Addressing Substance Use in the Workplace

Addressing substance use by employees can save lives and businesses.

Posted Aug 13, 2019

The CEO of a large New York company recently met with us to discuss a business problem: a culture of heavy substance use. He was worried about the health of his employees, and he was worried that it was hurting the company’s bottom line.

He explained, “They're drinking and partying too much. By themselves, with our clients, and at our company events. It’s impacting their physical wellbeing and our productivity and reputation. I think I’m just going to have to do something drastic, like have drug-sniffing dogs roaming the halls, or perhaps I should just fire everyone.”

Substance use is ubiquitous and has a direct or indirect impact on almost everyone in the U.S. Therefore, it is no surprise that it is impacting workers and employees. In the United States, the cost of substance use may exceed $400 billion (Goplerud, Hodge, & Benham, 2017). While such macro-level estimates are useful, it sometimes is hard to quantify the precise cost (in dollars, well-being, and lives) on any given company.

To help fill in this knowledge gap, the National Safety Council, Shatterproof, and the University of Chicago have collaborated to design “The Real Cost of Substance Use to Employers” tool, which estimates the prevalence and cost of substance use in a workplace based on the size of the employee base, the industry, and the location. 

This tool is helping to shed light on just how knotty the problem is. Consider a famous employee, Robin Lehner, who is a National Hockey League goalie. Mr. Lehner has been open about struggles with mental health and substance use, in particular, seeking to encourage and bolster others who may be facing similar struggles (Greenfield, 2019).

Yet his candidness may have cost him significantly when it comes to his career. Older and less successful goalies have been given contracts instead of Mr. Lehner, and some have speculated that this is a clear manifestation of addiction stigma (Greenfield, 2019). Would you rather have a great goalie who has a history of substance use disorders (SUDs), or a good goalie who has no such medical history? That’s a question that NHL general managers are asking themselves.

Some might argue that encouraging disclosures like Mr. Lehner’s will set a bad example for others. Some may even feel that continuing to employ individuals with SUDs will only encourage others to use because of the seeming lack of consequences. These lines of thought are typical because addiction is often considered volitional (thus punishment is necessary) and is stigmatized (SUDs are a mark of shame). We believe that both of these thoughts are mistaken.

American society and workplaces have—more or less—enforced censure of individuals with SUDs, and it has not worked to eradicate substance use. Close to one in ten American workers has a substance use disorder. That’s an astounding number. If we apply that rate to NHL goalies, where we know that there are 31 starters and at least one backup on each team, we suddenly realize that the odds are that Mr. Lehner is not alone in his struggles: There are probably five or six goalies who similarly struggle with SUDs. In addition, the National Institute on Alcoholism and Alcohol Abuse has found that more than 25% of working-age adults binge drink once or more per month.

What can be done? U.S. law somewhat points the way forward, as it affords formal protections for individuals with SUDs through the Americans with Disabilities Act of 1990 and the ADA Amendment Act of 2008. These protections are broad, requiring that employers allow for modified schedules so that treatment can be received, rehabilitation can take place without negative impact on job security, and reassignment to less stressful posts is possible (Avery, 2019).

Gary Gottlieb, a professor of psychiatry at Harvard Medical School, recommends a number of principles for addressing substance use disorders in the workplace. One, employers should prioritize substance abuse challenges. We have discussed the magnitude of the problem in this article. The time to act is now, and action will only follow clear directives that come from senior leadership

Two, employers should create an environment in which employees feel motivated and empowered to seek help. Creating such an environment means addressing stigma, which includes talking about fears surrounding lost promotions and other potential negative consequences of being honest about one’s SUD. If coming forward for help is penalized, then fewer people will come forward. This is a matter of creating the right incentives and eliminating disincentives.

One solution that we support—and that the CEO we met with ultimately put in place—is that employers should turn to outside providers and establish long-term relationships. What is one way to encourage employees to seek help while simultaneously assuaging fears over retribution? Have a confidential, readily available, and free or low-cost third-party provider on-site at least once per week. In addition to its obvious benefits, this solution would stand as a visible symbol of a company’s commitment to its employees and their health.

The CEO we spoke to implemented this solution and saw an immediate impact. “I should have realized punishment would never work. They are taking advantage of free treatment, and we are all encouraging each other to modify our substance use patterns.” As for Robin Lehner, he recently signed with a new team, the Chicago Blackhawks, who recognized his true value as a goalie and person. 

References

Avery, J. (2019). Addiction stigma in the U.S. legal system. In J. D. Avery & J.

J. Avery (Eds.), The stigma of addiction: an essential guide (pp. 153-166). New York: Springer Publishing.

Editorial Staff, NIAAA. (July 24, 2019). Alcoholism & Treatment Statistics by Profession. NIAAA. Retrieved from https://www.alcohol.org/professions

Goplerud, E., Hodge, S., & Benham, T. (2017). A Substance Use Cost Calculator for US Employers With an Emphasis on Prescription Pain Medication Misuse. Journal of Occupational and Environmental Medicine, 59(11), 1063-1071. doi:10.1097/jom.0000000000001157

Gottlieb, G. (June 24, 2019). Taking On Substance Use Disorder As An Employer -- Getting It Right. Forbes. Retrieved from https://www.forbes.com/sites/onemind/2019/06/24/taking-on-substance-use-disorder-as-an-employer-getting-it-right/#5c07d458cee8

Greenfield, J. (July 26, 2019). Robin Lehner believed he deserved a long-term deal — but the Islanders thought otherwise. Now, their loss is the Blackhawks’ gain. The Chicago Tribune. Retrieved from https://www.chicagotribune.com

Substance Abuse and Mental Health Services Administration. (2019). Retrieved from https://www.samhsa.gov/workplace/toolkit/assess-workplace