This document provides an overview of a presentation on substance abuse and prevention in the workplace. The presentation covers key topics such as indicators of substance abuse, addictions, prevention strategies, return-to-work strategies, employee assistance programs, drug and alcohol testing, and maintaining positive workplace morale and mental health. Effective solutions involve screening, brief interventions, treatment referrals, and changing workplace policies and culture to promote wellness and prevent problems.
3. 3
Do you have any workplace issues we
can try and solve for you in this
session?
4. What is Mental Health?
4
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?
5
People learning and be able to cope with:
Stress
Changes in life and the workplace
Demands in the workplace
Home life
Work life
6. Freud
6
Love and work
are the
cornerstones
of our
humanness
http://www.freud.org.uk/
7. and you wonder why we work?
7
―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. 9
“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. 10
Why does this matter to
Canadian employers?
Making the case
11. 11
Presenteeism
Absenteeism
Extended Health Claims
Disability Claims
Lost Productivity
12. Stress in the Workplace - 3 in 10 at risk
12
Sector Serious Significa Total % Reporting Risk
Concerns nt
Concerns
Manufacturing 5% 33% 38%
Public 3% 29% 32%
Administration
Health Care 4% 28% 32%
and Social
Assistance
Retail Trade 4% 24% 28%
Finance and 2% 22% 24%
Insurance
13. Mental Health – Overlapped by
13
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 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
14. Abusers in Past Year as Percentage
14
of Adults (Canada)
20 19 15 14 2
Alcohol Tobacco Medications Marijuana Illicit Drugs
Source: Attridge & Wallace (2009), MacMillan et al. (2009)
15. Behavioural Addictions
15
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
16. Addictions are in the Workplace
16
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
17. Workplace Demographics
17
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.
18. Alcohol and Drug Addictions Costs
18
to Society: Canada
$ Billions Combined costs of:
39.8 health care
law enforcement
work productivity
disability
premature death
8.9
Average $1,267
per every citizen
1992 2002
Source: Single et al (1996); Rehm et al (2006)
19. Other Workplace
19
Consequences
Majority of all addiction Costs of
related costs (61%) are in Addictions
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 Work Productivity
company risks for safe work All Other Areas
environments, equipment
loss and lawsuits.
Source: Attridge (2008), Attridge (2009)
20. Case Study - Jack
20
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 Manager
Expressed Suicide wish, disclosed
drug use, asked for help
21. Response to Jack
21
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
22. Two-Year Relapse Prevention Program
22
In cooperation with EAP Program
Set schedule of counselling appointments
over 24 months
Review and 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
23. Why is the problem to difficult and
23
complicated?
ANY IDEA WHAT
CAUSES ADDICTIONS?
24. What ―Causes‖ Addictions
24
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?
25. How does someone get addicted
25
Traditional Continuum Model of Progression
Toward Substance Abuse (Alcohol/Drug):
Source: Attridge & Wallace (2010)
26. Epigenetic Neuroscience Research
26
―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)
27. New Research - Epigenetics
27
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.
28. 28
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
32. Range of Treatments
32
self-help (often multiple failed attempts) = weak evidence
group-based peer-support programs (AA) = modest evidence
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
TRENDS = Gender differences & Holistic treatment model
best
33. Addiction is a
33
Life-long Condition
The Addiction Cycle Often Repeats Over Time, Even with
Treatment and Can Worsen
Source: Cleck & Blendy (2008)
34. Rx Treatments for Addictions - Limited &
Often Ineffective
34
Effective treatments for drug abuse involve both behavioral therapy
and medication.
However - the list of medications approved for treatment of
addiction is quite limited.
Many of the medication treatments available are only given when
the addict is actively using the addictive substance.
Thus, very few treatments are prescribed during the critical
withdrawal period when needed to prevent relapse.
No medications for addictions are available for prevention.
Source: Cleck & Blendy
2008
35. Solution
35
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_pr
evention_of_workplace_stress.pdf
36. Solution: Changing the Workplace to
Prevent Problems and Support Workers
36
Research has consistently revealed that
interventions delivered at the organizational
level are needed and also tend to be often
more effective than traditional interventions
delivered at the individual level because
they address the prevention of problems.
Employee ―Engagement‖ in Work
Family Leave Benefits & Flex Scheduling
Positive Corporate Culture
Psychological Safety Legal Context
Source: Attridge et al. (2009), Barling (2007), Bergerman et al. (2009), Harvey et al. (2006),
Richardson & Rothstein (2008)
37. Workplace Solutions - Morale
37
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
38. Workplace Solutions – HR Forms
38
Performance Appraisal
Make it employee focused
Career path
Training
Tools they need
Job description updated
39. Workplace Solutions – HR Policies
39
NO BULLYING!
Bullying any co-worker on or off the workplace
is still an offense
Creates low self-esteem and toxic work
environment
40. Workplace Solutions – HR Policies
40
Absenteeism Management
Establish average absentee rate
Place those x% above, in an Absenteeism
Management Program
41. Workplace Solutions: Manager Training
Agenda
41
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, Accommod
support on how to
ation
act and react
Performance Management
Prevention, Recognition, Respo
nse Skills
43. What is an
43
―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
44. Which results in
44
Employees choosing to work or
continue to work for your
organization… even when presented
with other and more enticing
employment opportunities
46. Corporate programs - EAP
46
A program that offers:
short-term, professional counselling and referral
services
support in dealing with a wide range of stressful
situations (personal/work related)
assistance and advise
Services are free and confidential
47. What is an EAP?
47
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
48. Typical EAP Usage
48
8-12% (2007) (avg range from 2 of 3
major Canadian EAP providers)
11% in 1997 (Can Federal Public Service)
25% in a mine, where the counsellor was
a former miner who just hung out for
coffee with the miners
49. Typical Reasons for Calls to EAP
49
Work
place Family
18% 8%
25%
Alcohol
Substance Abuse
25%
Depression
22% Stress
50. Reasonable Cost
50
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?
51. 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
51
52. Drug & Alcohol Testing
Discrimination rules Safety sensitive
No pre-employment position is one
testing where impairment
No random drug due to drug or
testing alcohol use could
result in injury to self
No alcohol testing
or others
for non-safety
sensitive positions
52
53. When can you test?
Random alcohol testing for
safety sensitive positions ok
Drug or alcohol testing for
―reasonable cause‖ or ―post-
accident‖ is ok
53
54. 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?
54
55. Face to face Therapy
55
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)
56. Access not always possible
56
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
57. 57
•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.
58. Summary of Research
58
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)
59. Summary of Research
59
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)
60. EASNA’s 2009 Purchaser’s Guide to
EAPs
Selecting and Strengthening
Employee Assistance
Programs:
A Purchaser’s Guide
60
63. Resources
America’s Health Insurance Plans - www.ahiphiwire.org/wellbeing
63
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
64. Our offer to you
64
Please call if you have any HR, or workplace
issue that you are overwhelmed with
We can help you
We also are pleased to do Free Workshops for
your organization (some limits apply) Let us
know what your needs are and we will make it
happen!
65. CG Hylton - Services
HR Consulting Benefits, Pensions,
Job Descriptions EAP
Strategic Planning
Salary Grids
Drug and Alcohol
Wellness at Work
programs
Staff Morale
Dept re-orgs
Training and
Leadership
Workshops
compensation
Tel 403 264 5288
chris@hylton.ca
65
66. Thank you for the opportunity to
66
meet today!
Tel 403 264 5288
or 800 449 5866 (800 4hylton)
chris@hylton.ca
Hinweis der Redaktion
What does this mean for the workplace?
Freud said some funny things but he did make some astute observations: “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”Marie Jahoda, positive mental health movement, pointed out that work Provides structure, Provides social meaning, Provides opportunity for social interaction , Provides an identity…. Not to mention- provides an incomeHowever, multiple studies have demonstrated increasing rates of workplace distress, demoralization and disabilitye.g. 2002: Health Canada study suggest that there is a work/life imbalance- that the lack of balance is getting worse, especially for middle managers and public sector.
Does this mean work or the workplace causes mental illness?Not really, as we do not know the exact cause of any disorders, likely a combination of biogenetic and psychosocial factors which will vary from person to person.But, a psychologically unhealthy work environment can contribute to the onset and severity of a disorderWhile at the same time, a psychologically healthy environment can prevent the likelihood and minimize the severity of a disorder
The cycle of addiction. Following the initial exposure to an addictive sub- stance, acquisition of drug taking occurs, in which infrequent drug taking escalates into chronic drug use. Periods of chronic drug use are followed by intervals of withdrawal. These periods of abstinence from the addictive drug can last days, weeks, months, or years. However, most addicts do not remain drug free and relapse back into drug use, creating a vicious cycle. Stress can exacerbate drug taking throughout this process facilitating initial drug exposure, increasing acquisition of drug taking, and causing a relapse to drug-taking behavior during withdrawal. Source: Attridge PNWER presentation
Institute for Health Economics and Alberta Health, Jan 2009