Addiction, chronic pain in the workplace: Part 1

Addiction tips and traps
Approximately 10% of employees experience a substance use disorder, according to the National Institute on Drug Abuse. And 2009 research from Dewa, Chau and Dermer finds that estimates of diagnosable mental illness in the Canadian working population also hover around 10%. Compounding the problem is the fact that people with mental disorders are more than twice as likely to have a substance use disorder than those without a mental illness, according to 2004 research from the World Health Organization and the Centre for Addiction and Mental Health. Despite their prevalence, these conditions are often undiagnosed or misdiagnosed.

“The problem with addictions [is that] they resist detection,” said Dr. Ray Baker, associate clinical professor of HealthQuest Occupational Health in Vancouver. Not only do addictions mimic many common mental disorders, such as depression and bipolar disorder, they are also often covered up or ignored by doctors, supervisors, friends and families.

In addition, stereotypes can blind people to addictions—particularly in the workplace. Baker illustrated this point with a real-life case study of a typical addict. This individual was a physician who had been highly successful, both academically and professionally. At 37, he presented as depressed and suicidal. He was drinking heavily and diverting pharmaceuticals from his workplace for personal use. His colleagues had missed several red flags and opportunities for intervention; rather, it was his wife who initially sought help. He underwent a six-month residential treatment, followed by supports such as group therapy, exercise and meditation. Twenty-five years later, he is sober, happily married and professionally successful.

That physician is Baker himself. “If you want to find people who are substance-dependant, don’t look at the bottom of the pile, look at the top,” he stressed. “Until we burn out, we look really good.”

Although the workplace is often the last area of an addict’s life to suffer, employers should watch for warning signs—particularly changes in attendance and performance patterns. “If I had one trick in the workplace, it would be [to have] a good computerized attendance program,” said Baker, explaining that these programs can highlight problems such as absenteeism around weekends, holidays and paydays. Other signs to watch for include changes in appearance or behaviour; increasing interpersonal conflict; incidents, near misses and accidents; apparent impairment; and repeat disability claims. (Baker estimates that half of all disability claims mask addiction-related problems.)

While supervisors are not responsible for diagnosing addiction or mental illness, they do have a role in recognizing the signs and having those “difficult conversations” with employees who require help, so they should be trained accordingly. “An awful lot of good things come out of workplace training. It is a really cost-effective thing to do,” Baker affirmed.

Many treatment options are available for individuals with addictions and/or mental illness. But to be effective, treatment must concurrently address all diagnoses and must include a long-term recovery component. “If you spend $30,000 on treatment and don’t follow up, you’ve wasted your money,” Baker added.

Changing behaviour, moving mountains
Dr. Michael Vallis, director of Capital District Health Authority in Halifax and a professor at Dalhousie University, agrees with Baker about the importance of follow-up treatment. In his presentation on behaviour change interventions, Vallis noted that any therapy will be ineffective if the patient isn’t compliant.

Unfortunately, it’s normal human behaviour to disregard beneficial medical interventions, said Vallis, citing statistics from several American studies published in the Journal of the American Medical Association (JAMA) and the Archives of Internal Medicine.

• 50% of all medications are not taken as prescribed.
• Only 20% of people follow their doctor-recommended low-salt diet.
• 35% of deaths can be attributed to smoking, poor diet, inactivity and alcohol—behaviours that are well known to be unhealthy.
• Only 3% of the population routinely follows four primary healthy behaviours (not smoking, maintaining a healthy weight, being active and eating five servings of fruits and vegetables daily).

“Healthy behaviour is abnormal behaviour,” he explained. And our tendency to avoid healthy choices isn’t surprising, given that our two primary motivators are pleasure and avoidance of pain. Fast food, alcohol and drugs feel good; working out (at least in the short term) feels bad. Add in sociobiological factors that promote food as comfort, and an environment that discourages physical activity, and it’s easy to see that “there are a lot of good reasons not to change,” said Vallis.

Yet the power of change is well documented. Two landmark trials (one Finnish, the other American) in the area of prediabetes, for example, clearly show that people who improve their lifestyle can delay the onset of diabetes at rates better than those who take medications. “Yes, change is hard, but these studies validate the role of behaviour change,” said Vallis.

Behaviour change counselling—a combination of motivational interventions, behaviour modification and emotion management interventions—is a patient-centred counselling style that can be helpful for those who are reluctant to change, who routinely encounter barriers that impede change or who are ambivalent about increasing healthy lifestyle behaviours. However, such counselling can be challenging in a work environment where a perceived “employee-versus-employer” dynamic often creates barriers, Vallis added.

The employer’s role is to identify employees who have unhealthy coping strategies and are in need of behaviour change counselling, to educate staff and recommend resources and to support employees in their change efforts. Vallis pointed to his own employer, Capital Health, which recently banned high-fat doughnuts and muffins from the on-site coffee shop, as an example of a workplace that supports healthy choices.

Vallis stressed that the goal of his presentation wasn’t to make people experts in behaviour change counselling, but rather to raise awareness of the challenges and strategies relating to it.

“If you are mindful of these issues, it may make it easier for the individual to choose behaviour change.”

Elizabeth Garel is a freelance writer and editor specializing in healthcare. She is based in Toronto.

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