Substance Use and Mental Health: Supporting Employees Without Stigma

Over the past three years, employers across the U.S. have become increasingly concerned about substance misuse by their employees. For good reason: the numbers continue to climb.

 

More than 40 million Americans 12 and older have a substance use disorder, which is defined by an uncontrolled use of a substance despite harmful consequences, including alcohol, tobacco, prescription medications or other drugs.¹ A staggering 107,600 people died from drug overdoses in 2021, the highest death toll on record, according to estimates from the U.S. Centers for Disease Control and Prevention (CDC).²

 

“During the pandemic, we’ve seen significant concerns from employers relative to these issues,” says Dr. Adam Seidner, chief medical officer at The Hartford.

 

Two-thirds, or 66%, of employers surveyed by The Hartford reported substance misuse and addiction is a significant workplace issue, a 30% jump since March 2020.

 

It's hard to blame the surge in substance misuse on any single factor. “I can't pinpoint one specific thing that is causing it,” says Dr. Jeanette Tetrault, MD, FACP, FASAM, professor of medicine and public health at the Yale School of Medicine and its associate director for the Program in Addiction Medicine and the program director for the Addiction Medicine Fellowship. “It really is a confluence of factors.”

 

One unifying factor, however, is the COVID-19 pandemic, which exacerbated the already crisis-level of hidden mental health conditions. “Underdiagnosed and untreated mental health also drives substance use and substance use disorder,” Tetrault says. The pandemic-related lockdowns, which resulted in job losses and social isolation, contributed to the rising rates of substance use disorder and substance-related consequences as well,” she adds.

 

“One of the things that is very clear is that stress can drive substance misuse,” says William Stoops, professor of behavioral science, psychiatry and psychology at the University of Kentucky (UK), faculty member of the Center for Drug and Alcohol Research and associate director for clinical research of the UK Substance Use Priority Research Area. “We know for a fact that is incontrovertible.” That's why the pandemic led to increases in substance misuse and mental health issues. “Everyone was stressed and isolated,” he says.

 

It is also common for people with substance use disorder to have a mental health condition. “If someone has a mental health diagnosis, it is likely that they will be predisposed to self-medicate,” Stoop says. “The reverse is also true,” he adds. “You may develop depression or anxiety from a substance misuse.”

 

The recent increases in substance misuse are a worry on both a personal and financial level. The cost of substance misuse is estimated to be staggeringly high. The National Council on Alcoholism and Drug Dependence pegs the bill at $81 billion annually.³ That cost comes from several factors, including lower worker productivity and increased health care expenses, NCADD reports.

 

Misused substances, which include alcohol, marijuana, heroin, cocaine, opioids and others, can have a deleterious effect on employee performance, Seidner says. “There's poor decision-making, which can lead to accidents or waste in the workplace,” he says.

 

Seidner also points to absenteeism and presenteeism. Absenteeism is when someone habitually fails to show up to work without planning for time off. Presenteeism involves showing up but not being in a fit state to perform the tasks required of the job. The first should be an obvious problem: When many unscheduled worker absences occur, it becomes harder for a company to run efficiently. Presenteeism can be less transparent but no less problematic with the risk of errors and injuries.

 

“Employers should understand the concept of fitness for work and what it is,” Seidner says. He defines it as “an individual's capacity to work without risk to their own or others' health and safety.” As a chief medical officer for a leading workers’ compensation insurer, he understands the potential for risks, particularly in the manufacturing industry or where heavy equipment is used and reaction time and cognitive function are critical.

 

Stoops agrees. “If you have a hard-charging employee who suddenly starts making errors, then you want to understand that,” he says. “It could be mental health or a bad couple of days.” Either way, managers should be encouraged to connect with the employee.

 

“Due to the pandemic, we know mental health issues have increased," says Amber Clayton, senior director of knowledge center operations at the Society of Human Resources Management (SHRM). “Everyone's lives have been affected and so employers are encouraged to be more empathetic. They now typically have open-door policies with employees to engender trust between management and their direct reports.”

 

A common challenge for managers is how to tactfully have these conversations.

“The one thing employers need to remember is that as managers, most of us are not counselors,” SHRM’s Clayton says, reflecting on the positive trend of “employers now directing workers to the employee assistance programs (EAP) and providing mental health resources through the health plan.”

 

To support its managers, employees and their families, Jeannie Tomlinson, Head of Corporate Health and Wellness at The Hartford, says The Hartford provides education about substance misuse and addiction year-round. “We really have a continuous flow of information about substance use disorder throughout the year,” says Tomlinson. This includes manager training, webinars conducted by the company’s EAP, events with its nonprofit partners the National Alliance on Mental Illness and Shatterproof (which also has its own educational programming), and perhaps most important, “spaces where employees could share their own personal experience – from blogging on the company intranet to small group discussions on personal topics, including addiction.

 

“At The Hartford we focus on educating our employees regarding mental health and substance abuse and providing an open and supportive environment. These efforts help reduce stigma,” Tomlinson says.

 

The Hartford focuses heavily on prevention and early intervention. That's why the health and wellness team works to ensure that employees are aware of available resources, including 10 free EAP visits per year and access to apps such as Daylight for anxiety, and reSET^® and reSET-O^® for substance use disorder treatment. The company also offers free drug disposal bags.

 

“Families of The Hartford’s employees can call up at any time to request a bag and clean out that medicine cabinet so there aren't any lingering prescriptions in the home that could be misused or lead to an accidental overdose,” she says.

 

The comprehensive suite of corporate health benefits and support services is in stark contrast to how things worked two decades ago. Jeremy Burke, currently a senior learning consultant at The Hartford, recalls his battle with alcohol use disorder when he worked for another company. “I was very much guilty of presenteeism, showing up and not functioning,” he says. That was because he often stayed up late at night drinking and arrived at work either heavily hungover or still intoxicated. His resulting state of mind meant he could not perform his duties at the required level.

 

Exacerbating the alcohol use order was that depression and anxiety had been an issue for Burke since he was a child. But mental health was something that never or rarely got spoken about decades ago. “It was really stigmatized at the time,” he says. “I didn't seek help for that so I self-medicated.”

 

Eventually, his poor performance led to a reprimand from his boss – and a suggestion to call EAP. “Two decades ago, there were very different levels of awareness [of the topic] and the types of support,” he says. “I didn't bother calling the EAP number.”

 

Burke knew he was lucky to keep his job during that meeting. But it didn't do anything to stop his drinking. Instead, it was a traffic accident that changed things. “I flipped the car while I was almost three times the legal limit for alcohol,” he says. He subsequently got arrested for driving while intoxicated, and that event laid bare his problem to the world. “Aside from legal jeopardy, I was now on the verge of losing my marriage and family because issues were out in the open,” he says.

 

That could have been the end of a promising career and a family life. But it wasn't. Fortunately for Burke, his church had an Alcoholics Anonymous program he started attending. “That's where things really shifted,” he says. I'm one of the lucky ones that walked into a meeting and never looked back.” He's remained sober for almost two decades.

 

Tetrault, the Yale professor, says changing social attitudes, such as those mentioned by Burke, also means a more multi-faceted discussion about substances. “For a long time, when people were asked about substance use, the question was simple: ‘You don't use substances, do you?’” she says. It was a leading way to phrase the question, basically requiring an emphatic ‘No!’ to avoid stigma and repercussions at work. “I think that the changing narrative is helping people feel more comfortable talking about it and seeking help,” she says.

 

After all, offering benefits is only half of the equation. “Employers should be making sure that the access to treatment is there – providing health insurance. The other part is actually using it, Dr. Seidner adds. “It's about making sure that stigma isn't there so that those that really do need it can benefit.”