Expert Interview transcript: Substance Misuse in the Workplace

May 30, 2018 from the CDC Workplace Health Resource Center

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[BACKGROUND MUSIC]

ANNOUNCER: This expert interview is a product of the Workplace Health Resource Center at the Centers for Disease Control and Prevention.

CASEY: Well, hello folks. Substance misuse, either by employees, or their family members, or loved ones, has a tremendous negative impact on American workers, workplaces, employers, and really our economy as a whole. So what should employers know about substance misuse? And perhaps more importantly, what can they do about it? Today we’re going to explore this very important intersection between work and the epidemic of substance misuse that is growing in our nation.

My name is Dr. L. Casey Chosewood. I’m the Director of the Office for Total Worker Health within the National Institute for Occupational Safety and Health. We’re part of the Centers for Disease Control and Prevention, or CDC. And today I’m joining you from our CDC headquarters in Atlanta. As I mentioned, the topic for this expert interview is substance misuse in the workplace. And today I’m very pleased to be talking with you with two very well-informed experts on the subject: Dr. Deborah Galvin and Dr. Laurie Cluff.

Let me just start with a brief introduction for each of them. Dr. Deborah Galvin works for SAMHSA: the Substance Abuse and Mental Health Services Administration. This is part of the U.S. government’s Department of Health and Human Services in Washington, D.C. Deborah serves as a federal lead for preventing prescription abuse in the Workplace Technical Assistance Center. Dr. Laurie Cluff is a workplace health and safety research psychologist at RTI International: a research and technical services company located in Research Triangle Park, North Carolina.

Laurie’s work supports SAMHSA’s projects to prevent substance misuse. Let me start now welcoming both you Deborah and you Laurie. We’re so happy that you could join today for our discussion.

LAURIE: Thanks, Casey.

DEBORAH: Thank you very much.

CASEY: Well, let’s get started. It’s certainly no surprise to many in our audience, and certainly no surprise at all to our experts, that the nation is really facing a public health crisis right now around substance misuse, and unfortunately a rapidly escalating increase in overdose deaths. We’re on pace now for more than 65,000 deaths in 2018. We really need your help. Can you both help our employers understand the impact of substance misuse on their own workers and on their business as a whole? Deborah, I’m going to ask you to start us off today.

DEBORAH: Yes, thank you. Well, substance misuse is really a growing challenge for American businesses. Over the last five years there’s been a rise in the misuse of alcohol and drugs at work, which can potentially lead to negative health, economic, and personal consequences for employees and their families such as: addiction, the risk of overdose, liver, cardiovascular, and neurological damage, emotional and financial stress, injury, and a slew of other harm.

The use of drugs or alcohol by employees inside or outside the office can be costly for businesses leading to increased turnover rates, negative workplace incidents, poor workplace morale, and unpredictable, defensive interpersonal relations. The impact on those having the problem, as well as their colleagues, is huge. According to findings of the Hazelden Foundation, six out of ten adults knows someone who has reported for work while under the influence of alcohol or drugs.

In financial terms, the National Council on Alcohol and Drug Dependence estimated alcohol and drug misuse cost United States businesses over $81 billion annually in lost productivity and it causes employers to incur a 300 percent increase in medical costs and benefits. In human terms, up to 40 percent of industrial fatalities and 47 percent of industrial injuries can be linked to alcohol consumption and alcoholism.

And much more when you consider prescription drugs and illicit drugs; indeed it’s been estimated that those misusing opiates alone cost employers nearly twice as much in healthcare expenses as others: approximately $9,000 a year. Substance abusers are five times more likely to file a workers’ compensation claim, and also likely to use two and a half times more medical benefits.

Further, according to a study by the National Drug Intelligence Center at the Department of Justice, substance misuse accounts for over $49 billion in reduced workdays. Whether in a factory, office, or driving a vehicle, employees under the influence of drugs or alcohol can be physically and/or mentally impaired-leading to reduced productivity, quality of work, customer satisfaction, and profits.

Their drug use is related to increased accidents, legal liabilities, medical claims and workers’ compensation payouts, sick leave, absenteeism, product defects, misuse – I mean missed deadlines, incomplete projects, equipment damage, loss, theft, selling of drugs on the job, and the cost of diverting company resources to address these problems, which could have been used for other purposes.

The preoccupation with obtaining and using substances also interferes with attention and concentration. Businesses also bear the cost of recruiting, hiring, and training new employees to replace those who can no longer work due to substance misuse or overdose, as well as the cost of supervisors and human resource personnel-diverting their focus to address substance misuse issues and many other hidden and indirect costs. Laurie?

LAURIE: That’s right, Deborah. And just to say it another way: whether you work in an office, in a retail establishment, a restaurant, or a school you’re employs or your coworkers may be struggling right beside you with substance use problems. Just to throw a couple more numbers at you, about 7.2 million U.S. adult workers recording misusing an opioid at some point in the past year. And national surveys conducted by the government estimate that about three-quarters of adults who have a substance use disorder are employed.

So we’re not talking about people who are not in the workforce. Three-quarters of them are employed. Now we know that some industries have higher rates of employee substance misuse than others, and some of those higher-rate industries include construction, the arts and entertainment industry, and food service. And then on the other hand, some industries we know have lower rates, and these would include federal, state, and local government, education, and health and human services.

But it’s important to remember that no industry is free from these issues. So we’ve also done some research and we know that the industries with the highest levels of misuse are often male-dominated, and they often have a younger workforce. But even when we’ve removed the effects of gender and age, we’ve found that still employees in the construction, and entertainment, and food service, and other industries still have higher rates of misuse than some of the other industry groups.

And we know that there are factors that are just a part of some occupations that are associated with increased substance use risk. So some of these risk factors include higher than normal injury rates, high stress, exposure to traumatic events as part of the work, variable working hours or sometimes shift work that can disrupt sleep patterns, and also having really ready or easy access to drugs and alcohol.

CASEY: Thanks so much to both of you for helping paint a very clear picture of the challenges that really are facing employers in this space. I especially like, Laurie, your mention of how oftentimes difficult working conditions, really the demands of jobs, and how jobs are designed and the requirements of those jobs that are really an important risk factor for this crisis. Let’s sort of take a deeper look at this challenge.

Let’s sort of move to the role that employers can play in preventing this problems, and oftentimes workplaces are having to deal with the issue, but it’s always great from a public health perspective if we can swim upstream and think of ways that we can actually prevent substance misuse using the structure and the power of the workplace, so Laurie, let me start by posing that question to you.

LAURIE: Okay, great. Well, employers are really in a unique position to help prevent substance misuse because work and health, as we’ve talked, about are really so connected. The work itself, those working conditions, as well as the opportunities that employees have to engage in healthy behaviors at work can affect their health, and of course employees’ health affects their ability to be productive while they’re at work.

So one of the most basic things that an employer can do is to increase awareness for employees, and then maybe indirectly the employees’ families about substance misuse because most adults spend a significant part of their time at work this provides a really good opportunity for prevention messages to reach them. Employers can provide information to all of their employees about how to do very basic things like find out more about substance misuse.

Even things like basic terminology so that they know if their teenager might be talking about something that is a little bit risky. Employers can provide information about specific risks associated with different substances as well as signs of misuse. They can provide their employees with information about how to get assistance, and this might be from an employee-assistance program that is part of the workplace, or it may be how to get a referral to a healthcare provider.

Employers can also help employees learn about how they could seek out some help to help a friend or a family member. And then if things are a little bit further along, they could help employees locate local substance misuse treatment options in their community. Deborah, did you want to talk about how workplace injuries can relate to opioids?

DEBORAH: Yeah, one of the things we’re really hearing a lot about in the news and we’re being faced with today is opioid prescription misuse and other related opioid issues. Opioid prescriptions are frequently provided in work-related injuries, and can and do frequently lead to addiction. In many cases, the psychosocial work environment can also lead to the need for individuals to self-medicate with opioids and/or other drugs.

Other reasons people become involved include peer pressure to fit in with their colleagues by using drugs increasingly to relax or keep awake, enhance an activity, change a mood, or experiment with mind-altering drugs. Employer-based insurance covers a larger portion of the U.S. population than any other type of coverage. As payers, employers have influence over pain management treatment options, and can work with their benefits plan to cover alternative pain relief treatments like physical therapy, massage, meditation, and acupuncture.

Employers can also work on improving job characteristics and the work environment to reduce work stress. In other words, they can ensure job demands are realistic, watch for employees working excessive hours, provide adequate pay and leave among other things. Employers can integrate substance misuse in a broader workplace wellness programming by providing materials and screening tools for substance misuse and mental health at health fairs, talking about prescription drug use in the context of healthy, sleep and stress management, and physical activity.

For example, SAMHSA sponsored a program called Team Awareness, which a customizable worksite prevention training program that addresses behavioral risk associated with substance abuse among employees, their coworkers, and indirectly their families. The training, which was done by Joel Bennett and is also through his company, seeks to promote social health and increased communication between workers, improve knowledge about and attitudes towards alcohol and drug-related protective factors in the workplace such as company policy and employee assistant programs, or EAPs, that increase peer referral behaviors.

Stigma differentiates substance misuse from other diseases, and is primarily what can make seeking assistance and other resources or the return to work so difficult for an individual who has become addicted. Persons receiving addiction treatment face many challenges in obtaining and maintaining employment, with stigma being a major issue. An array of resources are crucial in this area, including funding for supportive employment programs and appropriate staff to deliver employment services.

Employers can also consider other proactive strategies: supporting a drug-free workplace, offering an employee assistance program or an EAP, then preventative evidence-based programs including peer support or social health, and health promotion, programs such as Team Awareness, which I described previously, Team Resilience, Operation RedBlock, and SmartRx. Many of these can be found at the SAMHSA website.

Different worksites may have different requirements including positions requiring regulated drug testing. So according to the business and what is available through that business, a wide variety of programs are out there that can and do act as proactive means to reduce substance misuse.

CASEY: Thanks very, very much, Deborah. That’s excellent information. We’re talking about how challenging this problem is, but what I’m hearing from you both is there is a tremendous amount that employers can do to move to better working conditions and appropriate interventions to actually health prevent substance misuse-so really valuable information. Deborah, also I appreciate you mentioning stigma because that is oftentimes raised as quite a challenge when employers are ready to take the next step.

And perhaps that also applies to the worry that some employers have about, “Oh my heavens, and I going to follow all the rules and regulations, and the privacy concerns that might come up if I delve into this topic of substance misuse?” So Laurie, let me direct this question to you. What regulations or laws should employers keep in mind when they’re thinking about intervening around substance misuse for their workers?

LAURIE: Alright, well we can kinda scratch the surface here, and I should say I am not a lawyer, but a few things to keep in mind: federal worksites and federal contractors, as well as some physicians that are safety sensitive or security sensitive, are required to have a drug-free workplace policy, but all employers need to be aware of regulations related to the Americans with Disabilities Act, the Civil Rights Act, the Family and Medical Leave Act, and in some cases other laws that may differ by state, for example recreational or medical cannabis laws.

So hiring managers and supervisors also need to be aware at a very basic level of what they’re even allowed to ask employees about medical conditions they may have, and their use of prescription drugs, and what the hiring manager and the supervisors are allowed to ask even vary on the stage of the hiring process that the employee’s at compared to when they’re actually an employee of the organization.

So there are some clear guidelines on the SAMHSA Division of Workplace Programs site, but I would say it’s worthwhile when putting a substance use policy or program in place to consult with an employment attorney. As with any other workplace matter, it’s critical to protect employees’ privacy, to provide training on any policies that are put in place, and of course to enforce the rules equally. And again I would really suggest taking a peek at the Division of Workplace Programs site because they do have some useful details on legal requirements.

CASEY: Thank you very much for that, Laurie. Very, very informative. Let’s imagine now that our listeners today are really ready to take that next step. So they’re looking for a few key strategies-a handful of things that they can put in place sort of as a first step to move in the right direction to help address this crisis. Let me start with you, Laurie again: what are some key strategies that employers – really regardless size, regardless of industry or occupation, what are some key strategies they can implement right away in this space?

LAURIE: Okay, well, one of the first things that we recommend is that if an employer doesn’t already have a substance use policy – a written substance use policy, it should develop a written policy customized for its organization. So many existing policies out there don’t explicitly cover prescription drug misuse or cannabis misuse, and these policies need to be updated. A written policy helps an employer have a record of the organization’s efforts, as well as a reference if an employee or their legal representation challenges that policy.

So it may also protect the employer from certain kinds of claims made by employees. So in brief, a drug policy usually includes the goals or the statement of the policy’s purpose, how it defines – how the organization defines substance misuse, what behaviors are prohibited, when and where the policy applies, which employees are covered – so things may differ based on international employees versus domestic, or contractors versus permanent employees.

And then the policy also would cover what consequences of violating it are. And there are templates and examples available online. I kind of did a quick Google and several sites came up so it doesn’t have to be something that is really difficult to do or that you have to start from scratch on this. So we’ve also touched on this, but all employers can also train management and employees on substance misuse risks.

This is pretty low-hanging fruit, I think. Familiarize employees and managers with the specifics of any substance abuse policies that are in place, as well as what substance misuse prevention strategies and programs are available to them at that workplace. Maybe they’re already saying there, for example, an employee assistance program that are just kind of under the radar. Employees don’t know about it or don’t know how to access it, and it’s really a resource that’s already in place.

The employer is already paying for it, so it’s important for things like in the EAP to be promoted, and make sure that employees know that it’s a confidential service, and know what services are available and how to access those services. Employers can provide training and support to managers and supervisors on how to recognize and appropriately address any kind of suspected substance misuse.

Another thing to consider is to provide training for staff on how to obtain and administer Naloxone, which is of course, the opioid overdose-reversible drug, and some employers might want to consider having it available on-site, particularly for workplaces that have a lot of interactions with the general public-it may be a lifesaving small piece of equipment to have on-site if somebody’s trained to use it.

And then to reiterate a point that Deborah made earlier, and that you kind of followed up on, Casey, all employers can work to create a workplace environment that does not stigmatize substance use or substance misuse. One way to help do this is by making substance misuse part of their overall wellness or health promotion program-so just kind of building it into something that people are kind of already expecting and already used to.

It’s important to promote any trainings or materials related to substance misuse to all employees at all levels so that no group or certain type of employee is singled out for this kind of training. And part of getting rid of the stigma is to try to normalize discussions about substance misuse because we know and we’re hearing more about it every day that misuse and addiction does affect all types of people. So Deborah, do you want to talk about structuring benefits packages?

DEBORAH: Sure, thank you. Benefits package needs to cover the misuse of drugs and alcohol, and in the past many corporations and businesses just fired people who got addicted to an illicit drug and/or a prescription drug. Today we see that it’s to our advantage to provide a structured benefit package to shift away from reliance on only firing people, but to keep them and to provide the kinds of comprehensive management to reduce the problems of opioids and/or other drugs and alcohol.

There’s growing evidence with opioids for example, that there are evidence-based non-pharmacological options that are very good at reducing pain and getting at issues where people before got addicted to drugs can now use other resources. These treatment management and alleviation of pain methodologies can be used on their own or in combination with drug therapies. Therapies which hold promise include acupuncture, massage, osteopathic and chiropractic manipulation, meditative movement therapies, Tai chi, yoga, mind-body behavioral interventions, and dietary components, and self-care and self-efficacy strategies.

Additionally, there is a new to enhance substance misuse support services such as confidential screening, counseling, treatment, peer support groups, meditation, assisted therapies, and follow up treatment and recovery services. We need to provide and enhance return-to-work programs following a drug misuse incident including return-to-work agreements, outlining expectations, online training and resources, helpline and community resources, collaboration with human resources, drug testing specifications, and privacy adherence.

So there’s a whole range of services that can be provided to people who are employees to try to reduce the impact of becoming addicted.

CASEY: Wow, thanks so much to both of you. These strategies are exceptional, and it was really a lot of information so I’ll take just a moment to help summarize some of those key sort of outputs that you mentioned that employers can actually put in place. First of all, Laurie, you started off by talking about the importance of a workplace substance use policy-sort of just setting the stage for discussion and program development in this area.

You talked about training management and employees on substance misuse risk-giving them the skills they need to not only recognize, but to really be able to intervene, if they find that the challenge exists. Laurie reminded us that the employee assistance program or EAP programs can play a very valuable role in this setting. And making sure employees know about that benefit – it’s quite common in most workplaces, promote that benefit and make sure employees know how to access the benefit.

You both told us about providing the right training and support to managers and supervisors on recognizing suspected substance misuse, and how to address working conditions and injury risks so that pain and injury are far less likely to occur so there’s no need for as much opioid use in the workplace setting. And then you also talked to us about making sure that we’re addressing stigma.

By folding in our programming with ongoing wellbeing and health promotion activities within the workplace, and Deborah, you did a great job of reminding us of the power of benefits design, and how structuring benefits can also encourage people to approach pain and injury with non-pharmacological means, and making sure that we enhance the support services that are available for people who make be struggling with substance misuse.

And finally, you ended the discussion on these key strategies to everybody by talking about giving assistance to those workers who do have injury, or illness, or absence, and enhancing our return-to-work strategies. So extremely valuable input that I think will definitely be actionable for many of those listening to us today. So in our remaining time together, I just have one final question for you.

And Deborah, I will start with you here. What are some key resources that really have a strong evidence base that you would consider high-quality resources to help employers address this information, and where do they go for more information?

DEBORAH: We have a large number of programs that we’ve funded in the past. Some of them have become programs that are well known and have been now utilized across the nation in many situations such as Team Awareness. Many of these resources have been written up and can be found at the SAMHSA workplace website, which is at https://www.samhsa.gov/workplace, and our phone numbers are there. People can call us and talk to us about what’s written, and we can provide a lot more information for particular types of programs, types of industries, specific needs, different drugs, alcohol, and whatever.

Additionally, there are a wide range of federal and nonfederal organizations that offer key resources in this area including the Centers for Disease Control, the National Institute of Health, the National Institute of Drug Abuse, and places like SHRM, which is the Society of Human Resources and Management, along with Employee Assistance Program Association, and other places. Many of these can be found on the Internet and can be accessed that way.

We’re happy to send people off to particular locations if they have specific needs, and we’re available to assist in this fashion on any issue related to substance misuse in the workplace.

CASEY: Thank you so much for those great resources, and once again, the website for SAMHSA is www.samhsa.gov/workplace. And remember SAMHSA is S-A-M-H-S-A. Folks, I have enjoyed our conversation today. I think what you shared is really beneficial for employers who are seeking to do the best possible work they can in this space for their workers. Taking care of our workers – our people – is a critical way to make our businesses more successful.

And you’ve given folks some wonderful ways to intervene today. So, Deborah and Laurie, I want to thank you both. This has been so informative. Thank you for joining me today.

DEBORAH: Thank you.

LAURIE: Thanks.

CASEY: Well, folks that concludes today’s interview. I’d like to thank all of you in our audience for listening. I hope you use the information shared by Deborah and Laurie to take steps to meet head on the challenge of substance misuse among workers in our nation’s workplaces. On behalf of CDC’s Workplace Health Resource Center, thank you for making workplace health your business. I am Dr. Casey Chosewood. Have a great day.

[BACKGROUND MUSIC]

ANNOUNCER: To find free, credible resources for creating healthy work environments, visit CDC’s Workplace Health Resource Center at CDC.gov/whrc. It’s a one stop shop with hundreds of resources, including case studies, evidenced based summaries, issue briefs, tools for small businesses, webinars, videos, and more.

If you’d like more information about CDC’s Workplace Health Resource Center, send an email to workplacehealth@cdc.gov. And we’ll follow up with you.

The opinions expressed in this recorded interview are those of the guest speakers and do not necessarily represent the official position of the Centers for Disease Control and Prevention.