January 8, 2020
By Christal Montague, MSW, LMHC, CASAC, CARC
Chief Strategy Officer
Outreach Development Corporation
Drug addiction is a disease that needs to be treated and talked about like any other disease. The devastating opioid epidemic that has left no community untouched has only heightened the conversation, as treatment professionals and advocates engage policymakers, researchers and communities-in-need, toward developing targeted solutions to this unprecedented public health crisis. However, solutions aren’t clear for employers when their own staff have a substance use disorder history or a personal connection to the crisis, and, increasingly are seeing or hearing about the deaths of clients and former clients, friends and family members, resulting in vicarious trauma. What do we do when our employees struggle with an active substance use issue, whether it be new, or a relapse?
It has been an enduring tradition that providers in the addiction treatment field recruit and employ professionally trained individuals who themselves are in recovery. In recent years, this tradition has also been emphasized through the growing profession of Peer Advocates and Peer Recovery Coaches, whose lived experiences are also viewed as essential assets in engaging, empathizing, and working with individuals and families struggling with SUD. Understanding that addiction is a chronic and relapsing disease, what is the best work culture to address an active addiction issue or a relapse? How do agencies manage the unintended consequence of trauma among treatment clinicians? What are the best policies for employers?
Given the dynamic complexities involved, it is no surprise that the behavioral health workforce has been confronting overlapping challenges that include burnout and vicarious trauma, and perpetual staff vacancies due to the shortage of qualified and credentialed personnel – a crisis that leads to further quandaries.
As our employees’ responsibilities and required skill sets evolve to meet additional regulatory mandates (integrated care model, person centered care, outcome oriented system of care, ongoing regulations, to name a few), employers face many change challenges. These changes are also compounded with mandated reporting and investigation practices that have emerged in recent years. While intended to protect those whom we are charged with serving, these have promoted a climate in which an allegation has the potential to extraordinarily jeopardize the careers, licenses, and livelihoods of our workforce, while placing equally extraordinary pressures on employers to maintain a work environment that is safe for both clients and staff.
Given the busy competing demands within the field, administrators at times may not have the opportunity to cultivate, coach, and develop employees that may be challenged and hence, miss a valuable opportunity to prevent turnover, at a minimum.
How do we expand and enhance our critically needed workforce? How do we recruit, train, and retain a workforce qualified to effect long-term improvements in the lives of individuals with substance use disorder? How do we promote wellness and recovery in our staff? To begin, let’s consider our own inclinations, human resource approaches, and personnel practices, so that we can contemplate how we may be self-contributing to a weakening workforce, and seek innovative initiatives to turn this around.
As employers, in order to create a safe environment for our workforce to be able to do their best and ensure optimal treatment for clients, it is incumbent upon us to demonstrate that we care about our employees’ well-being and health. Some may say that we do this by providing health care coverage that staff can participate in, as well as offering time for them to be able to address health needs. These are important and essential, but we can include some additional aspects if we are going to develop and sustain a workforce to address the continuing opioid epidemic, the most pressing public health problem in a generation.
There are several ways in which we can begin to rethink our policies, drug education and counseling programs to keep our employees and workplace safe and productive amid this opioid epidemic:
1. Encourage an environment where employees can disclose opioid (or other substance use) related issues, or risk thereof, without fear of reprisals. We need to be models for others in our field by using language that de-stigmatizes the disease.
2. Practice a true open-door policy. Many employees fear that as soon as they reveal to their employer that they have a substance use disorder, they face termination. It is important that we find a way to communicate an open-door policy that encourages communication, feedback, and discussion about any matter of importance to an employee, including workplace concerns, questions, or suggestions, and most crucially, the disclosure of personal information, in an environment of trust and safety. Staff must be assured that their health and well-being are of highest importance to us.
3. In organizations utilizing workplace drug testing, reconsider zero tolerance policies as they relate to positive toxicology results. Begin to explore and establish what types of substances are permitted while working: medications for the common cold, anti-nausea, migraine, mood disorder, etc. Consider also eliminating pre-employment drug testing. Some providers have experienced prospective candidates displaying reluctance to take, and/or are unable to pass, pre-employment drug screens, though the medications they use may be appropriately prescribed for verifiable medical or mental health conditions. In lieu of automatic termination on first detection or positive toxicology result of employees, consider instead a policy that provides a second chance by incorporating compulsory counseling interventions.
4. Equip all staff, including administration, to recognize the signs of addiction. To be clear, this is not to promote a culture of “snitching” or finger-pointing, but to safely raise concerns. Just as important as it is to cultivate an environment in which employees feel safe to come forward with concerns with personal substance use, equipping all staff to recognize the signs of addiction is paramount for accountability and to also minimize speculation.
5. Engage the services of local employee assistance programs (EAPs) as a benefit for personnel, to whom staff in crisis may be referred. EAPs that offer confidential support for employees and their family members for an array of work-life stressors, including substance concerns, can help staff to access the treatment needed to address presenting or threatening substance use problems.
The opioid epidemic that we continue to confront today remains compounded by a workforce shortage of eligible, committed individuals who want to work in our field. Ongoing discussions about solutions to the opioid crisis for individuals, families, and communities provide an opportunity for providers to look within, consider the extraordinary impact and toll the epidemic demands of our own personnel, and urgently remind ourselves that we shouldn’t ignore nor neglect our workforce.