Addictions in the Workplace

Impact is costly to employees and employers

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Dr. Robert C. Fusco traveled here from San Francisco, where he is chief clinical
officer at United Behavioral Health, a UnitedHealth Group Company. He came armed
with some telling statistics that show expenses are everywhere.

Fusco pointed out that absenteeism at work is up to three times more common
in people with addictions and that people with addictions are four times as
likely to utilize our hospitals.

Lincoln D. Almond, a partner in the Providence law firm Edwards & Angell
and son of the former Rhode Island governor, contributed his experiences in
labor law. He raised a good point.

Successful business people, he said, tend to be problem solvers; it’s their
nature. But addictions are not easily solved. It’s not as easy as sending someone
away for a couple of weeks to get better and expect them to return as your top
sales performer or office manager.

“Employers tend to have an unrealistic perception of what it takes to solve
a problem,” said Almond.

Mederic McLaughlin, director of behavioral health and case management at Roger
Williams Medical Center, suggested that it is important to address issues of
addiction before a person hits “rock bottom” whenever possible.

Doing so, said McLaughlin, allows for leverage in fostering treatment; in
addition to saving a job or marriage that may be hanging in the balance.

“The single most important thing an employer can do is to have an effective
Employee Assistance Program,” he said. “This is a treatable, medical condition.”

Judith G. Hoffman, a social worker and vice president of Employee Assistance
Programs’ Resource International Employee Assistance Services, sees addiction
as a “complicated illness.”

“We have to provide employees with a safe place,” she said.

Dr. John Straus, associate medical director of addiction medicine at Roger
Williams Medical Center, sees some tough cases.

“Part of the disease is denying that you have a disease,” he said.

Donna Peterson, a registered nurse and the day treatment clinician at Roger
Williams Medical Center, echoed that sentiment.

“People think it has something to do with will power,” she said. “It has nothing
to do with will power.”

That’s something Sandy Hill learned. Hill, a recovering alcoholic who worked
in administrative offices in both the city of Cranston and at the State House,
was a guest on panel discussions and is featured in the PBS video.

Michael Pare, editor of the Providence Business News, served as moderator
for the discussion.

Opening comments from the panelists:

Hill: Well, I was invited to participate in this because I suffer from
the disease of alcoholism. My alcohol problem began while I was in the workplace,
but it really didn’t develop until I finally retired. I’m a retired employee
of the state and of the city of Cranston. I developed drinking alcohol sometime
maybe about 12 years ago. Actually I’m late in life starting. And it just …
I just liked what it did for me. I liked how it made me feel. And I thought
I was getting away with something. And for years after that I even took it to
work. I thought I was very secretive about it, but people were aware of it especially
at the Cranston level. At the state level it wasn’t so obvious, but it was still
there. When I retired … I really didn’t seek help until sometime after that.
And the help that I received was at the Roger Williams Day Treatment Addiction
Treatment Center. And I’ve been sober now for 16 months.

Dr. Fusco: I’d like to talk to you employers about some of the reasons
why addictions in the workplace should be on the radar screen. Some of the reasons
important to them and some of the things that employers can do to make an impact.
Number one, addictions in the workplace are costing American employers a ton
of money. There is an article in the Annals of Internal Medicine that suggested
that in the year 2000, this problem cost American businesses $150 billion. And
it’s been estimated that for every addicted employee, an employer has to shell
out an additional 25 percent of their salary in extra losses and expenses. Now
a lot of this is related to productivity issues in the workplace. And there’s
another big piece that’s related to increase in health-care cost. There is good
news. And the good news is … that treatment is available, and treatment is effective.
But there’s some bad news too. And that is that there is a very significant
gap in accessing effective treatment – that there are too many people with problems
who recognize that they have problems who seek treatment for problems and are
really unable to get that treatment. The most recent national survey on drug
use and health which is conducted by SAMBA suggested that in 2002, there might
have been 250,000 Americans who sought treatment for addictions and were unable
to get help for it. Now that prompted Tommy Thompson, secretary of Health and
Human Services, to suggest that there is no other medical problem for which
our society would tolerate such difficulty in getting access to treatment. And
President Bush has responded with a new initiative called Access to Recovery,
which is emphasizing the availability and effectiveness of treatment.

Almond: I’m a labor and employment lawyer, and I counsel employers
on compliance issues and dealing with workplace problems, disciplinary problems.
And I can attest to what Dr. Fusco said about the costs of addiction in the
workplace in terms of productivity issues, attendance, problems, costs of legal
defense, claims that can arise. There are a number of legal issues that arise
in the area of workplace addiction in terms of whether an employer is required
to grant somebody a leave, disability discrimination issues, testing for drugs
and alcohol. But what I would like to get out of today’s session, what I’d like
to learn to assist my clients is what Dr. Fusco said about being a flexible
employer encouraging access to effective treatment. The problem that I see with
clients is they call, and they know that an employee has a problem, but maybe
that employee doesn’t know that she has a problem. And I often label it as the
principle of no good deed goes unpunished. You have employers who want to do
the right thing, and then when they do it, an employee who doesn’t recognize
there’s a problem – they spend a lot of time and money and really haven’t gotten
anywhere. And I’ll give you an example of what I went through with one client
in particular who had an employee who I believe was suffering from alcoholism
although I’m no expert on that. It was an employee who had performance issues
over a lengthy period of time and in lieu of being fired had been disciplined,
was always disciplined at a lower level and told to go get help and given leaves
of absence from work. And this just went on and on. Co-workers would cover for
the employee, and the employee never got better. And it got to the point where
on a particular day, a co-worker who was unwilling to take the risk of again
covering for this employee notified a supervisor, and they tested the employee
for alcohol. The employee drove trucks as part of his job, so they had rights
under certain federal regulations to test. They tested the person. I believe
he was at .356 blood alcohol at about 10:30 in the morning. We had an arbitration,
and he ended up losing his job because of that. We had arbitration months and
months later. And the union representing the employee – their defense was he
needs help, and he’s seeking help. But then when I questioned him at the arbitration,
he conceded he really hadn’t been participating in the help. I guess I’m caught
between the dilemma of my clients who want to do the right thing and whether
that is really going to be effective if the employees aren’t recognizing whether
they have a problem. And I don’t know if – again I’m not an expert in addictions
or alcoholism – but you hear a lot about people having to hit rock bottom or
reach some epiphany before they admit they have a problem and then start on
the road to recovery. And I think we had many employers who knew that the employee
had a problem and were willing to help, but the employee was not willing to
help themselves. I also have employers as clients who think they know employees
have a problem, and they really don’t. They’re diagnosing people when they have
no basis to. For instance, I remember one situation where an employee had had
a couple of repeated DWI arrests. And the employer jumped to the conclusion
that the employee must be an alcoholic. Well, I don’t think that DWI necessary
means you’re an alcoholic.

McLaughlin: I worked with one client in another state that was self-insured,
and they were spending 45 percent of their health care dollar claims on something
that was modifiable. … And you know, using AAP and preventive health care had
tremendous impact. So an employer that is self-insured has significant economic
gains. It is a large impact economically – $150 billion lost productivity, lost
time, workers’ compensation accidents, health-care costs, injuries – a number
of things. But the key is that it’s treatable. People can modify their lifestyles
accordingly. But for health-care providers, especially hospitals, you just can’t
provide inpatient services. You have to provide the full continuum of care because
somebody can go through for instance an inpatient detox, and unless they’re
successfully handed off and hooked up into after-care treatment in a number
of forms – day treatment, in terms of outpatient, outpatient continued from
there they tend to fall back into the inpatient side. And then we recycle them,
and that increases the costs for health care. So it’s important that if an organization
is not providing the full spectrum of care that they have tight hookups for
after-care and the hand-off of those patients to those other providers is the
key.

Straus: As the associate medical director of Roger Williams, I run
a 15-bed inpatient unit. And so I see people at their most crisis point just
about. They’ve gotten restraining orders. They’ve been told to not come back
to work until they get treatment. They just were arrested. They just broke a
bone or some other consequence of their drinking. And so this is a voluntary
unit. And by being there, they’ve acknowledged somewhat their problem. They’re
not at the point where they’re denying that they have a problem. They may not
be completely able to accept what it needs to treat it, but they’re willing
to accept help. And I also teach the interns and residents at Roger Williams
Hospital. And there is a recent article in the New England Journal of Medicine
– a study about the Ram Corporation in June. And they looked at 30 acute health
conditions that doctors treat, and they looked at quality indicators of whether
the doctor is doing a job, whether they’re asking about the condition, whether
they’re offering the right treatment. And the best-treated condition was cataracts
with 80 percent of doctors were treating it right. And at the very bottom of
the list of those 30 conditions was alcohol dependent, and only 10 percent of
doctors treated it right, offered screening for the problem and offered the
appropriate treatment. And so the interns being trained at Roger Williams Hospital,
because we have an addiction unit, are being taught the right way to screen,
and as primary care doctors, that’s really where the intervention is. It shouldn’t
really be the employer’s responsibility to diagnose and send for treatment.
It should be the family and the physician who are looking for the problem and
offering help.

Pare: Dr. Fusco, maybe you can expand a bit on the cost of addictions
in the workplace.

Fusco: Several panel members have actually already mentioned some of
the categories that these costs fall into. But some of the data – absenteeism
– probably two to three times more common in people with addictive disorders
than it is in the norm. Disability – it turns out that in developed countries,
alcoholism is the number one cause of disability in men and the number 10 cause
in women. There’s something that we’re talking about as presenteeism. I don’t
know whether the panel heard that term before. But it’s a neat word. It describes
the phenomenon of people showing up at work but impaired and really unable to
do the job the way that they’re supposed to. And this is very common. And frankly
I don’t know what the costs of that are. I mean the costs of that are very hard
to get to. Then health care cost is very high in alcoholics and substance abusers,
probably twice what they are in others. And there are studies that show that
addicted people use hospitals to the tune of four times as much as others –
four times as many days in hospital. And 20 percent to 30 percent of all emergency
room visits are related to alcohol and substance abuse. And of course, we all
know those are the very high cost services, the hospital days and emergency
room visits.

Pare: Sandy, can you relate to the problem of going to work at less
than 100 percent?

Hill: Absolutely. I can remember going to work with a hangover and
wondering how I was going to get through that day. And I did get through it,
but couldn’t remember it really. You know, I thought I was getting through it.
And some of my co-workers – one of my co-workers in particular – she really
knew what was going on with me but never really approached me. And that’s the
whole thing. No one ever said anything to me. I just went about my business
whether it was good, bad or indifferent. I just went about my business. No one
ever said to me, ‘Gee, there’s something wrong with you today; you know, what’s
going on with you?’

Pare: Did you have an EAP, Employee Assistance Program, available to
you?

Hill: Yes, well, part of our insurance covered a program like that,
but I wasn’t going to ever let you know that I had a problem. If no one was
asking me, I wasn’t going to bring it up. But I wish I had done it. I would
have saved myself many years of anguish if I had approached my employer and
said, ‘You know, look, I’m having a problem.’

Pare: Does this sound like a typical story?

McLaughlin: Yes, I think that’s unfortunately true. However, I put
together an EAP for one of the hospitals I worked at. And part of the EAP is
also to change the culture and to train all the supervisors to identify and
not to have a passive model but to have a pro-active model so that if you see
an employee that had a certain productivity level and all of a sudden that dropped
off significantly, and there was no rationale for that or absenteeism went up,
tardiness went up, the assistants that go through the training for EAP, especially
if they have their own EAP, they’re geared to hone in on those symptoms and
actually approach the employee and be pro-active on that. So that’s one of the
benefits of having an EAP and also to train all the managers in the hospital
how to make referrals, appropriate referrals and in protection of the employee
that way.

Pare: From an employer’s point of view … is there a downside to getting
involved in an EAP? Why don’t we have more companies offering them to employees?

Almond: They are a good tool. My guess is that cost is one of the reasons.
You know, it’s a tough economy. People are looking in any way possible to cut
what they would consider to be unnecessary overhead, and you may have some businesspeople
who see that as unnecessary overhead in difficult times. I do think they’re
helpful. I think where employers need to be careful is to not selectively send
people to EAPs, to not go out there and diagnose employees as having problems
because there are cases where employees will come back and say, ‘I don’t have
a problem; you’ve accused me of having a drug addiction; you’ve publicly accused
me of that; and I’m going to sue you for defamation because you’ve ruined my
reputation in the community. Or you’ve accused me of being an alcoholic, and
I’m not.’ Or under the Disability Discrimination Statute, alcoholism can be
considered a disability. And there is an interesting twist in those statutes
that the definition of somebody who is covered with the disability is also somebody
who is regarded as having a disability by an employer. I remember reading one
case in particular where an employee was given a choice either to go get treatment
for alcoholism, or you’re fired. They were fired. And then the employee said
you fired me for perceiving me to be an alcoholic, and I’m really not. And so
what should be a good thing in EAP and now shoving it down the employer’s throat
and a way to try to correspond to the employer. What I’d like to hear from Dr.
Straus on, and what I’m interested in is this whole idea of what do you do when
an employer wants to help an employee, but the employee doesn’t want to be helped?

Pare: Dr. Straus, you’re dealing with people at a chronic level that
are at a real boiling point. Do you see a lot of that?

Straus: They’ve reached their critical mass. Everything in their life
is falling apart. And if someone’s work performance is suffering, and it’s obvious
to everyone, but the employee is being oblivious to it, there isn’t a lot you
can do besides, you know, decide whether this person is jeopardizing themselves
or the company either physically or legally. If someone is driving like your
example, you can’t tiptoe around the problem waiting for the opportune time
or the person to realize there’s a problem and accept treatment. And companies
vary in how willing they are to work with someone.

Pare: Lincoln Almond, what’s in it for the business side? I mean obviously
there’s a chance that they can save some money or that they can salvage some
good employees by instituting an EAP or something like it.

Almond: Well, I think that’s the key. What’s in it for the business
side – because any business you’re not going to thrive without good people.
And if you have good people who you’ve invested time in, and you’ve invested
training in, you would rather – I don’t like to use the word salvage – but I
think you can help to support that employee to solve a problem just like you
would support an employee who broke a leg skiing if they were a good employee
or had some other disease other than alcoholism. You would want to support that
employee to help them get back to be a productive employee. So think there is
a culture that would be supportive of this. It’s a difficult issue. And I’ve
seen a lot of employers who want to do the right thing and then when the employee
is not ready to confront the problem, they spend a lot of time and money, and
maybe they avert or discharge, but then they get to the same point two years
later after a lot of heartache. And it’s a very difficult problem because it
almost makes you – after an employer has been through that a couple of times,
they might want to say, ‘You know, if Jane is not doing her job, it’s not my
business why; I just have to deal with the performance at work.’ And if they
have problems in their personal life, maybe we have an EAP, it’s up to them
to use it. But if they don’t toe the line at work, they’re going to lose their
job.