Chemical dependency disorders in the workplace are a costly and dangerous proposition for your organization and your employees. But less than half of Orange County adults who need care for mental health or substance abuse services go on to receive treatment. St. Joseph Hoag Health is on the front lines of this public health crisis, offering programs and resources throughout Orange County to help those struggling with addiction to alcohol, prescription painkillers and other drugs. We spoke with Marshall Moncrief, regional executive director of the St. Joseph Hoag Health Institute for Mental Health & Wellness, to understand the nature of workplace addiction, why it matters to your business and how to manage it.

Q: What is addiction?

Addiction is a mental illness—a disease that afflicts the decision-making sectors of the brain.

People tend to think of addiction as bad behavior or weak morals. We have this image of the typical “drug addict” as a desperate indigent, in a back alley, robbing people for drug money. While that’s an unfortunate reality for some who struggle with addiction, it’s an outdated image that does not apply to most. At St. Joseph Hoag Health, we treat teachers, firefighters, executives, even nurses and physicians—professional people and contributing members of the community, from very good families and all walks of life.

Like almost any other disease, addiction can be treated very effectively. But only if we first de-stigmatize addiction and acknowledge that it’s a legitimate medical condition.

Q: What is the root cause of addiction in the workplace?

In a word, stress.

Stress is a major health hazard in the workplace, with both physical and mental consequences. Some occupations are intrinsically stressful—especially life-or-death jobs like nursing, firefighting, and police work. But the leading causes of workplace stress can be found in any organization—everything from long hours, high expectations, job insecurity, and lack of empowerment to more extreme conditions like fear of bullying or harassment.

Some workers try to alleviate stress by relaxing after work with alcohol or drugs. The problem is, people often don't understand the strength of these substances—the stranglehold they can have on the brain. For some folks, it’s a short step from self-medication to addiction.

Q: How can you tell if an employee is an addict?

The first point I should make is that “functional addiction” can fool the most observant HR professional. This is partly because, as I mentioned, the stereotypical image of the addict can blind us to reality.

In addition, the addictive substances of choice are changing in ways that can be harder to detect. Say an employee is struggling with alcohol addiction. Alcohol is a difficult substance to consume at work. Plus, chances are someone would eventually smell alcohol on their breath. But what about the addictive opioids we’ve all heard about on the national news? Pills are tiny little things that are easily put in a purse or pocket, only to be ingested sitting at a desk somewhere, without anybody knowing.

That said, thereare telltale signs that employers can look for as potential early warning signs of addiction:

• Unexplained absences, tardiness, or accidents
• Anxiety or nervousness
• Chronic underperformance, frequently missed deadlines, less attention to detail
• Increasing withdrawal or changes in social networks
• Physical symptoms such as uncharacteristically high or low energy, bloodshot eyes, impaired coordination, slurred speech, unusual breath or body odor

Q: Why does addiction in the workplace matter to employers?

I’ve had many conversations with employers who express skepticism and frustration on this topic. They simply don’t understand why their employees’ addiction is their problem. While I understand this skepticism—and I’m completely empathetic to their plight—there are many compelling reasons for employers to embrace this issue.

First and foremost, undiagnosed mental illness—including substance addiction—can cost an organization heavily through absenteeism, “presenteeism,” diminished productivity, and excessive health care expenses.

Second, since addiction is a legitimate medical illness, it should receive the same high-caliber, compassionate care as any other disease. Most if not all employers agree that employer-funded health care is appropriate for cancer, heart disease, diabetes, or any other physical ailment. So why not addiction?

Third, a given proportion of your employees will suffer from addiction, no matter what. Cities in Orange County’s coastal and southern regions have higher rates of hospitalization and death from drugs and alcohol than other cities. But regardless of industry, geography, or demography, a more or less consistent percentage of the workforce—your workforce—will suffer from addiction. As I like to say, the numbers don’t deviate, and addiction doesn’t discriminate. Therefore, I advise employers to accept this basic reality and implement strategies to anticipate, manage, and minimize its negative impact.

The biggest challenge with addiction in the workplace is the persistent stigma. Addicts don’t usually appreciate how much their addiction interferes with their performance. But even if they do understand, the stigma of addiction prevents them from seeking help. They’re simply not going to raise their hand and say, “Boss, I’m having a problem with pills—I’d better take some time off and get a handle on this.”

By the same token, many employers have an outdated conception of addiction as a behavioral or moral problem. Nobody involved understands that addiction is a legitimate medical illness that can and should be treated.

Q: How should employers manage workplace addiction?

More than anything else, employers should embrace current evidence and best practices around addiction care.

We’ve had workers—teachers, nurses, firefighters—whose employers have a more enlightened understanding of addiction as a mental illness. The results have been amazing. By interweaving this acceptance into the culture of the organization—time off, appropriate medical intervention, ongoing medical monitoring—those companies are signaling to all their employees that it’s OK to admit you have an addiction problem and to seek help.

Beyond this, there are a handful of straightforward strategies that seem to work well:

• Partner with your insurance, EAP, and mental health providers to design robust programs that have the greatest likelihood of success
• Update or reinforce your policies and testing for prescription drugs—especially opioid-based drugs
• Invest in knowledge, education, and training for your employees—at all levels
• Ensure confidential access to appropriate assistance and treatment covering (at minimum):
  • Detoxification
  • Counseling
  • Medication replacement therapies

Q: What is the employee’s responsibility for addiction management?

When I talk to employers about addiction issues, I always stress that this is a two-way street. Just because addiction is a legitimate medical illness, that’s not a free pass for problematic and sometimes criminal behaviors. It’s the addict’s responsibility to manage their illness—just like people with type 1 diabetes have to manage their illness. But, again, employers can play a very compelling role in creating the environment, the openness, and the compassion—which changes the culture at large.

At the end of the day, we should all want the same thing. Healthy individuals, healthy businesses, and healthy communities.

For over 30 years, St. Joseph Hoag Health has had some of the best-respected addiction treatment programs in Orange County. We’re embedding mental health clinicians in our primary care offices—to be a stronger support system for our primary care physicians—and to enhance screening for substance abuse and mental health challenges.

To learn more: Contact us at (949) 381-4777 to learn more about our continuum of mental health care, including inpatient and outpatient treatment for chemical dependency, depression, bipolar disorder, and other psychiatric and behavioral health issues.

Sources:

http://www.ochealthiertogether.org/index.php?module=indicators&controller=index&action=view&indicatorId=51&localeId=267

http://www.ochealthinfo.com/about/admin/pubs/od