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Case Studies on Substance Abuse in the Workplace

Lord Victor Adebowale CBE and Sarah Reed

CASE STUDY 1: LYDIA: A 43 YEAR OLD TEACHER FROM LONDON

For years lydia has been a self-described “functional alcoholic.” that is, she did not drink during the day and continued with her job without bringing attention to the fact that she had a problem. As soon as her children were seated at the dining room table, eating dinner, she started to drink wine heavily. Her colleagues were unaware of the effect this dependency was having on her family—specifically her two young children.

Lydia had always drunk a lot, but following a brain aneurism, leading to a period of extended sick leave, alcohol started to affect her in a different way. This was combined with depression and stress caused by a particularly difficult student in her class. Finally, the culmination of work pressures, her family breaking down, and the realization that her drinking was a problem led lydia to admit herself into a residential rehab program.

At the time, although admitting to herself that she needed help, lydia was unable to tell her Headteacher (principal) that she was an alcoholic, concerned about what he may think. She sought union and GP advice as to whether or not she should tell the truth. Both advised her to be honest, but, concerned about the stigma surrounding alcohol and the fact that one of her children was at the school where she taught, lydia decided to tell her employer that she had had a nervous breakdown—linking it to her previous sickness—and that she was entering a residential rehab clinic. In the course of the conversation she did admit that alcohol may have played a part in her breakdown. The Headteacher was supportive but said that the senior management team (SMT) at the school would have to be told and later escorted her from the premises.

Lydia is now in her second month at a residential rehab service. Social services are involved with her children, and she has not heard at all from her employer. She feels completely cut off. Planning to go back to work in September, lydia now has the prospect of facing her colleagues, class, and children’s parents to contend with, along with her recovery. From a friend she has found out that there is some workplace gossip surrounding her leave, that parents of her class are disgruntled at how cover at the school has been managed and that her SMT position has been filled by someone else. In lydia’s words: “I feel like I’m being punished for doing the right thing. When I go back, I will be paranoid that everyone will be talking about me behind my back. I feel like my 20-year career, my professionalism, means nothing now.”

CASE STUDY 2: RICHARD

Richard used to be a marketing executive for an It company in the City of london. The role was fast-paced and target-driven. There was a high turnover of staff, and certain behaviors were accepted as long as targets were met. Therefore it was easy to hide the fact that Richard had a substance misuse problem.

Signs, eventually, started to show at work—his behavior changed: he was often late or absent; would often come into work with a hangover; a quick drink after work would not stop at one or two pints but would last long after his workmates had left until closing time and then continue back at his flat. Richard admits that “the signs were there. My boss was concerned but didn’t act on the symptoms.”

Toward the end of his time at the company Richard was crying out for help, knowing that he had a problem but without any idea of what to do about it: “I didn’t feel like I could ask for help in that environment or that my boss would be able to help or know what to do.”

His whole life was falling around him and, as he continued to struggle unsupported with his substance misuse and the pressures of his job, his employers turned a blind eye. Finally, he hit rock-bottom. It was at his lowest point that he left work and entered a rehab service.

Following his time in rehab, now successfully on the route to recovery, Richard started to volunteer at a drug drop-in service. A few years later he took up employment as a case worker there, uniquely positioned to help others in a similar situation to which he once found himself.

CASE STUDY 3: SOPHIE

Sophie had worked at a large chain of supermarkets since she was 16. Ten years later her history of substance misuse started to affect her ability to work on the shopfloor. Her line manager noticed and started to ask her questions—not in a judgemental way but as a friend. Trusting that what she told her line manager would be kept confidential, Sophie admitted to having a drug problem. She was having some problems at home and her use of cannabis had escalated, and she was now taking numerous substances. Finally, she asked for help.

Her employers immediately treated her substance misuse as a health problem and were able to recommend a number of different treatment routes for her to take. During her time off she was paid, and there remained a constant dialogue between her and her manager as to her progress, how she was feeling, and what she wanted to happen afterwards in terms of returning to work.

After completing rehab, Sophie continued attending a drop-in service. It was at this point that she spoke to her manager about coming back to work. After a long and frank discussion, it was decided by both Sophie and her manager that she would not be returning to work. “I feel like I decided what was best for me without being judged. I appreciated their honesty and they appreciated mine. They were really supportive.”

According to the 2007 study by the Chartered Institute of Personnel and Development (CIPD), alcohol abuse in the workplace costs the UK somewhere in the region of £2 billion each year, with drug abuse accounting for an estimated £800 million. The government’s Alcohol Harm Reduction Strategy for England says that “alcohol misuse among employees costs up to £6.5 billion in lost productivity” (Prime Minister’s Strategy Unit, 2004, p. 31).

The risks of this trend continuing are obvious:

  • for the economy, lost working days and loss of revenue;

  • for organizations, this loss of financial productivity is partnered with potentially detrimental effects to company reputation, absenteeism, staff health, well-being and motivation;

  • for the individual, potential psychological and financial costs to them and their families through loss of employment and the adverse health effects intrinsically linked with substance misuse.

Although the prevalence of substance misuse is higher in the unemployed compared to those in work, reports suggest that this gap is narrowing. With the current suggestion being that one in ten workers uses drugs and one in four workers under 30 has used them in the last year, it would seem that the effects and associated risks of substance misuse in the workplace are set to continue, and most likely increase (Smith et al., 2004). This trend is propounded by the increase in polydrug use and associated complex needs, specifically mental health issues. Is there, then, anything that can be done from a corporate position to curb these effects, or is this impact inevitable? Is the risky behavior of drug and/or alcohol misuse by employees just a symptom of today’s society, which would continue regardless of any corporate response?

Through case studies and first-hand experiences, this chapter will shed light on what has and hasn’t worked for real people, the importance of staff engagement, proactive rather than reactive staff welfare policies, and the need for an organizational culture of support rather than judgment.

By engaging with the five key principles discussed, this chapter concludes that employers are in a unique and powerful position to ensure the health and well-being of their employees. Through company policy and procedure they can deter substance misuse, support individuals in seeking the treatment they need, or, conversely, drive it further underground.

Substance Misuse in the Workplace

Where literature can be found on how employees should respond to the effects of substance misuse in the workplace, there is an undercurrent in the majority which prioritizes the rights and responsibilities of employers to protect their business rather than focusing on the health, safety and well-being of their employees. Any workplace response, whether it be HR policy on substance misuse or development of a new business model, is based on cost-benefit analysis. There are many influencing factors a company considers when making decisions of any kind. These include the sector(s) in which the company works as well as the company’s size, value, reputation, and legal responsibility and duty of care to its staff and clients.

For some businesses, the cost of its employees being affected by substance misuse is negated by meeting targets, the environment in which they work or simply the “culture of their business.” Stories from the City of cocaine being brushed off of bankers’ shoulders as they’re pushed back on to the trading floor by their manager may be extreme, but are not rare. Yet, for others, the employer’s duty of care to its staff’s health and well-being outweighs the financial costs of ensuring that they are supported into treatment, through their recovery and, wherever possible, back into the workplace.

As the Changing Minds Campaign put it, the general issue of drug and alcohol use has “surfed waves of public concern” (Royal College of Psychiatrists, 2003). The same can be said for media representation of the subject and those affected by it. In the 1980s coverage focused on associated health issues and tragedies caused by drug use; in the 1990s criminality was the focus. In 1998 the ten-year Government Drug Strategy set out policy relating to harm reduction, reducing Class A use by the under-25s and increasing numbers accessing treatment. In 2008 the focus shifted slightly to restrict the supply of illegal drugs and reduce the demand for them. It focuses on protecting families and strengthening communities (HM Government, 2008, p. 5). All the while the media continue to create stereotypes, emphasizing the stark difference between the celebrity glorification of “rehab” as a “weekend away” versus street drugs propelling knife crime.

A similar “peaks and troughs” relationship can be assigned to the right to have a work-life balance. Increasingly, since the signing of the European Convention on Human Rights and the subsequent 1998 Human Rights Act into British law, legislation has shifted toward highlighting an employer’s responsibility for their employee’s health and well-being while protecting each individual’s right to a private life. However, what should happen when this equilibrium between work and home life blurs and moves into potentially life-threatening behavior is unclear.

In the last few years there has been a resurgence of research into drug misuse at work as the costs and number affected become clearer. Research findings, non-profit organizations, and a number of public bodies have promoted a more proactive stance by employers to act in a more responsible way, instead of promoting a culture of turning a blind eye. “How-to” guides and toolkits have been drafted to advise companies on how best to support employees misusing substances, catching the problem early rather than waiting until the issue escalates to a more dangerous level. For example, a partnership of the Health and Safety Executive of Northern Ireland and the Department of Health, Social Services and Public Safety (2003) has produced guidance for employers and employees on how best to develop and implement workplace drugs and alcohol policies. Here, the central proposition is one of “raising awareness, early recognition and support,” working in a person-centered rather than a company-centered way (p. 2).

Reasons for adopting a workplace substance misuse policy have been given on the basis of legal, corporate and societal obligations. However, the policy in practice guides has consisted of suggestions only, and government pressure has stopped short of enforcing these as adoptable good practice. One reason for the lack of directive legislation is the ambiguity of statistical evidence.

Over the last few years a number of research projects have been commissioned to fill some of the existing gaps, but all have concluded that, to varying degrees, the relationship between substance misuse and workplace incidents is minimal. Even given the estimates of financial cost to the economy as a whole, individual employers are most likely to wait until there is a direct correlation between financial loss and substance misuse for their bottom line. In the meantime, many remain ambivalent in their preparedness.

The Independent Inquiry into Drug Testing at Work (IIDTW) was established to provide a detailed and impartial review of drug-testing in the UK workplace and the surrounding issues and arguments at a time when the number of drug-testing companies, and the use of drug testing in the US, was increasing. After 18 months of inquiry one of the report’s conclusions was that “the evidence for clear-cut deleterious effects of drug use on business is equivocal. What is less so is the belief by the business sector of the harm that drug use, and alcohol consumption in particular, causes to British industry” (IIDTW, 2004, p. 33).

Although 58 percent of nearly 250 respondents to a TUC (Trade Union Congress) questionnaire felt that someone they knew had performed less efficiently at work because of drugs or alcohol, the report concluded that there remains a lack of evidence to suggest that substance misuse is having a serious or widespread effect on the workplace. Without statistical proof there is a lack of momentum propelling companies to act in this area. The CIPD survey on Managing Drug and Alcohol Misuse at Work (2007) found that although 40 percent of the 500 respondent organizations felt that alcohol was a significant cause of employee absence and lost productivity, 42 percent of organizations have no policy in place to help manage the impact of drug or alcohol misuse at work (CIPD, 2007, p. 4).

Legislation

Given the costs incurred by the UK economy, estimated to be 14 million lost working days a year, one would presume that a framework of national policy leading to workplace procedure would have been developed. However, legal guidance is limited. Where it does exist it remains largely open to interpretation with both the IIDTW and the CIPD finding legislation in the UK inconclusive, requiring further investigation and clearer guidance to eradicate existing confusion.

The most relevant pieces of legislation governing substance misuse in the workplace can be found in Table 5.1. Due to inconsistent application of the law, based on its vagueness and openness to interpretation, the IIDTW calls for greater certainty and, in particular, a confirmation from government of its position on the legality of drug-testing, especially for non-safety-critical occupations. In the absence of any test cases solidifying how specifically the relevant legislation can be applied, it would seem that very few employers have anything like the appropriate policies needed to deal with employees’ substance misuse, with only 12 percent of respondent organizations involved in the CIPD and People Management research having referred employees with drug problems to specialist treatment and rehabilitation over a two-year period (CIPD, 2007, p. 3).

Whether the effects of the recession on the finance sector, or the credit crunch in general, will increase the numbers of those needing substance misuse support, so bringing about policy reform, has yet to be seen. But as local and international businesses face more uncertain economic times ahead, proactive risk management and clear legal frameworks are becoming more and more important.

Table 5.1 UK legislation governing substance misuse in the workplace
Legislation

Relevance

The Misuse of Drugs Act (updated 2005)

Places strict restrictions on the possession, supply, production, import and export of any controlled substance, classifying controlled drugs into three classes: A, B and C. The classified substances are all illegal, and could lead to criminal prosecution for both employee and employer.

Human Rights Act (1998)

Imposes a right to respect of home, correspondence and private life. Boundaries relating to how employers can interfere with or pry into an employee’s private life are still being tested by emerging case law.

Data Protection Act (1998)

Provides that all information surrounding possible drug or alcohol misuse is handled securely and confidentially.

Employment Rights Act (1998)

Gives an employee the right not to be unfairly dismissed, potentially applicable when an employer dismisses an employee in relation to a drug or alcohol offence either in inappropriate circumstances or following defective procedure.

May also be applicable if an employer seeks to force an employee to undertake a drug or alcohol test in unreasonable circumstances.

The Health and Safety at Work Act (1974)

Places responsibility on employers to provide and maintain a safe and healthy work environment. The inability to deal with an employee who is under the influence of alcohol or drugs and may constitute a risk to others, could leave the business open to prosecution.

Imposes a civil duty of care on employers to ensure the health and safety of their employees.

Management of Health and Safety at Work Regulations (1992)

Places a duty of care on employers to carry out checks to ensure the health, safety, and welfare of their employees.

Corporate Manslaughter Act (2007)

Provides that directors can be held liable if they fail to effectively manage their organization and this causes a person’s death.

Drug-testing

Although a significant proportion of UK employers see alcohol and drug use as a cause of employee absence and lost productivity, many organizations still find themselves without the proper polices in place to manage or mitigate risks before they pose a significant problem—particularly important when early intervention can be the difference between someone getting their life back on track or losing everything.

One of the most controversial options open to employers, when forming procedural responses, is drug-testing in the workplace as a corporate solution (see Table 5.2).

According to the IIDTW there are eight principal, although not exclusive, forms of testing at work including pre-employment testing; mandatory random testing and voluntary testing (IIDTW, 2004, p. 9).1 [5]Contention remains specifically around the ethics of testing and whether this workplace response is effective at deterring substance misuse or just drives it further underground. There is a danger that positive tests do not actually establish present impairment, but simply indicate recent use, crossing the boundaries between what is personal and work time.

Many parties, including 40–50 percent of US companies already testing workers for drugs, advocate the use of drug-testing as a deterrent (IIDTW, 2004, p. 41). Although the majority of businesses in the UK are not yet conducting drug or alcohol tests and, according to IIDTW interviews, did not think that this would likely change in the near future, 200,000–300,000 tests are carried out each year, primarily in safety-critical roles (Royal College of Psychiatrists, 2003, p. 3).

Table 5.2 Arguments for and against drug-testing in the workplace
Arguments for drug-testing in the workplace

Arguments against drug-testing in the workplace

Safety: Concern that an individual who is impaired by alcohol or drugs is a safety risk to him or herself, co-workers and/or the public. This is specifically applicable to safety-critical roles including bus drivers, ambulance workers, and pilots.

Identification: Drug-testing does not identify impairment, but merely the presence of metabolites in a recent time period, potentially only indicating past use that has no impact on workplace performance. Therefore it may not provide an appropriate or useful result for an employer.

Organizational efficiency: Substance misuse causes lower productivity, absenteeism, and high staff turnover.

Breakdown of trust: A policy of drug-testing may create suspicion amongst the workforce, who may feel as if they are under surveillance, and may withdraw goodwill.

Reputational risk: Drug-impaired performance can damage the organization’s reputation.

Recruitment of staff: Some people may prefer not to work for employers who test for drugs, especially in a mandatory way.

Employee welfare: Drug-testing, it has been suggested, can improve the health and welfare of employees by deterring drug use and identifying those with problems, who can then be encouraged to seek help.

Loss of existing staff: By dismissing employees after a positive drug test, a member of staff in whom the organization has been invested will be lost.

Although drug-testing is one way of managing the risk of substance misuse in the workplace, its range is limited and it tends to ignore the more complex needs of the individuals affected. The efficacy and cost-effectiveness of drug-testing is yet to be empirically proven, with many experts advocating reference-checking, the training of supervisors, regular performance reviews and employee assistance programs as equally effective approaches.

Company responses to positive test results also pose a significant risk of driving the problem further underground. If a previous example of a positive test has not been managed in a confidential manner or was perceived negatively across the workforce, it is unlikely that staff will feel comfortable in coming forward and asking for help. This is not to say that drug-testing at work cannot be effective in determining someone’s drug dependency and provide a route into treatment, but the way in which an employer reacts to a positive result is crucial to how employees will engage with this approach. Therefore any workplace response involving drug-testing must be partnered with trust in the system, strict confidentiality and a clear framework of support into treatment. Where drug-testing is used in safety-critical roles and a positive result automatically leads to disciplinary actions, it is essential that there are opportunities for employees to come forward and seek help as an early intervention.

Health and Well-being

The comprehensive literature on how to manage general health problems (i.e., back pain, common mental health problems and cardio-respiratory conditions) considers a far wider scope than most substance misuse policies when reviewing how an individual’s behavior can be influenced or changed through workplace policy and procedure.

In What Happens at Work? A Review of Evidence Assessing the Effectiveness of Workplace Interventions to Prevent and Manage Common Health Problems,(Hill et al., 2007) there are a number of key findings that can be applied to staff welfare procedures, which could include substance misuse problems:

  1. Interventions should involve some form of employer-employee partnership or consultation.

  2. The workplace can be an appropriate and effective setting for the prevention of problems.

  3. Interventions should be comprehensive, addressing both individual and organization-level factors.

  4. Communication and an understanding of the end goal is essential.

  5. Consideration and evaluation of workplace practices and the links these have to employee health should

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    not be undervalued.

Behind each of these findings is an under lying culture in that the employer needs to consider the social impact of the health issue as well as the financial or performance risks linked to business delivery. A similar application to the issue of substance misuse in the workplace would mark a significant shift in staff welfare policies for many organizations. Some employers, specifically primary care trusts (PCTs), public services and non-profit organizations, have already adopted policies treating substance misuse as a health problem. This approach, rather than treating it exclusively as a disciplinary issue, is supported by the CIPD research which advocates that employers should do more to help workers fight drug and alcohol issues due to the high success rates of individuals returning to work following treatment.2 [6]

MEDWAY PCT EXAMPLE

The government Office for the South East promotes the Medway primary Care trust Drug and Alcohol Misuse policy as one good-practice example. The policy defines alcohol and substance misuse as primarily health problems and recognizes that those suffering from such conditions often do not realize that they require help or may not know where to obtain it. Therefore the PCT has adopted a policy which gives support and assistance to anyone identified as having a problem, and, as far as possible, supports them during their recovery program.

The aim of the policy is to:

  • recognize an employee’s alcohol and/or substance misuse as a health problem and to ensure that neither patient care nor the organization are adversely affected by it

  • raise awareness of the issues associated with the use of substances and to discourage the use of them by being clear that it will be treated as a health matter; supporting employees to access advice, counseling, treatment, and rehabilitation where needed; and supporting managers to identify and deal effectively with employees displaying signs of substance misuse.

The policy concludes by stating that every effort should be made to ensure that, on completion of the recovery program, employees are able to return to work where this would not jeopardize either a satisfactory level of job performance or the employee’s recovery.

Source: Medway PCT Drug and Alcohol Misuse policy (2003).

The fact that drug-testing in the UK has not become mainstream and that legislation continues to be open to interpretation leaves many businesses without any formal process of testing, recognition or treatment protocols when they find themselves affected by an individual’s substance misuse. In turn, the individual is left without any support and effectively left to slip through the net. As Richard’s case study at the beginning of this chapter illustrates, employees need to feel confident that their employers will know what to do if they do ask for help. Without this knowledge it is less likely that someone who requires support will ask for it. Having a specific substance misuse policy in place is a start. Having national legislation backed by independent research advocating how workplace policies work best, so that all employees have equal access to treatment, advice, and information without being judged or penalized in any way must be the next step.

How to Manage Substance Misuse in the Workplace

As the numbers of people affected by substance misuse continue to increase, how to effectively manage the associated risks in the workplace will need to move beyond knee-jerk reactions and employer protectionism. As stated in the PKF Charities Risk Survey (2008, p. 3), “The whole point of risk management is to find a way to maintain an organisation’s risk exposure at a level with which it is comfortable.” This means being able to spot emerging risks and act before they escalate by embedding risk management in every faction of service operation and delivery. Proactive risk management is a huge challenge facing organizations as it often requires a shift from effectively managing day-to-day risks to monitoring developing risk areas and considering how these may affect the company or staff in the future.

The issue of substance misuse in the workplace requires companies to measure, manage, and control the risks such behavior poses to the organization, staff teams, and the individual involved. Many people’s responses to substance misuse are largely shaped by stigma fueled by negative portrayals of drug users in the media and propounded by a fear of the unknown. As Lydia’s case study illustrates, the stereotypes held by friends and colleagues on an employee’s return to work make the journey through and out of treatment exponentially harder. Although Lydia’s experience indicates a supportive manager she did not feel able to tell him the truth about her alcoholism due to the stigma surrounding the issue and the judgment that follows. Opinions expressed to her from friends during her stay in rehab have ranged from comparisons to high-profile celebrity cases to views of rehab involving straitjackets and locked rooms. For Lydia, the prospect of facing down these judgments is not a pleasant one.

Banishing ignorance takes time, requires considerate management action to drill down to the front line not only in terms of the company’s response to substance misuse but also in terms of a broader understanding of associated issues. By developing a policy, organizations can help raise awareness and understanding about substance misuse and what triggers it. Beyond any social responsibility to staff and the wider community to not propel social negatives, it makes good business sense to have a clear and educated policy in place for several reasons:

  1. For legal reasons—although UK law is currently ambiguous and does not require organizations to have workplace substance misuse policies in place, this situation will not continue, and UK businesses could, without adequate policies in place, fall short of their legal obligations relating to the application legislation listed above, including the Management of Health and Safety at Work Regulations, the Human Rights Act and the Corporate Manslaughter and Homicide Act 2007.

  2. For financial reasons—having a policy in place allowing for early intervention will save the company money in the long run by catching the issue sooner rather than later. This means that an employee can be supported in seeking professional help before the risks of their behavior or absenteeism causes loss of revenue.

  3. For reasons of organization reputation—the external reputation of the company can be damaged if there is no policy in place to manage the behavior of an individual who is acting under the influence of alcohol or drugs. It also helps a company’s reputation if it is seen to be taking its corporate social responsibility seriously.

A Person-centered Approach

It is dangerous to think that the risky behavior of drug and/or alcohol misuse by employees is just a symptom of today’s society. It is also misleading to assume that someone only has a drug or alcohol problem when it physically surfaces through changes in behavior/outcomes/absenteeism, and is independent of any other influencing factors. Substance misuse is often the result of a combination of personal, social, and work-related pressures resulting in a range of complex needs. The treatment of the addiction may be the most pressing issue for employers, but in supporting the individual in the most person-centered way, housing, family, financial and psychological factors should not be ignored since they may well be the cause of the substance misuse rather than a symptom.

Addressing risks associated with substance misuse is essential, although no quick or easy solutions are available. The risks involved in drug use are significant, especially to the state of an individual’s physical and mental health. No one person’s experience of addiction is the same to another’s, and a one-size-fits-all approach is never going to be effective. Whether or not someone takes drugs is dependent on many socioeconomic factors, and how people engage with treatment will also depend on a range of variables including age, gender, ethnicity, and religion. Workplace policies rarely take these factors into consideration. Very few employers proactively educate their staff about the impacts of substance misuse and the differences of these impacts on different groups, much less design policies to reflect them. According to guidance from the Government Office for the South East (n.d.), the most effective policies are those that engage the workforce in their development and are “tailored to [the company’s] unique size, function and workplace environment.”

Even though statistics show that substance misuse is increasing and that this is likely to have a greater impact on the economy in the future, the recorded accidents and dismissals at work related to substance misuse in the UK are still relatively low. This poses the risk that no action is taken, particularly because those who have a dependency on drugs or alcohol may be very good at hiding it. The risk of not acting, or not being prepared to act, then becomes that much greater because “functioning alcoholics,” for example, are able to slip through the net. Lydia, featured in Case Study 1 above, found this to be the case. Her life was breaking down around her, but, because she didn’t show any obvious “symptoms” at work, her alcohol misuse went undetected; meanwhile, Lydia’s life was spiraling further out of control.

To avoid this happening, employers need to change the focus of their workplace policies to incorporate tangible ways to ensure early intervention instead of compounding the issue and potentially driving it further underground. Currently in the UK this is not happening consistently. As recent research has found, only 33 percent of employers train managers in how to manage substance misuse at work, and just 22 percent train employees generally in organizational procedures in tackling drug and alcohol issues (CIPD, 2007, p. 2).

With the effectiveness of drug-testing still debatable, workplace policies need to have a wider scope to deal with the root causes of an individual’s substance misuse, if the organization is to respond adequately. This means having the right training in place to equip managers to detect early signs and have the knowledge of how to support employees into the right form of treatment. When asked what his employer could have done differently to better support him, Richard, in Case Study 2 above, said that just knowing that his employers would have options and information would have helped. Instead, without this confidence, Richard felt that he had to deal with his substance misuse alone.

Five Key Principles

There are five key principles that can help employers practice their duty of care to employees while , supporting good business practice in the long run:

  1. a clear framework, allowing for open dialogue between employees and employers,

  2. proactive engagement,

  3. early intervention,

  4. support into treatment, and

  5. support back to work wherever possible.

Through the use of e-mail and intranet sites Managers are now more than ever able to educate staff teams on a range of issues at minimal cost. This could include the causes, symptoms, and treatment of drug and alcohol misuse, acting to dispel fears and stereotypes that may inhibit individuals seeking the support they need. Employees need to know what their company policy is, their rights and responsibilities within it, and the actions employers will take. It needs to be clear what the employer’s duty of care of the employer is and how any substance misuse problem will be dealt with in the short, medium, and long term. Procedural frameworks then need to be applied consistently and without discrimination.

Proactive engagement works in two ways:

  1. Employers play a huge role in shaping the welfare of their staff and are placed in the best position to educate, engage, and encourage whole workforces on what is healthy, what is safe and how to seek help if required. With a clear framework in place, employers should not simply feel their part is done. They should seek to engage with staff on a regular basis and ensure they are aware of help available to them whether this be in-house or external agencies. Proactive, rather than reactive, policies could be the difference between someone turning their life around, or falling further into addiction so managers being able to recognize associated changes in behavior and responding quickly is imperative.

  2. Employees have a responsibility to proactively engage with company policies and take responsibility for their own health and well-being. Having confidence to have open and honest dialogues with line managers is essential for this process to work. Employees should feel able to speak in confidence to their line managers without fear of gossip or judgment, in the knowledge that they have been appropriately trained and equipped to deal with issues as they arise. The current suggestion that only a third of employers train managers in how to manage these issues at work is not good enough.

The idea of employers taking more responsibility for the health, safety, and well-being of their employees stems from the unique position and influencing role the workplace presents. It provides opportunities for early detection, intervention, and support for individuals with substance misuse problems by being aware and acting on trigger signs such as absenteeism, mood swings, high accident levels, altered work performance, changes in relationships with colleagues and clients and so on. Employers are also well placed to provide stability and general well-being for employees’ families. By promoting a culture of blame and judgment, rather than support and recovery, potentially positive outcomes are denied.

Drug and alcohol problems can develop for a variety of reasons, often over a lengthy period of time. The impact of the use of both legal and illegal substances may not necessarily impede a person’s ability to do their job. Initially there may be minimal impact on an individual’s productivity, and it could be months or even longer before anyone would notice a difference in a person’s behavior or his or her behavior caused concern. In other more safety-critical circumstances, the impact of drug or alcohol misuse could have an immediate and detrimental impact. Early intervention and recognition of symptoms is therefore essential.

Organizations cannot militate against all risks, but they should have adequate procedures in place to identify risks early on, and they should embed risk management in daily practice. Early intervention is vital: in extreme cases, it can be the difference between life and death. Interventions should not wait until an individual has lost his or her job, home or family. Therefore, effective policies will require managers to have conversations—albeit often difficult ones—with individuals who give cause for concern at the earliest possible opportunity, and not wait until it is too late.

Substance misuse problems can be treated, and workplace policies should reflect this. By treating the substance misuse problem as a health issue, employers should know and be able to communicate pathways into treatment and support staff as they would with any other sickness issue. Treatment will not be the same for every person, so a range of responses will be required to enable the individual to access the most personalized support.

Individuals suffering from such problems should be encouraged to seek help and treatment in overcoming them with a view to achieving a full recovery, thereby allowing a return to work wherever possible. Employers can make this easier by:

  • Providing the opportunity for referral to appropriate treatment agencies.

  • Granting appropriate time off work to attend such treatment as is recommended by the individual’s GP

  • Recognizing any periods of treatment as periods of sickness absence, as with any other form of ill-health.

  • Appropriately modifying duties in consultation with Occupational Health and the individual during any period of treatment and for an agreed interval thereafter, subject to operational requirement and feasibility.

  • Maintaining a level of confidentiality determined between Occupational Health, senior management and the individual, except where there may be a risk of self-harm or harm to others.

Support back to work in the same role or even company is not always feasible or desired by either party. For some, it would be a step back to return to a negative environment or one which caused the substance misuse in the first place. In Case Study 3, Sophie’s employer had supported her through treatment, but, following her stay in rehab, both parties decided that Sophie would not return to work. Sophie and her line manager continued to communicate throughout her treatment and afterwards when both mutually agreed to Sophie leaving the company. For Sophie, it was essential that she was part of the decision, that the time she had spent working there was not forgotten, and that the best decision for both was reached through consultation. For the employer, it was important to have this ongoing dialogue so that both parties could make an informed decision as to whether or not to end Sophie’s employment and how to proceed in a way that would not be detrimental to Sophie’s recovery.

For Lydia, in Case Study 1, this process is yet to happen; but this element—how to go back to work afterwards—was particularly important to her, and the cause of much anxiety. She decided to enter a residential rehab, an exceptionally hard decision to make, especially with two young children. Having made that decision, she has since been left feeling isolated because she has not heard from her colleagues or line manager either verbally or in any written communication. By treating substance misuse as a long-term sickness or health problem, relevant good practice can be applied, including regular communication, assessment and the use of return-to-work strategies. Having in place a similar framework to that used for a sickness absence minimizes an individual’s anxiety about returning to work.

Conclusion and Recommendations

From the case studies and the five steps that their insight informed, there are clear actions that can, and should, be taken to limit the risks involved, and particularly to deal with the after-effects, of an employee’s substance misuse. The bigger issue is the fact that UK employers are currently not providing adequate or sufficiently structured support to limit the psychological or financial impacts of this hazardous behavior on the company, much less on the individual.

The evidence that substance misuse has an impact on business is irrefutable; it is estimated to be costing the UK economy up to 17 million working days a year (Prime Minister’s Strategy Unity, 2004). All major research into drug and alcohol misuse in the workplace, local government guidance, and health and social care service providers recommend the development of workplace drug and alcohol policies. However, the ambiguous nature of UK legislation means that employers are able to interpret their application of “duty of care,” instead of having it clearly defined, and are not legally obliged to have a policy in place. Although the findings by the CIPD survey (2007) suggest that 58 percent of organizations have a policy in place, this by no means reflects consistency of approach.

Employers are in a unique position to counter the effects of high-risk individual choices and behaviors by actively engaging, managing, and supporting individuals from an early stage into treatment and back into the workplace. It is therefore not inevitable that people fall through the net if policies are in place. In fact there is evidence to suggest that, with early intervention and the right support, 60 percent of those employees who organizations have referred to treatment or supported through rehabilitation remained working for the organization after successfully managing their problem. This, of course, would be more encouraging if the percentage of employers referring individuals with a drug problem to treatment each year was higher than 12 percent. Clearly there is quite a way to go before a systematic and uniformed approach to substance misuse in the workplace, providing support to employees through treatment and beyond, is established (CIPD, 2007, p. 3).

This chapter concludes that employers, by engaging with the five key principles discussed, can form a corporate approach that could go some way toward curbing the effects of substance misuse at work. Employers can act to limit the effects on the employee, organization, and wider community they belong to by fostering a culture of greater understanding of the triggers and causes of drug and alcohol dependency, as well as of the signs of addiction. By treating alcohol and drug misuse as a health issue, company policy can assist individuals positively in coming forward and seeking the treatment they need, knowing that they will be greeted with a fair, considered and, most importantly, structured response and framework of support. Conversely, without a policy in place, companies can effectively drive substance misuse and its associated risks further underground.

If UK Plc is going to reduce the impact of substance misuse not only on the number of lost working days, but on the health and well-being of its staff, further research is needed to test empirically the effectiveness of various drug and alcohol policy approaches in order to establish:

  • which policies work most effectively in creating open channels of dialogue in which staff feel comfortable asking line managers for support,

  • a comparative analysis of employees being referred into drug and alcohol treatment to establish the route of this and the role substance misuse policy plays, and

  • the return-to-work ratios of employees who have had substance misuse problems and how this relates to the corporate policy in place.

With the use of drug-testing at work potentially increasing in the future and with the continuing ambiguity of UK legislation, it is essential that more is known not only about how well existing policies work based on evidence, analysis and comparison, but also about how companies can best respond, based on statistical evidence and good practice.

Hill, D. , Lucy, D. , Tyers, C. and James, L. (2007) What Works at Work? Review of Evidence Assessing the Effectiveness of Workplace Interventions to Prevent and Manage Common Health Problems, London: HM Stationery Unit. Available at: http://www.employment-studies.co.uk/pdflibrary/whwe1107.pdf

Prime Minister’s Strategy Unit (2004) Alcohol Harm Reduction Strategy for England, London: Strategy Unit.

Singleton, N. and Lynam B. (2009) “Policy forum: The other half of the equation: employers’ readiness to recruit problem drug users,” Drugs and Alcohol Today, 9(1).

Royal College of Psychiatrists (2003) Drugs and Alcohol—Whose Problem Is It Anyway? Who Cares?, written by the Alcohol and Drugs Misuse Subgroup of the Changing Minds Campaign, September. Available at: www.rcpsych.ac.uk/pdf/whocares.pdf

Smith, A. , Wadsworth, E. , Moss, S. , Simpson, S. (2004) The Scale and Impact of Illegal Drug Use by Workers, Research Report 193, prepared by Cardiff University for the Health and Safety Executive, London: HSE. Also available at: http://www.hse.gov.uk/research/rrpdf/rr193.pdf


Category: Case study

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