The first Thursday of every February marks what is known as Time to Talk Day in the UK, an annual event dedicated to sparking important conversations about mental health; a day when friends, families, communities, and workplaces come together to listen to, learn from, and support one another in effort to change (and maybe even save) lives, and to help break the stigma around mental health.

In the UK alone, nearly two-thirds of people have been afflicted with a mental health issue at some point in their lives, while one in six report experiencing a common mental health problem in any given week, including depression, anxiety, PTSD, phobias or panic disorder, and suicidal ideation. Interestingly, it is reported that up to 70 percent of those living with mental health disorders in the UK also struggle with substance abuse and addiction.

But while initiatives like Time to Talk Day may be making it easier for some to talk more freely and openly about their mental health issues in the workplace, stigma persists among employees suffering specifically from drug and alcohol problems; in fact, close to half of those with substance use disorders say that existing stigma makes them feel ashamed of their issues and hesitant to disclose them, resulting in only about 10 percent of them ever actually seeking out care—even if they are outspoken and proactive about other mental health issues they experience. This is largely out of fear of facing discrimination, alienation or social isolation from peers, or facing other repercussions within their professional or work life, including wrongful suspension, demotion, or termination, or trouble finding work altogether.

Addiction in the Workplace

Addiction in the workplace is a larger problem them some might initially think. More than 70 percent of an estimated 22.4 million drug users and 80 percent of 41.2 million binge drinkers in the US are employed, and it is estimated that more than three in four employers are impacted by employee opioid use alone. But despite these numbers, addiction in the workplace often goes unnoticed, as those struggling with substance abuse can be very good at hiding their disorder—especially when the side effects of their addiction have a positive impact on their job performance.

What makes employees so desperate to hide their disorders from their peers—and is thus ultimately responsible for addiction’s veiled presence at work—is the discouraging amount of stigma that still exists around such disorders. According to the Shatterproof Addiction Stigma Index (SASI), more than half of the people surveyed still harbor the prejudicial belief that addiction is a “moral failing;” the result of an individual’s irresponsibility, lack of moral strength, or bad character.

This not only impacts how people with addiction are treated within their own social networks or communities—as almost three in five respondents expressed an unwillingness to be friends with, socialize with, or even live near a person with an SUD—but it also impacts how they are treated at work: Close to two-thirds of respondents told Shatterproof that they would not be willing to work closely on a job with someone who has an SUD, while nearly three-quarters of respondents said they would not be willing to hire a person with an SUD to do work for them.

Such stigmatic beliefs are even worse for those in leadership positions, as over 80 percent of respondents said they would not be willing to have a person with an SUD as their supervisor—with over half of respondents sticking to that opinion even if the person was in recovery. This further discourages employees from disclosing their addictions or SUDs, as although recovery is possible and their issues treatable, even recovering or recovered addicts still grapple with persistent stigma.

What Can Be Done?

Despite these findings, there is, however, a silver lining: regardless of their attitudes toward people with an SUD, respondents were unanimously in favor of both employers and healthcare providers (1) improving and expanding access to treatment, (2) covering treatment the same as any other illness, and (3) treating their SUD as an illness, rather than as a crime or offense. And all were ultimately in agreement that employers are responsible for supporting their employees with addiction or substance use disorders.

There is a lot that can be done in order to help employees with SUDs recover from their illnesses; in fact, employers oftentimes play a crucial role in their journey to recovery, as nearly a quarter of substance users currently avoid seeking treatment exclusively out of fear that they will face repercussions at work. This hesitancy is not surprising, given the beliefs held by their peers. But perhaps even more off-putting is the erroneous belief—held not only by employers and coworkers, but even by healthcare professionals as well—that substance use disorder is not a chronic medical illness, nor the treatable disease that it is.

With that said, in order to support employees in their workforce who are dealing with a substance use disorder, employers first and foremost need to have a robust understanding of what exactly an SUD is—more importantly, what it is not—and must familiarize themselves with some of the roadblocks that these employees so often face when it comes to being transparent about their struggles and accessing needed care.

Breaking the Stigma: What is Substance Use Disorder?

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), substance use disorder occurs “when the recurrent use of alcohol and/or drugs causes clinically significant impairment, including health problems, disability, and failure to meet major responsibilities at work, school, or home.” Often co-occurring alongside mental health disorders, like said disorders, SAMHSA recognizes SUDs as chronic brain disorders that involve changes in thinking, mood, and/or behavior.

Moreover, and perhaps more controversially, as they do with mental health disorders, most medical organizations like the American Medical Association and the American Society of Addiction Medicine, also define addiction as a complex disease caused by a combination of behavioral, psychological, environmental, and biological factors; thus making it akin to any other chronic disease like asthma, diabetes, cancer, and heart disease, and thus making a person with addiction just as much a victim of their disease as is someone with any other type of chronic condition.

As previously noted, however, despite more than half of people living in the US accepting this definition of addiction, an alarming majority of them (80 percent) still seem to harbor the belief that addiction is a matter of choice, willpower, and personal responsibility.

To dispel some of the stigma that persists around what addiction or substance use disorder is, it’s important to break down some of the key underlying factors that create a risk of developing the disease, including:

• Genetic predisposition. Research has long since indicated that the development of addiction—and the speed at which the disease progresses—may be influenced by inherited, or genetic traits. In fact, some experts posit that genetic risk factors alone account for nearly half a person’s likelihood of developing an addiction. For instance, a 2019 study conducted among cannabis users recently discovered a link between the gene CHRNA2 and the likelihood of cannabis use disorder.

• Family history of addiction. Obviously, the role that genetics play in risk of addiction makes family history a considerable risk factor, but there are other risks that a family’s use of substances presents—encompassing virtually all other risk factors. These include (1) early exposure to or use of substances, (2) early exposure to trauma, (3) lack of family involvement or support, (4) interpersonal conflicts, and (5) familial beliefs or attitudes that condone and/or promote the misuse of substances.

• Brain composition (“deficits“); early use. Studies have shown that early use of drugs can lead to an increased risk of developing an addiction, due to changes that occur in the still-developing frontal and temporal lobes of children or adolescents, in which the hippocampus (responsible for learning, forming new memories and corresponding emotions) and the amygdala (responsible for decoding emotional memory and activating response) become hardwired to release external cues to trigger the craving and use of substances or other addictive behaviors in response to dysphoric or stressful experiences, based on prior euphoric, rewarding experiences with substance use.

• The repeated use of substances. Just like the early use of drugs or naturally occurring deficits or dysfunctions in the brain can lead to impairments in executive functioning and the reward circuit, the repeated use of substance can also cause neuroadaptation leading to an impairment or inability to control further engagement in substance use or other addictive behaviors. This also increases the likelihood of relapse and its recurrence, as triggers or environmental cues such as stress may cause the brain to signal cues to use.

• Early exposure to trauma. According to research from the CDC, exposure to adverse childhood experiences, which include physical, sexual, or emotional abuse, neglect, and household dysfunction (I.e. incarceration, mental illness, divorce, death), can lead to high stress and physical or psychological issues that increase the risk of substance misuse and addiction. In fact, survivors of childhood trauma have been found to be four times more likely to develop an alcohol-related disorder, and two and a half times more likely to smoke cigarettes.

• Comorbidity; presence of mental health issues. In addition to sharing underlying causes and risk factors, substance use disorders and mental health disorders are often co-occurring, as one often leads to the other. Research suggests that the presence of mental health issues often lead to substance use as a form of self-medication or a way to cope with symptoms.

• Lack of or disruption to social support; isolation. Studies find that social support can serve as a significant protective factor when it comes to preventing or delaying the development of addiction, largely thanks to the promotion of resiliency and positive coping skills. Conversely, isolation has been associated with an increased risk of depression and anxiety, which in turn may increase the risk and/or use of substances and thus a dependency on substances. Studies also show that distortions in meaning, purpose, connection with oneself and others, as well as spiritual connections with the transcendent, can impair executive functioning and lead to the development of adverse coping skills and addictive behaviors.

• Prescriptions to addictive drugs. The use or nonmedical misuse of certain types of highly-addictive prescription drugs—specifically, opioids and stimulants—can lead to adverse health conditions including addiction. Adolescents and adults living in the US are especially at risk of becoming dependent on prescription drugs, as recent studies as well as those in the entertainment industry have started to bring attention to the US medical system’s overprescription of opioids, as the country currently makes up nearly a quarter of the 16 million individuals worldwide estimated to have opioid use disorder (OUD).

• Culture. What many who place blame on people with SUDs for lacking “personal responsibility” oftentimes forget to consider is the influence that culture and social norms and customs can have on a person’s own attitudes and behaviors. For instance, people belonging to a marginalized ethnic or cultural group have been shown to have higher risk and incidence of mental health and substance use disorders due to the greater number of stressors that they face, including discrimination and isolation. Additionally, acculturating or belonging to a culture that has a laxed or even promotional view of substance use can increase the risk of an individual developing a dependency.

Creating a Conducive Work Environment: Education, Training, and Cultural Changes

On that note, before employers even start to look at what they can add to their benefits offerings to support employees with addictions, one of the first and most crucial steps that they can take in order to promote both prevention and recovery is improving the culture of the workplace. And one of the key ways in which leaders can achieve this is by rethinking how teams foster connections with each other.

Going out for drinks is perhaps the most universal social outing that teams engage in outside of the workplace. In fact, the average worker in the US is estimated to spend more than $3,000 per year on after-work drinks alone, as some organizations designate weekly “after-work happy hours,” while others might even encourage drinking during the workday itself. Moreover, research shows that many employees—particularly younger sectors of the workforce—have a rather laxed view of alcohol misuse, perceiving alcohol to be a “social lubricant” necessary for curbing social anxiety, establishing bonds, and cultivating a sense of community and belonging in the workplace.

But unfortunately, having this time of culture in the workplace can do more harm than good; studies have found that workplaces with heavy drinking cultures in which employees drink to build solidarity are associated with an increased risk and/or prevalence of addiction among their workers. Furthermore, alcohol has also been proven to lead to sexual harassment, violence or bullying, interpersonal conflicts, and hostile or disrespectful behaviors in the workplace—all of which serve as additional risk factors of addiction.

In order to foster a workplace culture that is supportive of employees with addictions and that helps reduce others’ risk of developing a substance use disorder, employers can aim to:

• Come up with alternative, sober post-work activities or events for team-bonding, such as going to a karaoke bar, signing up for a cooking class, organizing group hikes, or hosting board-game or potluck nights.

• Strictly enforce policies related to drug and alcohol use in the workplace; adopt stricter policies that prohibit the use of alcohol, tobacco and nicotine, and other substances while at work.

• Incorporate substance use awareness, education, and referrals to on- and off-site resources as part of internal communications.

• Organize organization-wide, mandatory trainings designed to inform employees on the characteristics, risk factors, and warning signs of addiction; dispel stigmas surrounding the disease; promote an open-culture when it comes to talking about mental health at work; offer tips on prevention and recovery; and instruct employees on how they can go about supporting peers with addiction.

Identifying Employees in Need: Signs of Addiction

In addition to educating employees on the risk factors associated with addiction and how it works, and training employees on how to be mindful, respectful, and supportive of their peers who may be experiencing a substance use disorder, it is also important that all staff—from the floor level to the C-suite—are able to recognize some of the warning signs of addiction, as they may present in themselves, their peers, or even their friends and family outside of the office.

According to MentalHealth.gov, some common signs and symptoms of substance use disorders that may present at work include:

• Change in or poor performance

• Drop in attendance; frequent tardiness

• Frequent accidents, injuries, or illnesses

• Engaging in illicit or problematic activities (fights, gambling)

• Behaving suspiciously; secretive

• Unexplained and/or sudden changes in mood, personality, or attitude; easily irritated or quick to anger or hostility

• Low morale; poor motivation

• Unexplained or irrational paranoia, fear, or anxiety

• New and/or frequent legal problems

• Sudden and unexplained need for money; financial problems

Addiction and substance use disorders also commonly result in changes to one’s physical appearance. Some of these changes may include:

• Bloodshot eyes or dilated pupils

• Sudden and/or extreme weight loss or weight gain

• Tremors, slurred speech, or impaired coordination

• Trouble staying awake or alert

• Poor balance and weakness in muscles

• Unusual smells on breath, body, or clothing

Another sign that dually serves as a risk factor of substance abuse is social isolation. Such isolation as a risk factor may be as a result of withdrawal or antisociality, physical separation from social support or networks or lack thereof, alienation or ostracization from peers, or self-enforced seclusion due to trauma or other mental health issues; whereas isolation as a sign or symptom is typically inspired by the desire to hide substance use. This distinction means little, however, as both can and should be treated as a warning sign psychological distress—if not addiction or substance abuse—and those experiencing isolation or exhibiting antisociality should be reached out to and supported as soon as possible.

This is especially true for remote workers of whom many may feel isolated from peers or supervisors, and overall are at a higher risk experiencing isolation due to long hours spent working from home, alone. Additionally, working remotely can make it harder for employers or peers to spot some of the other warning signs of addiction in their coworkers, thus making it easier for such disorders to hide. “The virtual world essentially allows peoples’ problems to be hidden forever,” vice president of healthcare and people strategy consulting for the Insurance Office of America, Sommer Sherrod, recently told Employee Benefit News.

As a result, it is critical that employers keep in close contact with remote workers, especially if they notice a sudden drop in engagement, including increased absenteeism or presenteeism, as well as detachment during meetings or other virtual communications like leaving their cameras off during meetings, not participating during meetings, not engaging in group or team chats, and not responding to private messages.

While addiction is a medical and private matter, and employers or peers may be hesitant to reach out to a peer they might have reason to believe is experiencing substance abuse or addiction, there is no harm in reaching out simply to ask, “How are you doing? How are things?” or “Do you need anything? How can I help?” In fact, providing employees with the time, space, and encouragement to open up about their issues on their own terms can instill in them a sense of agency needed for them to take charge and proactively seek out care.

Targeting Effective Support: Benefits Offerings and EAPs

Expanding Virtual Care Options

On the topic of remote workers, one crucial way in which employers can better support employees with SUDs or prevent the development of addiction altogether is by expanding their access to virtual care and telehealth options. As it currently stands, accessibility to treatment is considerably lacking, with a whopping 94 percent of individuals with an SUD failing to locate or access treatment. Moreover, due to the level of vulnerability that traditional programs require and the sensitive nature of those with SUDs, the current dropout rates for such programs are as high as 80 percent.

On the other hand, virtual care services—including wellness apps, 24/7 crisis support, curated modules, and self-tracking tools—have been proven to have higher effectiveness and retention rates than traditional programs, thanks to the flexibility they provide to clients, allowing them to access such services on their own time and from the privacy and comfort of their homes.

Furthermore, virtual care services provide individuals with the opportunity to go at their own pace when it comes to addiction recovery and allows them to determine the duration of their program or treatment plan—something that traditional, 12-step programs, may not always provide. This increase in autonomy—as well as the commitment required to keep up with self-assessment and self-tracking tasks and to set up and attend online appointments—also instills them with a greater sense of responsibility, which ensures that they are a more active and proactive participant in their recovery and not just a passive recipient of treatment.

Fostering Peer-to-Peer Support

For employees who may be continuing to work at home for most of—if not entirely or at least part of—the week as organizations continue to transition to hybrid work models, it is incredibly important that their employers stay on top of fostering an inclusive and connected workplace. Whether as a result of the pandemic, the “Great Reshuffle,” or perhaps even as a byproduct of the ongoing social and political unrest happening around the world, more and more workers are now starting to say they feel disconnected from their peers than in the years preceding the pandemic, presenting a huge risk for substance misuse and dependency.

“It really is starting to develop as an actuarial time bomb,” admits Bob Poznanovich, VP of Business Development at Hazelden Betty Ford Foundation. “If [you] have all these people that are struggling from a mental health perspective that maybe some of the normal control mechanisms that existed by going to work every day and being around peers and having that nine-to-five structure [helped with]…when all those built-in control mechanisms are gone…usage [increases] at significant numbers.”

The solution, according to Poznanovich, is to create pathways to make it easier for employees to connect with one another—especially for those returning to the workplace post-treatment or recovery. “There are organizations that are out there that have made big steps that have funded these initiatives or affiliation groups within their employer group [that allow] people who are in recovery to get together on company time or [use] company resources [and] virtual services to be able to peer support each other and to address not only recovery issues, but [those] in the workplace.”

Ultimately, by fostering peer-to-peer connections, employers can not only ensure that workers who may be be currently struggling with or recovering from addiction are able to get the interpersonal support that they need to manage their symptoms, workplace responsibilities, and their potential return to the workplace, but can also work to curb or altogether prevent the development of SUDs among their staff, as positive peer relations serve as both a rehabilitative and protective measure.

Strengthening Benefits Communications

Another solution that serves as both a rehabilitative and protective measure is improving employee benefits communications. According to research from the Hazelden Betty Ford Foundation, nearly half of employees with SUDs admit that they don’t know whether their employers provide any services or resources related to addiction, or are not sure what specifically they do offer.

Largely contributing to these statistics, according to Poznanovich, is employees’ general resistance toward inquiring about the benefits that are available to them out of fear of inadvertently disclosing their illnesses and being discriminated against as a result. “Most employees are so afraid of retribution in the workplace that they won’t even ask what their benefits are, let alone ask for help.”

By getting ahead of employees’ inquiries by consistently promoting available services and explicitly encouraging their use, employers can work to establish a safe and conducive environment in which employees dealing with substance-related issues are able to seek help before their problems evolve into a disorder, and in which employees with SUDs feel comfortable enough to disclose their disorder, seek the help that they need, and achieve a long-lasting recovery.

Investing in Holistic Wellbeing Solutions

And one of the most effective ways to accomplish this is by investing in and leveraging a wellbeing program to both provide and promote relevant services. Take for instance, a recent success story that happened right here at WPO:

A Workplace Options client in India was looking to increase awareness about substance abuse among its employee population. They had multiple locations across the country and needed a multi-dimensional approach.

A team of professionals at WPO worked with the client on a strategy that would meet the goals of the program and implemented a plan using a unique combination of activities. The events were facilitated by trained therapists and professional actors, with the goals of engaging employees and educating them about substance abuse.

The team also developed seminars to be delivered to managers on empathy, engagement, and empowerment, and set up kiosks centered around self-care activities. To facilitate learning in another dimension, actors performed skits to highlight the effects of substance abuse and illustrate how people could potentially fall into addiction.

Prior to the event, employees were also sent details about a poster-making competition, in which many employees designed posters that centered around substance abuse, smoking cessation, and the effects of alcohol on the body; all of which were put on display during the event, and of which three were selected to win prizes.

Overall, employees were enthusiastic to participate in the activities, saying it was a fun learning experience, and the client was able to successfully educate its employees about substance abuse in an engaging and interactive way by implementing the strategy developed by the WPO team.

While this example perfectly illustrates what a wellbeing program can do to help an organization develop and implement an effective educational campaign around a topic related to employee health and wellbeing like substance use, there are three key solutions that a wellbeing program can provide to strengthen the clinical support that an employer offers to its employees; specifically, these are (1) coverage for and access to adequate, culturally-competent care; (2) access to specialized services encompassing a wide range of health and wellness needs; and (3) access to personalized, holistic care for the individual.

For instance, current research estimates that employer spending on mental health treatment comprises just 2.2-2.4 percent of total healthcare spending, while substance abuse treatment makes up even less at a meager one percent. Moreover, according to a recent report from Milliman on the widening disparities in network use and provider reimbursement between addiction, mental health, and physical health treatment, research found that substance abuse treatment was 1,000 percent more likely to be offered as an out-of-network benefit than primary or surgical care, resulting in mental health and substance use treatment providers being discouraged from joining in-network health plans. This means that under a lot of employer-sponsored health plans, employees do not have adequate access to the substance abuse or mental health treatment that they need.

But by investing in a wellbeing program, employers can give their workers better access to in-the-moment, crisis, or short-term support with specialists who are trained to help employees tackle a wide range of health and wellness issues—including addiction and mental health problems—through an array of modalities including telehealth, on-site, or in-person counseling sessions, follow-up services, and 24/7 crisis hotlines. And while wellbeing programs are not designed to provide medical treatment or substitute for traditional medical, mental health, or substance abuse services, they can connect employees with trusted services or resources for medical detox, mental health and addiction treatment, and medical procedures that are in their area, and more importantly, that are covered by their insurance.

Furthermore, wellbeing programs also provide specialized programs on a variety of health and wellness goals including drug-free workplace programs for employers, tobacco-cessation, rehabilitation, stay-at-work, and return-to-work programs for recovering employees, and other programs that help employees build resilience against stress and develop positive coping mechanisms, including programs such as work-life, financial, and wellness coaching, mindfulness programs, and more.

Employers can provide their employees with SUD, or those who are at higher risk of developing an SUD, with access to early intervention treatment through wellbeing program services like digital coaching, virtual cognitive-behavioral therapy or other types of counseling, curated modules and psychoeducational materials, and 24/7 access to mental health professionals.

Most importantly, by investing in a wellbeing program, employers can ensure that their workers receive personalized, holistic care, in which they are treated as the whole, dynamic human beings that they are. No two workers are alike; moreover, no two workers are struggling with the exact same set of circumstances or problems. While one worker may be dealing with an SUD in response to a traumatic life event, another may be struggling with an SUD because of a change in location and a loss of social support. Since each of these variables build off each other to influence a person’s health and wellbeing, it is critical that employees with SUD receive treatment that not only aims to resolve their addiction, but also aims to resolve or address the other problems or situations they may be dealing with that are creating this risk of addiction in the first place.

Ultimately, what experts like Poznanovich underscore is that employers do not need to develop or adopt radical solutions in order to support their employees with SUDs, but rather, need to focus on making needed changes to the culture of the workplace so that discussing and addressing addiction is normalized and accepted, and so that all health and wellbeing initiatives they have in place for other illnesses or circumstances are extended to addiction and substance abuse.

“[Employers have done these things] for other diseases…We’ve put a lot of strategies into the workplace to address illnesses that are really expensive. We’ve built centers of excellence programs to make sure people get to the best place to [receive] a heart transplant…We know how to pick really good providers that provide good outcomes. We know how to address diseases that are costly and deadly…But when you think about the number of people that are impacted by mental health and substance abuse, why not there too?” asks Pozanovich, adding, “I think we’ve got the models we just need the courage to extend those same strategies to substance abuse.”