Addiction in the Workplace

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Addiction in the Workplace

• International Society for
• Performance Improvement
• Vancouver May 9th 2006

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Effects of Addiction in the Workplace

• Costs the Canadian economy more than 18.4 B/y
• Costs the employer is 7,000 per employee/year
• The substance misusing employee is
• 2.2 X more likely to leave early or request time
  off
• 2.5 X more likely to have absences of 8 days or
  more
• 3 X more likely to be late for work
• 5 X more likely to file a worker's compensation
  claim
• 40 of industrial fatalities and 47 of
  industrial injuries can be linked to alcohol.

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Drug-Free Workplace Services

• Policy Development
• Supervisor Training and Coaching
• Employee Education
• Drug Testing
• Case Management Assessment, Treatment and
  Referral Services
• Interventions

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What is Addiction?

• A pathological relationship to any mood altering
  experience in spite of life damaging consequences
• Marked by denial
• Obsession and compulsivity
• Affects people emotionally, mentally, socially,
  physically and spiritually

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Substance DependenceDSM IV--Disability

• Maladaptive Pattern of Use - 3 or more
• Unsuccessful in cutting down/controlling
• Tolerance and or withdrawal
• Larger amounts/longer period than intended
• Much time using, or recovering from using
• Important social, occupational, recreational
  activities reduced or given up because of use
• Uses despite problems caused by or exacerbated by
  use

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Substance Abuse

• Maladaptive pattern of use
• Use results in failure to fulfill major roles
• Uses when physically hazardous
• Recurrent substance-related legal problems
• Continued despite persistent social problems

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Moral Theory of Alcoholism

• Weak willed
• Not disciplined
• Sinful
• They could stop if they wanted to

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Alcoholism as a Disease

• American Medical Association (1956) declares
  alcoholism is a disease
• Primary-genetic factors central to cause
• Predictable
• Progressive
• Requires abstinence
• Permanent

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Cognitive - Behavioral Model

• Interaction of individual and environment
• Social, emotional, psychological reinforcement
• Increasing reliance increasing dependence
• Recovery based on skill training

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Bio-Psycho-Social-Spiritual Theory

• Is multi-determined and treatment needs to be
  multi-faceted
• Lies on a continuum includes substance use
• Substance use follows variable pattern over time,
  may not be fatal
• Recovery may not require abstinence depending on
  severity

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Continuum of Use

• No-Use (2/10)
• Experimental (2/10)
• Occasional (2/10)
• Regular (4/10)
• Abuse or Problem (1/10)
• Dependent (1/10) no choice/ no control

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Types of Addictions

• Alcoholism
• Illicit Drug Misuse
• Prescription/Over the Counter Drug Misuse
• Process Addictions Gambling, Sex, Internet,
  Shopping, Food
• Co-Occurring Disorders (40)
• Multiple Addictions

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Co-Occurring Disorders- 40-60 of those addicted

• Mood Disorders Anxiety, Depression, PTSD,
  Bi-Polar
• Personality Disorders Antisocial, Histrionic,
  Borderline, Dependent
• Obsessive Compulsive Disorders
• Other Mental Illnesses

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Addictive Drug Classifications

• Depressants Barbiturates, Benzodiazepines,
  Alcohol
• Stimulants Amphetamines, Cocaine, Crack
• Hallucinogens LSD, MDA, Mushrooms
• Opiate Narcotics Opium, codeine, Heroine,
  Methadone, Demerol
• Cannabis
• Anabolic Steroids
• Club Drugs Ecstasy, Ketamine, Rohypnol

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Fitness for Work

• Shared responsibility for workplace safety and
  fitness for work
• The need for employees to show up fit to perform
  their work
• Co. offers policy, procedures (testing,
  disability mngt.)
• Range of support for employees

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Physical Signs of Alcohol or Other Drug Use

• Dilated or constricted pupils
• Red, watery eyes
• Easily distractible, appears hyper
• Trembling or shaking hands, fingers
• Person nods off
• Unsteady gait
• Slurred speech

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Duty to Accommodate

• The employer has a duty to accommodate and
  employee with a disability up to the point of
  undue hardship
• Accommodation varies according to the resources
  of the employer

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Underlying Personal Problems

• Alcohol, drug, gambling problems
• Relationship difficulties
• Family problems
• Vocational problems
• Legal problems
• Psychological problems
• Other problems

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Effects in the Workplace

• Incomplete, substandard work
• Poor judgement, confusion, forgetfulness
• Exaggerating work accomplishments
• Decrease in creativity, initiative
• Misses deadlines
• Skills are not current
• Overwhelmed by realistic workload

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Effects in the Workplace

• Swings/low productivity
• Attendance problems (late, takes time off)
• Cant handle complex tasks
• Covers up problems
• Blames others, deteriorating relationships
• Poor attitude
• Complaints from co-workers/customers

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Characteristics of the Dependent Person

• Shame-based
• Low self worth
• Emotionally immature
• Difficulty dealing with stress
• Difficulty with responsibility

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Defense Mechanisms

• Denial
• Grandiosity
• Rationalization
• Minimization
• Projection
• Avoidance

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Enabling actions taken to protect the person
with the problem from the consequences of his or
her actions

• Covering up
• Rationalizing
• Withdrawing, avoiding
• Blaming
• Controlling
• Threatening
• Sympathizing

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Reasons for Enabling

• To avoid conflict
• Because we feel helpless
• To avoid embarrassment or stigma
• Because we feel the problems is somehow a
  reflection of our own competence

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Documentation of Work Performance

• Factual
• Objective
• Verifiable
• Complete
• Accurate

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Ways for an Employee to Access Assistance

• Self-referral
• Peer referral
• Supervisory referral
• Formal/mandatory referral

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Stages of ChangeTranstheoretical Model

• Pre-contemplative
• Contemplative
• Determination
• Action
• Maintenance
• Lapse
• Relapse

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Precontemplation

• Raise doubt -- increase the clients perception
  of risks and problems with current behavior
• Educate about negative consequences of substance
  abuse

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Contemplation

• Explore the ambivalence conflicts between
  substance abuse and personal values
• Tip the balance -- evoke reasons to change, risks
  of not changing
• Strengthen the clients self-efficacy for change
  of current behavior.

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Preparation

• Help the client determine the best course of
  action to take in seeking change.

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Action

• Help the client take steps toward change
• Work on skills to maintain sobriety
• Acknowledge feelings and experiences as a normal
  part of recovery (PAWS)

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Maintenance

• Help the client identify and use strategies to
  prevent relapse
• Reassure, evaluate present actions and refine
  long-term sobriety plans

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Lapse - Relapse

• Help the client renew the processes of
  contemplation, determination, and action, without
  becoming stuck or demoralized due to relapse
• From Miller and Rollnick, Motivational
  Interviewing 1991

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FRAMES

• Feedback about personal risks or impairment
• Responsibility for change in on the participant
• Advice to change is given by the provider
• Menu of alternative self-help or treatment
  options is offered to the participant
• Empathic style is used in counselling
• Self-Efficacy or optimistic empowerment is
  engendered by the participant

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Continuum of Care

• Detox
• Support Recovery
• Residential Treatment/Day Programs
• Outpatient Counselling
• 12-Step groups (AA, Alanon, ACOA, Co-da)
• Dual Diagnosis/Community Support Groups

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After-Care Planning

• Residential Treatment Alumni Groups
• Outpatient Counselling
• 12-Step groups
• Dual Diagnosis/Community Support Groups
• Return to Work Agreements/Meetings

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After Treatment

• Respect confidentiality
• Provide education for all employees
• Schedule return to work meetings
• Utilize return to work agreements
• Provide ongoing supervision to review performance
  and support the employees success
• Provide flexibility to the employees schedule

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Post-Acute Withdrawal Symptoms (P.A.W.S.) 6 mo-2
yrs.

• Difficulty in thinking clearly
• Difficulty in managing feelings and emotions
• Memory problems
• Difficulty in recognizing and managing stress
• Difficulty in sleeping restfully
• Difficulty with physical coordination

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Stress Management
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Alcohol and Drug Testing Considerations

• Testing may be part of an overall approach
• Testing cannot differentiate between occasional
  and addictive use
• Testing may be useful after an accident or
  incident
• Testing after from treatment may be one way to
  provide support to the recovering employee and
  ensure that they are maintaining
  sobriety/abstinence
• Some employers are required to have testing in
  place

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Not a Bona Fide Occupational Requirements - Not
Acceptable

• Pre-employment alcohol drug testing
• Random drug testing
• Random alcohol testing of employees not in safety
  sensitive positions

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The End