Updating Workplace Conversations
Changing the Workplace Conversation Around Substance Use
Benefits and Pensions Monitor. The Magazine of Employee Pension Fund Investment and Benefits Plan Management.
By Maureen Palmer & Yolanda Billinkoff
Mental health benefits in Canada have drastically improved over the past several years and employers and insurers continue to lower the barriers to care. Today, more and more people are openly speaking about their personal mental health concerns.
But when it comes to substance use, intense shame remains. Dependence on alcohol is still considered a problem of lack of willpower or discipline; a moral problem, not a medical one.
Canadians drink 50 per cent more than the global average and almost one in five is categorized as a ‘heavy drinker.’ Yet fewer than one in 10 seek treatment, often due to stigma even at the hands of healthcare professionals.
Here’s an unconventional thought: instead of relying on healthcare to lead the conversation about compassionate, stigma-free substance use treatment, why not encourage the workplace to take on some of that role? “Evidence-based, lower barrier, non-judgmental substance use care services should be available to all employees, through extended health benefits packages,” says Jonathon Chapnick, owner of Portage Legal Services in Vancouver, BC, which advises businesses on how to be good employers. He spent the last 15 years dealing with HR and benefits issues at major Canadian unions and institutions. “Typically, employers use attractive benefits packages as retention and recruitment tools. Being innovative and cost-effective in this field can get businesses onto ‘Top Employer’ lists and help transform a culture with long-standing, deeply-ingrained social and structural stigma around addiction.”
Employers and their employees have the most to gain if companies chose to revolutionize their approach to addiction. The workplace pays a hug price for untreated substance use. Lost productivity costs Canada $15.7 billion annually. Alcohol costs employers 6.2 times more than other substances combined. Employees who engage in heavy alcohol or illicit drug use are 33 per cent less productive than their co-workers. In sectors with high average salaries, it’s estimated each worker with an untreated substance use disorder costs their employer almost $18,000 a year because they cause the highest turnover.
Profound Shift in Thinking
It begins with a simple, but profound shift in thinking, says Chapnick. “If you’ve set up a truly supportive benefits plan for substance use, employees would access it just like they do their physio or dental benefit, with complete confidentiality. No one knows that I need physio on my back or a filling. Nor should they. And that’s exactly how we should deliver substance use support. No one needs to know I’m struggling with alcohol or receiving treatment unless my health condition impacts my behavior or performance at work in a serious way. Normalizing is key to destigmatizing.”
You don’t have that problem at your place of work? Oh yes you do. By the time a Canadian hits 40 years old, one in two have or have had a mental illness and 30 per cent of employee mental health issues are substance use issues. People struggling with substance use are up to three times more likely to have a mental illness.
“We identify people at the point of crisis or incident and that’s way too late. For every workplace incident involving substance use, there are another nine or 10 people percolating towards an incident at some point in the future. These problems develop over decades in many cases so there is ample time to intervene earlier given the right tools,” say Elliot Stone, co-founder of ALAViDA, a virtual care provider focused on the science of substance use management. The digital platform connects patients with behavioural coaches, therapists, and physicians who work as a team to deliver personalized care right from their smartphones. It is an employee benefit with varying plans and personalized therapeutic programs for all substances and levels of severity that help individuals deal with substance use issues and minimize time out of the workplace.
It found that there was a silver lining to the pandemic. “With the support of institutions such as Genome BC and Canada’s Digital Technology Supercluster, we were already well along in the development of our digital tool.” But the uptick in acceptance of virtual healthcare has been a boon for us,” says Stone.
His vision is borne of personal pain. Three of his four grandparents suffered from substance abuse disorders. Two died of cirrhosis. “This is a problem worth starting a company over and rehab is an industry ripe for disruption,” he says.
Radical Shift
The method constitutes a radical shift from current practices and large insurance and benefits providers such as Pacific Blue Cross and PPI Benefits, labour unions, and education institutions have been eager to implement it.
“COVID-19 has exacerbated a costly, yet largely invisible, problem in the workplace. Increased reliance on substances as a coping strategy in these stressful times will have significant impacts on employees and their families, as well as employers in the form of chronic illness, increased healthcare costs, and disability claims. And yet targeted solutions to address this growing problem were largely absent from the benefits marketplace.” says Ed Hofstede, president of PPI Benefits and Agile Benefits.
But the path to disruption is complex. Workplaces frequently normalize the behaviour around substance use and employees face significant barriers to finding treatment. An employee’s path to traditional treatment begins with productivity dropping off, increased absenteeism, arriving late, and leaving early. When the inevitable crisis presents itself, the worker is told to go home and wait for further instructions, which often means a trip to expensive rehab or a period of expensive disability.
“And quite often this creates more anxiety and fear in the worker because the current patient experience is broken,” says Stone. “The vast majority of traditional rehabs do not yet offer a broad range of evidence-based treatment. Very few offer medically trained specialists and medication. Wait times range from 17 to 52 days. There is a one-size-fits-all approach, regardless of the degree of the problem.”
For Stone, the fiscal case is even more persuasive. “Traditional rehab often costs $30, 000 or more a month. ALAViDA costs a mere fraction of that. More than 82 per cent of those signed on report greater control and reduced substance use in as little as six months.” Creating effective substance use treatment benefits creates a phenomenal 565 per cent return on investment. “The benefits of getting out in front of this problem are enormous.”
Societal Shift
Building a supportive and inclusive workplace culture around substance use aligns the workplace with the societal shift in attitudes about drinking and using. Both risky substance use and addiction cause or contribute to more than 70 health conditions. While the “sober curious” movement has gained traction during the pandemic, substance use has spiked due to isolation, financial insecurity, and lack of social activity. While working from home might have become the new norman, a mental health tsunami driven by substance use is approaching and employers need strategies to support their teams and mitigate downstream long-term disability risk.
“That doesn’t mean no drinking at company functions,” says Chapnick. Gold tournaments, Christmas parties, and Friday night drinks, for example, are inevitable and can be good team building events. But having access to effective substance use care should be an equal part of every company’s benefit arsenal. It’s good business, and it’s the right thing to do.”
To see this article in magazine format, view page 16 and 17 of Benefits And Pensions Monitor-May 2021
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