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Promoting Healthy Workplace & Enhancing Team Dynamics


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Developing a drug & alcohol policy and communicating it to staff …

Developing a drug & alcohol policy and communicating it to staff
Accommodation issues surrounding addictions in the workplace
Dealing with addiction-related misconduct
Drug and alcohol testing in the workplace
Recognition, intervention, and support: employee, employer, and community involvement in rehabilitation, recovery, and the reintegration process

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  • What does this mean for the workplace?
  • Freud said some funny things but he did make some astute observations: “No other technique for the conduct of life attaches the individual so firmly to reality as the emphasis on work; for his work at least gives him a secure place in a portion of reality, in the human community”Marie Jahoda, positive mental health movement, pointed out that work Provides structure, Provides social meaning, Provides opportunity for social interaction , Provides an identity…. Not to mention- provides an incomeHowever, multiple studies have demonstrated increasing rates of workplace distress, demoralization and disabilitye.g. 2002: Health Canada study suggest that there is a work/life imbalance- that the lack of balance is getting worse, especially for middle managers and public sector.
  • Three legged stool, work, person, family and friends, Lose one leg you can still balance with your legs to rebuild.
  • Does this mean work or the workplace causes mental illness?Not really, as we do not know the exact cause of any disorders, likely a combination of biogenetic and psychosocial factors which will vary from person to person.But, a psychologically unhealthy work environment can contribute to the onset and severity of a disorderWhile at the same time, a psychologically healthy environment can prevent the likelihood and minimize the severity of a disorder
  • The cycle of addiction. Following the initial exposure to an addictive sub- stance, acquisition of drug taking occurs, in which infrequent drug taking escalates into chronic drug use. Periods of chronic drug use are followed by intervals of withdrawal. These periods of abstinence from the addictive drug can last days, weeks, months, or years. However, most addicts do not remain drug free and relapse back into drug use, creating a vicious cycle. Stress can exacerbate drug taking throughout this process facilitating initial drug exposure, increasing acquisition of drug taking, and causing a relapse to drug-taking behavior during withdrawal. Source: Attridge PNWER presentation
  • Institute for Health Economics and Alberta Health, Jan 2009
  • I think Perfect
  • Thanks for reference – what do you think about putting it in dark brown ( too distracting?) your call – Otherwise GREAT Slide
  • Many of the conditions that result in the highest percentage of the cost of health and disability coverage can be prevented by simple things such as good nutrition, regular exercise and proper monitoring of risk factors – blood pressure, cholesterol, blood sugarMajority of ers recognize that their ees health affects productivity and performance. Shift from the claims-based products to the service-based products. Traditional emphasis of benefit plans has been on diagnosing and treating illness – not on prevention. This is changing. There is a new focus on health and wellness.
  • When ees are productive and focused, they contribute to the success of the business. 76% of small business owners in Canada believe that taking care of ees makes them work harder for the company.But we are seeing rising trends in absenteeism, disability rates and mental health claims. Prevalence of Stress in the workplacePresenteeism – the measure of lost productivity cost due to employees actually showing up for work, but not being fully engaged and productive mainly because of personal health and life issues. Presenteeism is estimated to be up to 7 ½ times more costly to employers than absenteeism. Presenteeism costs employers an estimated $2000/yr/employeeTop risks identified by ers are work related stress, mental health issues, high blood pressure, smoking and diabetes.Benefits plans can help create a positive workplace for employees. But cost containment is a big concern and many small business owners believe benefits plans to be too expensive. The number one reason small business owners do not offer a plan is cost. Maybe they need to consider the cost of not having a benefits plan.
  • Transcript

    • 1. Managing Addictions in the Workplace Dec 5 2:50 pm Infonex Whitehorse Chris Hylton, MA CG Hylton & Inc. 800 449-5866
    • 2. Agenda• Developing a drug & alcohol policy and communicating it to staff• Accommodation issues surrounding addictions in the workplace• Dealing with addiction-related misconduct• Drug and alcohol testing in the workplace• Recognition, intervention, and support: employee, employer, and community involvement in rehabilitation, recovery, and the reintegration process
    • 3. Do you have any workplace issues we can try and solve for you in this session? 3
    • 4. Types of mental health : Addictions Definition: being abnormally tolerant to and dependent on something that is psychologically or physically habit-forming Examples: alcohol, drugs, gambling, shopping, eating, etc
    • 5. What is Mental Health?• World Health Organization defines mental health as "a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community” 5
    • 6. What is Mental Health?People learning and able to cope with:Stress – Changes in life and the workplace – Demands in the workplace – Home life – Work life 6
    • 7. What is this? 7
    • 8. Freud Love and work are the cornerstones of our humanness 8
    • 9. and you wonder why we work?• “No other technique for the conduct of life attaches the individual so firmly to reality as the emphasis on work; for his• work at least gives him a secure place in a portion of reality, in the human community” 9
    • 10. “Therein we have one of thefundamental paradoxes we face today: Work is good for your mental health and work can make you crazy”Out of the Shadows at Last: Transforming Mental Health, Mental Illness and Addiction Services in Canada (2006), Standing Senate Committee on Social Affairs, Science and Technology, Honourable Michael J. L. Kirby, Chair 10
    • 11. Presenteeism AbsenteeismExtended Health Claims Disability Claims Lost Productivity 11
    • 12. Mental Health – Overlapped by Addictions 25% of adults in a year have anxiety, phobias, panic attacks, depression, bipolar/manic depression, OCD, ADHD, schizophrenia, or suicide, with half having multiple MH conditions at same time 45% of mental health cases also have medical conditions – pain, heart disease, COPD, diabetes, asthma, hypertension, cancer, sleep problems 1 in 3 mental health cases also have substance or other addiction problems at the same time 12
    • 13. Abusers in Past Year as Percentage of Adults (Canada)20 19 15 14 2Alcohol Tobacco Medications Marijuana Illicit Drugs  Source: Attridge & Wallace (2009), MacMillan et al. (2009) 13
    • 14. Behavioural Addictions IncreasingAddiction Rate in Adult Historical Trend PopulationGambling 5% problem; 2% Increasing pathologicalSex 3% to 6% IncreasingFood / Eating 5% women, <1% men IncreasingInternet Use 1% unknown IncreasingWorkaholism 1% unknown Increasing 14
    • 15. Addictions are in the Workplace Most people with addictions have jobs and are actively in the workforce Alcohol and drug use tends to be higher among smaller size employers and in certain industries: ◦ construction and oil/gas mining ◦ transportation ◦ installation, maintenance and repair ◦ arts, entertainment and recreation ◦ accommodations and food services ◦ retail service occupations 15
    • 16. Workplace Demographics It Starts Young. Younger age workers are most at risk for developing mental health and substance abuse problems, as these often start in the teens and early adulthood. This age group is most relevant for prevention activities, early screening and brief interventions. It Gets Complicated. Older age workers may experience declining health status due to the cumulative effects from undertreated mental health and addiction problems. This age group is most relevant to integrated care approaches. 16
    • 17. Alcohol and Drug Addictions Costs to Society: Canada Combined costs of:  health care  law enforcement  work productivity  disability  premature death  Average $1,267 per every citizen Source: Single et al (1996); Rehm et al (2006) 17
    • 18. Other Workplace Consequences Majority of all addiction related costs (61%) are in area of diminished on-the job work productivity and unscheduled work absence. Addictions also are also associated with higher health care costs, worker injuries, disability claims, workgroup morale problems, job turnover, and company risks for safe work environments, equipment loss and lawsuits. Source: Attridge (2008), Attridge (2009) 18
    • 19. Why is the problem to difficult and complicated?ANY IDEA WHAT CAUSES ADDICTIONS? 19
    • 20. Various Theories Moral Model – only a “bad person” gets addicted and can’t quit Disease Model – what are the genetic and neurobiological factors involved? Behavioural Model – what is rewarding to the person about their addiction? Early Environment Stress – what kinds of toxic stress (abuse, trauma, low SES) was experienced as a youth or in past? 20
    • 21. How does someone get addicted Traditional Continuum Model of Progression Toward Substance Abuse (Alcohol/Drug): Source: Attridge & Wallace (2010) 21
    • 22. Epigenetic Neuroscience Research• “This is an extraordinary moment in the science of mental disorders. The intellectual basis of psychiatry is shifting, from reliance on psychological principles and theory to research findings and understanding the brain through neuroscience.”Dr. Thomas Insel, Director of the National Institutes of Health (NIH – US) (Journal of Clinical Investigations, 2009) 22
    • 23. New Research - EpigeneticsLinks Addictions to a Combination of Genetic and Biological Factors that Interact with Early Child Development ExperiencesThe Greek prefix epi- in epigenetics implies features that are "on top of" or "in addition to" genetics; thus epigenetic traits exist on top of or in addition to the traditional molecular basis for inheritance. 23
    • 24. development in utero and in childhood, environmental chemicals, drugs and pharmaceuticals, aging, and dietResults in cancer, autoimmune disease, mental disorders, or diabetes among other illnesses. National Institute of HealthSource Wikipedia: National Institute of Health 24
    • 25. 25
    • 26. Care and Prevention• Can the problem be treated or prevented? 26
    • 27. Range of Treatmentsself-help (often many failed attempts) = weakgroup-based peer-support programs (AA) = modesttalk therapy - cognitive behavioral therapy (CBT) = best evidencebrief residential detox with counseling = good evidence for severe casesRx medications and general medical care = mixed evidenceharm avoidance programs = emerging good evidenceScreening and Brief Intervention = best evidence 27
    • 28. What Treatments are you Familiar With?• Have they worked?• What is the cost?• What about the relapse?• How was the return to work monitored?
    • 29. Addiction is a Life-long ConditionThe Addiction Cycle Often Repeats Over Time, Even with Treatmentand Can Worsen Source: Cleck & Blendy (2008) 29
    • 30. Solution• Screening• Brief intervention• Referral for treatment• Study by Institute for Health Economics and Alberta Health last year• Organizational Interventions for the prevention of Workplace Stress Jan 2009 30
    • 31. “ ” SBIRT Screening Use a valid, brief (5 minutes or less)Alcohol Screening, Brief Intervention and referral to Treatment standardized questionnaire about quantity, Brief Intervention(SBIRT) isfrequency and consequences of alcohol use. the leading way to help employees and businesses to A behavior change strategy focused reduce the impact of unhealthy alcohol use. on helping your client reduce or Referral to Treatment and Follow-up stop unhealthy drinking. Linking your client to specialized Screenings addiction treatment and staying with the client to support sustained success. Brief Intervention Referral to Treatment and Follow-Up
    • 32. High Risk: Those who regularly exceed 2 or more of the recommended 5% daily, weekly or occasion limits for alcohol consumption. High Risk Moderate Risk: Those who regularly exceed one of the recommended 20% daily, weekly or occasion limits for alcohol consumption.Moderate Risk Low Risk: Drinkers who never exceed the 35% recommended daily, weekly and occasion limits for alcohol consumption. Low Risk No Risk: 40% Those who never drink alcohol. No Risk *Backgrounder | 2008 | The Case for Low-Risk Drinking Guidelines for BC |
    • 33. How do you know you are an alcoholic?• Any ideas?
    • 34. Alcoholism, also known as alcohol dependence, is a disease with four primary symptoms:• Craving − A strong need or compulsion to drink.• Loss of control − The inability to limit one’s drinking on any given occasion.• Physical dependence − Withdrawal symptoms, such as nausea, sweating, shakiness, and anxiety occur when alcohol use is stopped after a period of heavy drinking.• Tolerance − The need to drink greater amounts of alcohol over time in order to get the desired effect.Source: US Nat’al Institute on Alcohol Abuse & Alcoholism
    • 35. Workplace Solutions - Morale• Make the work place a positive place! – Celebrate birthdays – Celebrate holidays – Team building exercises: staff day at the movies, staff day in the park, etc• Sit fighting co-workers down and help solve the issues between them• Teambuilding workshops• Have a zero tolerance policy 35
    • 36. Workplace Solutions – HR Forms• Performance Appraisal• Make it employee focused• Career path• Training• Tools they need• Job description updated 36
    • 37. Workplace Solutions – HR Policies• NO BULLYING!• Bullying any co-worker on or off the workplace is still an offense• Creates low self-esteem and toxic work environment 37
    • 38. Workplace Solutions – HR Policies• Absenteeism Management• Establish average absentee rate• Place those x% above, in an Absenteeism Management Program 38
    • 39. Workplace Solutions: Manager Training Agenda What do substances look like? What do they do?Policies are only asgood as their Enabling, Privacy, Rightscommunication ER and EE ObligationsManagers need Treatment, Support,support on how to Accommodationact and react Performance Management Prevention, Recognition, Response Skills 39
    • 40. What is an “Employer of Choice”?• Any employer of any size in the public, private or not-for-profit sector that attracts, optimizes and retains top talent… because the employees choose to be there 40
    • 41. Work Life Balance• It is important to find the balance in life: family, work, school, and any other side projects or important aspects of your life• Canadian workers spend about 60% of their waking hours at work
    • 42. Workplace Wellness “Research shows that mostemployees believe the workplace is an appropriate and effective place to promote health and well-being issues.”
    • 43. Solution: Prevention! Planned action to stop the development of addictive behaviours, and promote health enhancing behaviours
    • 44. Physical Solutions• Prevent physical illnesses by offering employees time to stretch, walk, exercise, etc – For example: offer gym memberships• If one person is sick in the office, send them home! One person sick is better than everyone being sick.
    • 45. Workplace Solutions• Make the work place a positive place! – Celebrate birthdays – Celebrate holidays – Team building exercises: staff day at the movies, staff day in the park, etc• Sit fighting co-workers down and help solve the issues between them• Have a zero tolerance policy
    • 46. Management Support• Wellness programs• Have an open door policy• Listen to your staff and make sure they’re happy where they are
    • 47. Workplace Wellness• Does anyone have any programs they wish to talk about please?
    • 48. Trend #2 - Health and Wellness Programs48 CG Hylton 48
    • 49. Why? Employee Productivity• Absenteeism• Presenteeism• Stress• Chronic Disease CG Hylton 49
    • 50. Common Chronic Disease Risk Factors Tobacco Unhealthy Physical Alcohol Smoking Diet Inactivity Consumption Overweight/ Obesity High Blood Type 2 High Pressure Diabetes Cholesterol COPD Heart Mental Disease Renal Disorders Lung Disease Cancer Respiratory Cancer of mouth, Cancer of Prostate Disease pharynx, larynx, Pancreas, Colon Cancer Bladder, Kidney esophagus, liver Cancer Breast Cancer MusculoskeletalSource: Ontario Ministry of Health and Long-term Care CG Hylton 50
    • 51. Employee Health Today Most individuals are stuck in the “pre or contemplation” stage, High risk individuals will change health behaviors given the right coaching. Challenge for Employers: Engage employees who want to make this change Permanent Behavior Change Completion Maintenance Action Risky Behavior Preparation Contemplation Pre-contemplation Source: Mike Humphrey and Erika Van Flein of the University of Alaska.51 CG Hylton 51
    • 52. What is an EAP?• Mental health assistance for EEs and their families• So EEs may concentrate on work• Short service model• Coordinates response to critical incidents in the workplace• Deals tangentially with addictions 52
    • 53. Typical Reasons for Calls to EAP Work place Family18% 8% 25%Alcohol Substance Abuse 25%Depression 22% Stress 53
    • 54. Reasonable Cost• EAP costs fraction of average medical or dental plan• $200 per ee per mo for Dental insurance• $5 per ee per mo for EAP What Price? 54
    • 55. Stitch in time • If mentally, employees believe “I am disabled” is their natural state = difficult to cure • “I am temporarily having some difficulties that I with help of the EAP I will be able to overcome!” = easy to cure • Prevention key 55
    • 56. EAP Cost • Our EAP • No cost to set up • $125 per hour cost • Less expensive than programs that charge a set amount per ee per month 56
    • 57. Cost Comparison• 100 ees• 5% use plan• 3 sessions each• 15 sessions x 125 = $1,825• vs 100 x $4.50 x 12 = $5,400
    • 58. Case Study - Jack Safety-sensitive, oilfield construction Knee surgery due to work accident several years before Military Veteran, previous treatment for PTSD Missing work — leaving early, coming in late, called in sick, spoke to YOU Expressed suicide wish, disclosed drug use, asked for help 58
    • 59. Response to Jack Immediate appointment to assess safety and stabilize Immediate EAP or substance abuse specialist Employer input to counsellor • Observations of behaviour • Performance • Previous assessments/testing • Any other pertinent work history 59
    • 60. 2 Year Relapse Prevention Program• In cooperation with EAP Program• Set schedule of counselling appointments over 24 months• Monitoring of compliance with substance abuse recommendations, e.g. inpatient treatment, abstinence, & 12-step programming• Regular reporting of attendance• Option to coordinate on-going substance 60 testing
    • 61. Drug & Alcohol Testing• Discrimination rules • Safety sensitive• No pre-employment position is one where impairment testing due to drug or• No random drug alcohol use could testing result in injury to• No alcohol testing self or others for non-safety sensitive positions 61
    • 62. When Can you Test?
    • 63. When can you test?• Random alcohol testing for safety sensitive positions ok• Drug or alcohol testing for “reasonable cause” or “post-accident” is ok 63
    • 64. How nice should you be?Consider: Is it better to fight discrimination suit than injury or death claim caused by a drunk or impaired employee?Disclaimer: I am not a lawyer 64
    • 65. Face to face TherapyMental health and addiction problems are common to the workforce, overlap with many medical conditions and have negative consequences for the person and the companyResearch conclusively shows thattraditional face-to-face (FTF) psychotherapyis generally effective for mental health issues  Source: Lipsey & Wilson (1993), NICE (2008), Seeling & Katon (2008) 65
    • 66. Access not always possible But, access to and use of FTF treatment isproblematic. Less than 1 in 3 people affectedget quality care FTF care also is not uniformly effective forall patients even when received 66
    • 67. •Telephonic therapy for mental health has beentested in more than 30 research studies. The general conclusion is that telephonictherapy is effective or at least promising inmost of the empirical tests conducted.Cognitive Behavioral Therapy (CBT) has beenthe most commonly used form of intervention. Telephonic therapy services are effective formany conditions: Anxiety, depression, panicdisorders, substance abuse, trauma, PTSD,and others. 67
    • 68. Summary of Research Internet Counselling• Internet-based forms of psychotherapy (e-mail andweb tools) also shows initial support in over 20research studies; many with RCT study designs. Online therapy services and tools appear to workbest for certain kinds of patients, when used to supportother ongoing therapy, and for use as self-care andrelapse prevention. Positive clinical outcomes have also been obtainedwith therapist use of the Internet to interact via e-mail forpatients with depression, anxiety, social phobias, PTSD,eating disorders, and panic disorder. Source: Griffiths & Christensen (2006), Reger & Gahm (2009) 68
    • 69. Summary of Research Internet CounsellingConducted in UK by Kessler et al. (Lancet, 2009)It used an online, real-time CBT intervention for 113 patients,compared to 97 cases with care as usual by a general medicalpractitioner.In-person assessment of diagnosis and symptom severity,followed by a series of ten hour-long sessions of online text-based(e-mail) interaction with a mental health therapist.After treatment, more patients recovered from depression in theonline treatment group (38%) than in the control group (23%). Thiseffect also was found at 8-month follow-up (42% and 26%).Source: Kessler et al. (2009) 69
    • 70. What did we miss?
    • 71. Developing a drug and alcohol policy and communicating it to staff
    • 72. Accommodation issues surrounding addictions in the workplace
    • 73. Dealing with addiction-related misconduct
    • 74. Recognition, intervention, and support: employee, employer, and community involvement in rehabilitation, recovery, and the reintegration process
    • 75. W75
    • 76. ThankYou!Questions?
    • 77. Resources  America’s Health Insurance Plans -  Centers for Disease Control -  Canadian Institute for Health Information -  EASNA  Gallup-Healthways Well-Being Index™ -  Health Canada – Healthy Living -  Health Promotion Advocates  IHPM - Institute for Health and Productivity Management -  Mental Health Commission of Canada -  National Wellness Institute -  WorldatWork: global human resources association focused on compensation, benefits, work-life and integrated total rewards -