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

1. Managing Addictions in the
Workplace
Dec 5 2:50 pm Infonex Whitehorse
Chris Hylton, MA
CG Hylton & Inc.
800 449-5866 chris@hylton.ca

2. 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?
3

4. 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

5. 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

6. 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

7. What is this?
7

8. Freud
Love and work
are the
cornerstones of
our humanness
http://www.freud.org.uk/ 8

9. and you wonder why we work?
• “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”
9

10. “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

11. Presenteeism
Absenteeism
Extended Health Claims
Disability Claims
Lost Productivity
11

12. 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

13. 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

14. Behavioural Addictions Increasing
Addiction Rate in Adult Historical Trend
Population
Gambling 5% problem; 2% Increasing
pathological
Sex 3% to 6% Increasing
Food / Eating 5% women, <1% men Increasing
Internet Use 1% unknown Increasing
Workaholism 1% unknown Increasing
14

15. Addictions are in the Workplace
 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
15

16. Workplace Demographics
 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.
16

17. Alcohol and Drug Addictions Costs
to Society: Canada
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) 17

18. Other Workplace Consequences
 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) 18

19. Why is the problem to difficult and
complicated?
ANY IDEA WHAT CAUSES
ADDICTIONS?
19

20. Various Theories
 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?
20

21. How does someone get addicted
 Traditional Continuum Model of Progression
Toward Substance Abuse (Alcohol/Drug):
Source: Attridge & Wallace (2010) 21

22. Epigenetic Neuroscience Research
• “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)
22

23. New Research - Epigenetics
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.
23

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
24

25. 25

26. Care and Prevention
• Can the problem be treated or prevented?
26

27. Range of Treatments
self-help (often many failed attempts) = weak
group-based peer-support programs (AA) = modest
talk therapy - cognitive behavioral therapy (CBT) =
best evidence
brief residential detox with counseling = good
evidence for severe cases
Rx medications and general medical care = mixed
evidence
harm avoidance programs = emerging good evidence
Screening and Brief Intervention = best evidence
27

28. What Treatments are
you Familiar With?
• Have they worked?
• What is the cost?
• What about the relapse?
• How was the return to work monitored?

29. Addiction is a
Life-long Condition
The Addiction Cycle Often Repeats Over Time, Even with Treatment
and Can Worsen
Source: Cleck & Blendy (2008)
29

30. Solution
• 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_pre
vention_of_workplace_stress.pdf
30

31. “
”
SBIRT
Screening
Use a valid, brief (5 minutes or less)
Alcohol Screening, Brief Intervention and referral to Treatment
standardized questionnaire about quantity,
Brief Intervention
(SBIRT) isfrequency and consequences of alcohol use.
the leading way to help employees and businesses to
A behavior change strategy focused
reduce the impact of unhealthy alcohol use.
on helping your client reduce or
Referral to Treatment and Follow-up
stop unhealthy drinking.
Linking your client to specialized
Screenings
addiction treatment and staying with the
client to support sustained success.
Brief Intervention
Referral to Treatment and Follow-Up

32. High Risk:
Those who regularly exceed 2 or more of the recommended
5% daily, weekly or occasion limits for alcohol consumption.
High Risk
Moderate Risk:
Those who regularly exceed one of the recommended
20% daily, weekly or occasion limits for alcohol consumption.
Moderate Risk
Low Risk:
Drinkers who never exceed the
35% recommended daily, weekly and
occasion limits for alcohol consumption.
Low Risk
No Risk:
40% Those who never drink alcohol.
No Risk
*Backgrounder | 2008 | The Case for Low-Risk
Drinking Guidelines for BC | www.heretohelp.bc.ca

33. How do you know you are an
alcoholic?
• Any ideas?

34. Alcoholism, also known as alcohol
dependence, 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

35. 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. Workplace Solutions – HR Forms
• Performance Appraisal
• Make it employee focused
• Career path
• Training
• Tools they need
• Job description updated
36

37. Workplace Solutions – HR Policies
• NO BULLYING!
• Bullying any co-worker on or off the
workplace is still an offense
• Creates low self-esteem and toxic work
environment
37

38. Workplace Solutions – HR Policies
• Absenteeism Management
• Establish average absentee rate
• Place those x% above, in an Absenteeism
Management Program
38

39. Workplace Solutions: Manager Training Agenda
What do substances look like?
What do they do?
Policies are only as
good as their Enabling, Privacy, Rights
communication ER and EE Obligations
Managers need
Treatment, Support,
support on how to
Accommodation
act and react
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
40

41. 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

42. Workplace Wellness
“Research shows that most
employees believe the workplace is
an appropriate and effective place
to promote health and well-being
issues.”

43. Solution: Prevention!
 Planned action to stop the development of
addictive behaviours, and promote health
enhancing behaviours

44. 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.

45. 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

46. Management Support
• Wellness programs
• Have an open door policy
• Listen to your staff and make sure they’re
happy where they are

47. Workplace Wellness
• Does anyone have any programs they wish to
talk about please?

48. Trend #2 - Health and Wellness Programs
48
CG Hylton 48

49. Why? Employee Productivity
• Absenteeism
• Presenteeism
• Stress
• Chronic Disease
CG Hylton 49

50. Common Chronic Disease Risk Factors
Tobacco Unhealthy Physical Alcohol
Smoking Diet Inactivity Consumption
Overweight/
Obesity
High Blood Type 2 High
Pressure Diabetes Cholesterol
COPD Heart Mental
Disease Renal Disorders
Lung
Disease
Cancer
Respiratory Cancer of mouth,
Cancer of Prostate
Disease pharynx, larynx,
Pancreas, Colon Cancer
Bladder, Kidney esophagus, liver
Cancer Breast
Cancer Musculoskeletal
Source: Ontario Ministry of Health and Long-term Care
CG Hylton 50

51. 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
Permanent Behavior
Change
Completion
Maintenance
Action
Risky Behavior
Preparation
Contemplation
Pre-contemplation
Source: Mike Humphrey and Erika Van Flein of the University of Alaska.
51
CG Hylton 51

52. 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
Work
place Family
18% 8%
25%
Alcohol
Substance Abuse
25%
Depression
22% Stress
53

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?
54

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
55

56. 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

57. 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

58. Case Study - Jack
 Safety-sensitive, oilfield construction
 Knee surgery due to work accident
several 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
58

59. Response to Jack
 Immediate appointment to
assess 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 59

60. 2 Year Relapse Prevention Program
• 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
60
testing

61. Drug & Alcohol Testing
• Discrimination rules • Safety sensitive
• No pre-employment position is one
where impairment
testing
due to drug or
• No random drug alcohol use could
testing result in injury to
• No alcohol testing self or others
for non-safety
sensitive positions
61

62. 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
63

64. How nice should you be?
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
64

65. Face to face Therapy
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
Research conclusively shows that
traditional face-to-face (FTF) psychotherapy
is generally effective for mental health issues
 Source: Lipsey & Wilson (1993), NICE (2008), Seeling & Katon (2008)
65

66. 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. 67

68. Summary of Research
Internet Counselling
• Internet-based forms of psychotherapy (e-mail and
web 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) 68

69. Summary of Research
Internet Counselling
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)
69

70. What did we miss?

71. Developing a drug and alcohol policy
and communicating it to staff

72. Accommodation issues surrounding
addictions in the workplace

73. Dealing with addiction-related
misconduct

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

75. W
75

76. Thank
You!
Questions
?

77. Resources
 America’s Health Insurance Plans - www.ahiphiwire.org/wellbeing
77
 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