Accommodation I: Substance   Abuse and Prevention        1:45 pm Oct 25, 2010       Infonex 940 Vancouver        By Chris ...
Agenda2       Key indicators of substance abuse       Addictions       Internal prevention strategies       Return-to-...
3    Do you have any workplace issues we     can try and solve for you in this     session?
What is Mental Health?4       World Health Organization defines mental        health as "a state of well-being in which t...
What is Mental Health?5       People learning and be able to cope with:         Stress         Changes   in life and th...
Freud6            Love and work                are the             cornerstones                of our              humanne...
and you wonder why we work?7       ―No other technique for the conduct of life    attaches the individual so firmly to re...
8    But on the other hand…
9    “Therein we have one of the    fundamental paradoxes we    face today: Work is good for    your mental health and wor...
10     Why does this matter to      Canadian employers?         Making the case
11         Presenteeism          Absenteeism     Extended Health Claims        Disability Claims        Lost Productivity
Stress in the Workplace - 3 in 10 at risk12     Sector           Serious    Significa Total % Reporting Risk              ...
Mental Health – Overlapped by13                 Addictions    25% of adults in a year have anxiety, phobias, panic attack...
Abusers in Past Year as Percentage14     of Adults (Canada)     20          19          15                  14            ...
Behavioural Addictions15     Increasing     Addiction       Rate in Adult       Historical Trend                     Popul...
Addictions are in the Workplace16        Most people with addictions have jobs and are         actively in the workforce ...
Workplace Demographics17        It Starts Young. Younger age workers are most at risk for         developing mental healt...
Alcohol and Drug Addictions Costs18     to Society: Canada          $ Billions                                      Combin...
Other Workplace19     Consequences        Majority of all addiction                     Costs of         related costs (6...
Case Study - Jack20        Safety-sensitive, oilfield         construction        Knee surgery due to work accident     ...
Response to Jack21        Immediate appointment to         assess safety and stabilize        Immediate EAP or substance...
Two-Year   Relapse Prevention Program22         In cooperation with EAP Program         Set schedule of counselling appo...
Why is the problem to difficult and23     complicated?     ANY IDEA WHAT      CAUSES ADDICTIONS?
What ―Causes‖ Addictions24      Moral Model – only a “bad person” gets       addicted and can’t quit      Disease Model ...
How does someone get addicted25        Traditional Continuum Model of Progression         Toward Substance Abuse (Alcohol...
Epigenetic Neuroscience Research26        ―This is an extraordinary moment in the         science of mental disorders. Th...
New Research - Epigenetics27        Links Addictions to a Combination of Genetic         and Biological Factors that Inte...
28      development in utero and in       childhood, environmental       chemicals, drugs and       pharmaceuticals, agin...
29
So what have we learned so far?30        Source: Suomi (2010)
Care and Prevention31        Can the problem be treated or prevented?
Range of Treatments32        self-help (often multiple failed attempts) = weak evidence        group-based peer-support ...
Addiction is a33     Life-long Condition        The Addiction Cycle Often Repeats Over Time, Even with        Treatment an...
Rx Treatments for Addictions - Limited &     Often Ineffective34        Effective treatments for drug abuse involve both ...
Solution35        Screening        Brief intervention        Referral for treatment        Study by Institute for Heal...
Solution: Changing the Workplace to     Prevent Problems and Support Workers36     Research has consistently revealed that...
Workplace Solutions - Morale37        Make the work place a positive place!          Celebrate birthdays          Celeb...
Workplace Solutions – HR Forms38      Performance Appraisal      Make it employee focused      Career path      Traini...
Workplace Solutions – HR Policies39        NO BULLYING!        Bullying any co-worker on or off the workplace         is...
Workplace Solutions – HR Policies40        Absenteeism Management        Establish average absentee rate        Place t...
Workplace Solutions: Manager Training                     Agenda41                     What do substances look like?      ...
Workplace Solutions –         Employer of Choice42        What is an ―Employer of Choice‖?
What is an43         ―Employer of Choice‖?        Any employer of any size in the public, private         or not-for-prof...
Which results in44          Employees choosing to work or           continue to work for your           organization… eve...
How do you treat staff?45
Corporate programs - EAP46        A program that offers:          short-term,   professional counselling and referral   ...
What is an EAP?47        Mental health assistance for EEs and their         families        So EEs may concentrate on wo...
Typical EAP Usage48         8-12% (2007) (avg range from 2 of 3          major Canadian EAP providers)         11% in 19...
Typical Reasons for Calls to EAP49               Work               place     Family        18%         8%                ...
Reasonable Cost50      EAP costs fraction of average medical or       dental plan      $200 per ee per mo for Dental ins...
Stitch in time                    If mentally, employees                     believe ―I am disabled‖ is                  ...
Drug & Alcohol Testing     Discrimination rules      Safety sensitive     No pre-employment          position is one   ...
When can you test?    Random alcohol testing for     safety sensitive positions ok    Drug or alcohol testing for     ―r...
How nice should you be?Consider:is it better to fight discrimination suit than  injury or death claim caused by a drunk  o...
Face to face Therapy55    Mental health and addiction problems are     common to the workforce, overlap with many     med...
Access not always possible56      But, access to and use of FTF treatment is     problematic. Less than 1 in 3 people aff...
57     •Telephonic therapy for mental health has been tested     in more than 30 research studies.       The general concl...
Summary of Research58     Internet Counselling     • Internet-based forms of psychotherapy (e-mail and     web tools) also...
Summary of Research59       Internet Counselling     Conducted in UK by Kessler et al. (Lancet, 2009)     It used an onlin...
EASNA’s 2009 Purchaser’s Guide to   EAPsSelecting and Strengthening   Employee Assistance       Programs:   A Purchaser’s ...
W61
62      ASSESSMENT                             ACTION         TOOLS                          STRATEGIES            EVALUAT...
Resources        America’s Health Insurance Plans - www.ahiphiwire.org/wellbeing63        Centers for Disease Control - ...
Our offer to you64        Please call if you have any HR, or workplace         issue that you are overwhelmed with      ...
CG Hylton - Services   HR Consulting             Benefits, Pensions,   Job Descriptions           EAP                  ...
Thank you for the opportunity to66      meet today!      Tel 403 264 5288      or 800 449 5866 (800 4hylton)      chris@hy...
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Accomodation and prevention substance abuse

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Key indicators of substance abuse
Addictions
Internal prevention strategies
Return-to-work strategies
Inspecting current policy
EAP
D&A, Testing
Guarding Minds

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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.
  • 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
  • Accomodation and prevention substance abuse

    1. 1. Accommodation I: Substance Abuse and Prevention 1:45 pm Oct 25, 2010 Infonex 940 Vancouver By Chris Hylton, MA. CG Hylton & Associates Inc. 1
    2. 2. Agenda2  Key indicators of substance abuse  Addictions  Internal prevention strategies  Return-to-work strategies  Inspecting current policy  EAP  D&A, Testing  Guarding Minds
    3. 3. 3 Do you have any workplace issues we can try and solve for you in this session?
    4. 4. What is Mental Health?4  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. 5. What is Mental Health?5  People learning and be able to cope with:  Stress  Changes in life and the workplace  Demands in the workplace  Home life  Work life
    6. 6. Freud6 Love and work are the cornerstones of our humanness http://www.freud.org.uk/
    7. 7. and you wonder why we work?7  ―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‖
    8. 8. 8 But on the other hand…
    9. 9. 9 “Therein we have one of the fundamental 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. 10. 10 Why does this matter to Canadian employers? Making the case
    11. 11. 11 Presenteeism Absenteeism Extended Health Claims Disability Claims Lost Productivity
    12. 12. Stress in the Workplace - 3 in 10 at risk12 Sector Serious Significa Total % Reporting Risk Concerns nt Concerns Manufacturing 5% 33% 38% Public 3% 29% 32% Administration Health Care 4% 28% 32% and Social Assistance Retail Trade 4% 24% 28% Finance and 2% 22% 24% Insurance
    13. 13. Mental Health – Overlapped by13 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 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
    14. 14. Abusers in Past Year as Percentage14 of Adults (Canada) 20 19 15 14 2 Alcohol Tobacco Medications Marijuana Illicit Drugs  Source: Attridge & Wallace (2009), MacMillan et al. (2009)
    15. 15. Behavioural Addictions15 Increasing Addiction Rate in Adult Historical Trend Population Gambling 5% problem; 2% Increasing pathological Sex 3% to 6% Increasing Food / Eating 5% women, <1% men Increasing Internet Use 1% unknown Increasing Workaholism 1% unknown Increasing
    16. 16. Addictions are in the Workplace16  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
    17. 17. Workplace Demographics17  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.
    18. 18. Alcohol and Drug Addictions Costs18 to Society: Canada $ Billions Combined costs of: 39.8  health care  law enforcement  work productivity  disability  premature death 8.9  Average $1,267 per every citizen 1992 2002 Source: Single et al (1996); Rehm et al (2006)
    19. 19. Other Workplace19 Consequences  Majority of all addiction Costs of related costs (61%) are in Addictions 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 Work Productivity company risks for safe work All Other Areas environments, equipment loss and lawsuits. Source: Attridge (2008), Attridge (2009)
    20. 20. Case Study - Jack20  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 Manager  Expressed Suicide wish, disclosed drug use, asked for help
    21. 21. Response to Jack21  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
    22. 22. Two-Year Relapse Prevention Program22  In cooperation with EAP Program  Set schedule of counselling appointments over 24 months  Review and 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 testing
    23. 23. Why is the problem to difficult and23 complicated? ANY IDEA WHAT CAUSES ADDICTIONS?
    24. 24. What ―Causes‖ Addictions24  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?
    25. 25. How does someone get addicted25  Traditional Continuum Model of Progression Toward Substance Abuse (Alcohol/Drug): Source: Attridge & Wallace (2010)
    26. 26. Epigenetic Neuroscience Research26  ―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)
    27. 27. New Research - Epigenetics27  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.
    28. 28. 28  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
    29. 29. 29
    30. 30. So what have we learned so far?30 Source: Suomi (2010)
    31. 31. Care and Prevention31  Can the problem be treated or prevented?
    32. 32. Range of Treatments32  self-help (often multiple failed attempts) = weak evidence  group-based peer-support programs (AA) = modest evidence  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 TRENDS = Gender differences & Holistic treatment model best
    33. 33. Addiction is a33 Life-long Condition The Addiction Cycle Often Repeats Over Time, Even with Treatment and Can Worsen Source: Cleck & Blendy (2008)
    34. 34. Rx Treatments for Addictions - Limited & Often Ineffective34  Effective treatments for drug abuse involve both behavioral therapy and medication.  However - the list of medications approved for treatment of addiction is quite limited.  Many of the medication treatments available are only given when the addict is actively using the addictive substance.  Thus, very few treatments are prescribed during the critical withdrawal period when needed to prevent relapse.  No medications for addictions are available for prevention. Source: Cleck & Blendy 2008
    35. 35. Solution35  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 http://www.ihe.ca/documents/Interventions_for_pr evention_of_workplace_stress.pdf
    36. 36. Solution: Changing the Workplace to Prevent Problems and Support Workers36 Research has consistently revealed that interventions delivered at the organizational level are needed and also tend to be often more effective than traditional interventions delivered at the individual level because they address the prevention of problems.  Employee ―Engagement‖ in Work  Family Leave Benefits & Flex Scheduling  Positive Corporate Culture  Psychological Safety Legal Context Source: Attridge et al. (2009), Barling (2007), Bergerman et al. (2009), Harvey et al. (2006), Richardson & Rothstein (2008)
    37. 37. Workplace Solutions - Morale37  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
    38. 38. Workplace Solutions – HR Forms38  Performance Appraisal  Make it employee focused  Career path  Training  Tools they need  Job description updated
    39. 39. Workplace Solutions – HR Policies39  NO BULLYING!  Bullying any co-worker on or off the workplace is still an offense  Creates low self-esteem and toxic work environment
    40. 40. Workplace Solutions – HR Policies40  Absenteeism Management  Establish average absentee rate  Place those x% above, in an Absenteeism Management Program
    41. 41. Workplace Solutions: Manager Training Agenda41 What do substances look like? What do they do? Policies are only as good as their Enabling, Privacy, Rights communication ER and EE Obligations Managers need Treatment, Support, Accommod support on how to ation act and react Performance Management Prevention, Recognition, Respo nse Skills
    42. 42. Workplace Solutions – Employer of Choice42  What is an ―Employer of Choice‖?
    43. 43. What is an43 ―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
    44. 44. Which results in44  Employees choosing to work or continue to work for your organization… even when presented with other and more enticing employment opportunities
    45. 45. How do you treat staff?45
    46. 46. Corporate programs - EAP46  A program that offers:  short-term, professional counselling and referral services  support in dealing with a wide range of stressful situations (personal/work related)  assistance and advise  Services are free and confidential
    47. 47. What is an EAP?47  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
    48. 48. Typical EAP Usage48  8-12% (2007) (avg range from 2 of 3 major Canadian EAP providers)  11% in 1997 (Can Federal Public Service)  25% in a mine, where the counsellor was a former miner who just hung out for coffee with the miners
    49. 49. Typical Reasons for Calls to EAP49 Work place Family 18% 8% 25% Alcohol Substance Abuse 25% Depression 22% Stress
    50. 50. Reasonable Cost50  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?
    51. 51. 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 51
    52. 52. Drug & Alcohol Testing  Discrimination rules  Safety sensitive  No pre-employment position is one testing where impairment  No random drug due to drug or testing alcohol use could result in injury to self  No alcohol testing or others for non-safety sensitive positions 52
    53. 53. When can you test?  Random alcohol testing for safety sensitive positions ok  Drug or alcohol testing for ―reasonable cause‖ or ―post- accident‖ is ok 53
    54. 54. 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? 54
    55. 55. Face to face Therapy55  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 that traditional face-to-face (FTF) psychotherapy is generally effective for mental health issues  Source: Lipsey & Wilson (1993), NICE (2008), Seeling & Katon (2008)
    56. 56. Access not always possible56  But, access to and use of FTF treatment is problematic. Less than 1 in 3 people affected get quality care  FTF care also is not uniformly effective for all patients even when received
    57. 57. 57 •Telephonic therapy for mental health has been tested in more than 30 research studies. The general conclusion is that telephonic therapy is effective or at least promising in most of the empirical tests conducted. Cognitive Behavioral Therapy (CBT) has been the most commonly used form of intervention. Telephonic therapy services are effective for many conditions: Anxiety, depression, panic disorders, substance abuse, trauma, PTSD, and others.
    58. 58. Summary of Research58 Internet Counselling • Internet-based forms of psychotherapy (e-mail and web tools) also shows initial support in over 20 research studies; many with RCT study designs. Online therapy services and tools appear to work best for certain kinds of patients, when used to support other ongoing therapy, and for use as self-care and relapse prevention. Positive clinical outcomes have also been obtained with therapist use of the Internet to interact via e-mail for patients with depression, anxiety, social phobias, PTSD, eating disorders, and panic disorder. Source: Griffiths & Christensen (2006), Reger & Gahm (2009)
    59. 59. Summary of Research59 Internet Counselling Conducted 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 medical practitioner. 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 the online treatment group (38%) than in the control group (23%). This effect also was found at 8-month follow-up (42% and 26%). Source: Kessler et al. (2009)
    60. 60. EASNA’s 2009 Purchaser’s Guide to EAPsSelecting and Strengthening Employee Assistance Programs: A Purchaser’s Guide 60
    61. 61. W61
    62. 62. 62 ASSESSMENT ACTION TOOLS STRATEGIES EVALUATION  Organizational  Risk Report Card CRITERIA Audit  Action Responses  Evaluation  Initial Scan  Action Planning Planning Worksheet  PSR-12 Worksheet Employee Survey
    63. 63. Resources  America’s Health Insurance Plans - www.ahiphiwire.org/wellbeing63  Centers for Disease Control - www.cdc.gov/nchs/fastats/hinsure.htm  Canadian Institute for Health Information - www.cihi.ca  EASNA www.easna.org/purchasers.php  Gallup-Healthways Well-Being Index™ - www.well-beingindex.com  Health Canada – Healthy Living - www.hc-sc.gc.ca/hl-vs/index-eng.php  Health Promotion Advocates http://healthpromotionadvocates.org/sources_detail_documents.htm  IHPM - Institute for Health and Productivity Management - www.ihpm.org  Mental Health Commission of Canada - www.mentalhealthcommission.ca  National Wellness Institute - www.nationalwellness.org  WorldatWork: global human resources association focused on compensation, benefits, work-life and integrated total rewards - www.worldatwork.org
    64. 64. Our offer to you64  Please call if you have any HR, or workplace issue that you are overwhelmed with  We can help you  We also are pleased to do Free Workshops for your organization (some limits apply) Let us know what your needs are and we will make it happen!
    65. 65. CG Hylton - Services HR Consulting  Benefits, Pensions, Job Descriptions EAP  Strategic Planning Salary Grids  Drug and Alcohol Wellness at Work programs Staff Morale  Dept re-orgs Training and  Leadership Workshops compensation Tel 403 264 5288 chris@hylton.ca 65
    66. 66. Thank you for the opportunity to66 meet today! Tel 403 264 5288 or 800 449 5866 (800 4hylton) chris@hylton.ca

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