The Challenge and Promise of Workplace Substance Abuse Prevention Douglas W. Billings, Ph.D.

1. The Challenge and Promise of Workplace Substance Abuse Prevention Douglas W. Billings, Ph.D. Center for Workforce Health The ISA Group

2. The Challenge: Convincing employers to care about workforce substance abuse? • Reduced productivity • Increased healthcare and insurance costs • More turnover • The Promise: A comprehensive approach • Wellness programs • EAPs • Access to recovery-oriented systems of care • Computer-based solutions Focus of this Talk

3. Employers ask 3 essential questions: • How much will it cost? • How disruptive will it be? • What is the value proposition? • Paramount to keep these questions in mind The Bottom Line

4. Scope of the Problem: 276 billion/year

5. 76 percent of people with drug or alcohol problems are employed • These workers are not getting treated • Only 2.4m, of the 23.2m needing treatment for drug or alcohol use, received it (National Survey of Drug Use and Health, 2007) Why do Employers Bear Most Costs?

6. Absenteeism: Alcoholism is estimated to cost 500 million lost workdays annually • More likely to exhibit job withdrawal behaviors • Others suffer • 14% of employees had to re-do work within the preceding year • More than half of working family members report that their own ability to function at work was negatively impacted Breaking Down the Employer Costs: Reduced Productivity

7. Healthcare costs for employees with alcohol problems are twice as high • Almost half of all trauma and injury visits to hospital ERs are alcohol-related • 3.5 times more likely to be involved in a workplace accident • Increased workers’ compensation and disability claims Breaking Down the Employer Costs: Increased Healthcare/Insurance costs

8. Illicit drug users more than twice as likely to have changed employers three or more times in the past year • Replacing an employee costs from 25% to almost 200% of annual compensation • This does not include loss of • Institutional knowledge • Service continuity • Coworker productivity and morale Breaking Down the Employer Costs: Turnover

9. The most significant problems experienced due to employee substance abuse • Absenteeism • Reduced productivity • Lack of trustworthiness • Negative impact on company’s reputation • Missed deadlines • Increased health care costs • Unpredictable, defensive interpersonal relations Summary of Employer Costs: 2007 Survey of HR Professionals

10. Comprehensive employer substance abuse program should include • Primary Prevention • Workplace policy • Wellness and substance abuse education • Secondary Prevention • Confidential screening • EAPs • Brief Therapies • Tertiary Prevention • Outpatient and inpatient treatments • Confidential follow-up care Solutions to Workforce Substance Abuse

11. “The period of high risk for initiating use of the surveyed substances—previously late adolescence through the early 20s—now extends into the late 20s” The Workplace is the Perfect Place for Substance Abuse Prevention

12. Solutions to Workforce Substance Abuse: Primary Prevention - Workplace Policy • Factual information on the harmful health and productivity effects of AOD • Confidentiality and privacy • Combat stigma by telling employees they can seek treatment confidentially without jeopardizing their jobs • Support treatment for and recovery from substance use disorders

13. Solutions to Workforce Substance Abuse: Primary Prevention - Integration • Web-based stress management program resulted in less binge drinking • A General Motors plant offered education about cardiovascular disease • 42% of plant’s at-risk drinkers reduced their drinking to safer levels • Medical costs dropped by 13 percent

14. Solutions to Workforce Substance Abuse: Secondary Prevention: Screening • Goal is early identification and direct employee to appropriate interventions • Not a substitute for a complete assessment or drug testing • 4-item CAGE is an example • Can be done as part of a company wellness program, EAP, physician’s office, or online • Computer-based assessments tend to promote greater disclosure of stigmatized behaviors

15. Solutions to Workforce Substance Abuse: Model of Abuse • Substance abuse should be viewed as a chronic, manageable condition similar to diabetes and asthma • As with other chronic diseases, relapse is not uncommon • Does not mean failure • Indicates that treatment should be reinstated or adjusted

16. Solutions to Workforce Substance Abuse: Model of Abuse II • Outcomes for substance use treatment are as effective as outcomes for other chronic diseases

17. Solutions to Workforce Substance Abuse: Treatment Options - EAP • Designed to help identify and resolve productivity problems affecting employees who are impaired by personal concerns • Telephone-based services • Face-to-face programs • Prospective cost-benefit analysis by the Federal Occupational Health agency found for every $1 spent on their EAP • 1st year savings would be $1.27 • 5th year savings would rise to $7.21

18. Solutions to Workforce Substance Abuse: Treatment Options – EAP II • Gillette Company saw a 75 percent drop in inpatient substance abuse treatment costs after implementing an EAP • International holding company found that employees who used an EAP had fewer inpatient medical days than those who only participated in the company’s medical insurance plan • $426,000 in savings each year on mental health and substance abuse treatment

19. Solutions to Workforce Substance Abuse: Treatment Options – Brief Intervention • Focused process that relies on assessment, client engagement and rapid implementation of change strategies • Goal is to reduce risky substance use before the individual becomes dependent • Can be conducted in the workplace by EAPs, physicians’ offices, or online • Each $1 invested in screening and brief counseling interventions saves approximately $4 in health care costs

20. Solutions to Workforce Substance Abuse: Treatment Options – Out/Inpatient • 5-year study of 4,411 clients who received substance use treatment in 78 programs • 50% decrease in drug and alcohol use one year after completing treatment • 19% increase in employment and income • 80% decrease in criminal activity • 53% decrease in alcohol/drug related medical visits

21. Solutions to Workforce Substance Abuse: Treatment Options – Follow-Up Care • Following acute care, activities that promote self-management and reduce relapse should be initiated • Community support programs (e.g., AA/NA) • Booster sessions

22. Solutions to Workforce Substance Abuse: Web-Based Approaches • Can reach large numbers of users • Overcomes problem of insufficient providers • Perfect fidelity across time and place • Flexibility in accessing • Effective for addressing sensitive issues such as drug abuse • Practice communication and refusal skills with little or no embarrassment

23. Solutions to Workforce Substance Abuse: Web-Based Approaches II • Decreased costs • Require far less staff training, preparation, and delivery time • Can be used as a stand-alone intervention or as an adjunct

24. Effective Web-Based Programs: Behavior Change Principles • 3 Major Components • Increase knowledge and awareness of the benefits and risks of particular health behaviors • Raise motivation and self-efficacy • Develop key behavioral skills

25. Effective Web-Based Programs: MultiMedia Health Education Principles • Synchronize pictorial and verbal information • Avoid text-only screens • Allow learners to control and manipulate • Encourage active information processing • Tailor life context

26. Going Forward: Guiding Principles • Learning processes play a key role in drug abuse/dependence • Identify and recognize determinants of drug use • Intrapersonal (e.g., negative/positive emotions, reduce withdrawal symptoms) • Interpersonal (e.g., particular environmental cues) • Skills/resources in high-risk situations • Help patients recognize situations associated with drug use • Avoid those situations that can be avoided • For those that can’t, coping skills are taught

27. Going Forward: Skills Acquired • Coping with Craving • Clean, Drug-Free, and Alive • How to Say No • Seemingly Irrelevant Decisions • An All-Purpose Plan • If You Slip