This document provides an overview of a presentation on substance abuse and prevention in the workplace. The presentation covers key topics such as indicators of substance abuse, addictions, prevention strategies, return-to-work strategies, employee assistance programs, drug and alcohol testing, and maintaining positive workplace morale and mental health. Effective solutions involve screening, brief interventions, treatment referrals, and changing workplace policies and culture to promote wellness and prevent problems.

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. Agenda
2
 Key indicators of substance abuse
 Addictions
 Internal prevention strategies
 Return-to-work strategies
 Inspecting current policy
 EAP
 D&A, Testing
 Guarding Minds

3. 3
Do you have any workplace issues we
can try and solve for you in this
session?

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. 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. Freud
6
Love and work
are the
cornerstones
of our
humanness
http://www.freud.org.uk/

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
But on the other hand…

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
Why does this matter to
Canadian employers?
Making the case

11. 11
Presenteeism
Absenteeism
Extended Health Claims
Disability Claims
Lost Productivity

12. Stress in the Workplace - 3 in 10 at risk
12
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. Mental Health – Overlapped by
13
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. Abusers in Past Year as Percentage
14
of Adults (Canada)
20 19 15 14 2
Alcohol Tobacco Medications Marijuana Illicit Drugs
 Source: Attridge & Wallace (2009), MacMillan et al. (2009)

15. Behavioural Addictions
15
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. Addictions are in the Workplace
16
 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. Workplace Demographics
17
 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. Alcohol and Drug Addictions Costs
18
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. Other Workplace
19
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. Case Study - Jack
20
 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. Response to Jack
21
 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. Two-Year Relapse Prevention Program
22
 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. Why is the problem to difficult and
23
complicated?
ANY IDEA WHAT
CAUSES ADDICTIONS?

24. What ―Causes‖ Addictions
24
 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. How does someone get addicted
25
 Traditional Continuum Model of Progression
Toward Substance Abuse (Alcohol/Drug):
Source: Attridge & Wallace (2010)

26. Epigenetic Neuroscience Research
26
 ―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. New Research - Epigenetics
27
 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
 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

30. So what have we learned so far?
30
Source: Suomi (2010)

31. Care and Prevention
31
 Can the problem be treated or prevented?

32. Range of Treatments
32
 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. Addiction is a
33
Life-long Condition
The Addiction Cycle Often Repeats Over Time, Even with
Treatment and Can Worsen
Source: Cleck & Blendy (2008)

34. Rx Treatments for Addictions - Limited &
Often Ineffective
34
 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. Solution
35
 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. Solution: Changing the Workplace to
Prevent Problems and Support Workers
36
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. Workplace Solutions - Morale
37
 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. Workplace Solutions – HR Forms
38
 Performance Appraisal
 Make it employee focused
 Career path
 Training
 Tools they need
 Job description updated

39. Workplace Solutions – HR Policies
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 NO BULLYING!
 Bullying any co-worker on or off the workplace
is still an offense
 Creates low self-esteem and toxic work
environment

40. Workplace Solutions – HR Policies
40
 Absenteeism Management
 Establish average absentee rate
 Place those x% above, in an Absenteeism
Management Program

41. Workplace Solutions: Manager Training
Agenda
41
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. Workplace Solutions –
Employer of Choice
42
 What is an ―Employer of Choice‖?

43. What is an
43
―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. Which results in
44
 Employees choosing to work or
continue to work for your
organization… even when presented
with other and more enticing
employment opportunities

45. How do you treat staff?
45

46. Corporate programs - EAP
46
 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. 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. Typical EAP Usage
48
 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. Typical Reasons for Calls to EAP
49
Work
place Family
18% 8%
25%
Alcohol
Substance Abuse
25%
Depression
22% Stress

50. Reasonable Cost
50
 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. 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. 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. 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. 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. Face to face Therapy
55
 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. Access not always possible
56
 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
•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. Summary of Research
58
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. Summary of Research
59
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. EASNA’s 2009 Purchaser’s Guide to
EAPs
Selecting and Strengthening
Employee Assistance
Programs:
A Purchaser’s Guide
60

61. W
61

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. Resources
 America’s Health Insurance Plans - www.ahiphiwire.org/wellbeing
63
 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. Our offer to you
64
 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. 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. Thank you for the opportunity to
66
meet today!
Tel 403 264 5288
or 800 449 5866 (800 4hylton)
chris@hylton.ca