kessler et al. (2009)

What did we miss?

Developing a drug and alcohol policy and communicating it to staff

Accommodation issues surrounding addictions in the workplace

Dealing with addiction-related misconduct

Recognition, intervention, and support: employee, employer, and community involvement in rehabilitation, recovery, and the reintegration process

W75

Thank You!

Questions?

Resources America’s Health Insurance Plans - www.ahiphiwire.org/wellbeing

Centers for Disease Control - www.cdc.gov/nchs/fastats/hinsure.htm

Canadian Institute for Health Information - www.cihi.ca

EASNA www.easna.org/purchasers.php

Gallup-Healthways Well-Being Index™ - www.well-beingindex.com

Health Canada – Healthy Living - www.hc-sc.gc.ca/hl-vs/index-eng.php

Health Promotion Advocates http://healthpromotionadvocates.org/sources_detail_documents.htm

IHPM - Institute for Health and Productivity Management - www.ihpm.org

Mental Health Commission of Canada - www.mentalhealthcommission.ca

National Wellness Institute - www.nationalwellness.org

WorldatWork: global human resources association focused on compensation, benefits, work-life and integrated total rewards - www.worldatwork.org

77