Substance use disorder is the largest unmanaged disease in modern health care, but few options exist that allow those affected to continue to work while being treated and that address plan members whose substance use issues aren’t visible in the workplace.

“The overwhelming majority of substance use cases is invisible to the eye,” said Elliot Stone, chief executive officer and co-founder of ALAViDA Health, an app-based treatment program for substance use, during Benefits Canada’s 2021 Benefits & Pension Summit last week.

Alcohol and drug use treatments have been oriented around “the five per cent of known issues,” he said, but largely ignore the 95 per cent whose substance use flies below the radar. “This is not to discount just how serious this illness can get — there are certainly cases where it is very visible, but that’s simply not what we’re talking about when we’re talking about the workplace setting. These people are all around us. I’m willing to bet that . . . each one of you have thought of someone in your life. And I would ask you, are they in the five per cent or are they in the 95 per cent?”

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Treatments for substance use typically require participants to stop work and give up their obligations, totally abstain from drinking or drug use and even travel to treatment centres. But these options don’t educate or intervene with people whose substance use problems are just developing — the onset for such disorders often take years or even decades, noted Stone.

“This isn’t something where it happens all of a sudden; we have a lot of time to intervene earlier, we’re just not doing it,” he said, adding that typical substance use treatments won’t be considered by people who may have a disorder but are functioning well at work. “Do you think a mother of three drinking a bottle of wine every evening and still performing at work is really considering these obstacles? What about a partner in a firm — is disability and rehab really on the table? No, they’re going to sit on the problem until it becomes absolutely unbearable. They haven’t told their plan sponsor because they want to stay at work.” 

Dr. Diane Rothon, medical director and co-founder of ALAViDA, said effective substance use treatment should be “virtual [and] collaborative” with a “constellation of services,” including group or individual therapy, awareness and monitoring services that helps people understand what problematic drinking looks like to encourage behavioural changes and pharmacotherapy that can pair plan members with medication that reduces their cravings. These treatments also allow plan members to remain at work while reducing their substance use. 

“It’s about having a broader conversation and educating and making very low-barrier tools available,” said Stone. “So the same way that we count calories, we start to count our drinks or our use of cannabis. It’s about driving a healthier lifestyle, as opposed to getting an intensive treatment for something that’s gone too far. Because when it’s become a disability or a case that’s ready for inpatient treatment, it’s effectively way too late and we should be engaging much earlier.”

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Substance use disorders are one of the highest lifetime incidences of chronic illness, with 21 per cent of Canadians affected, according to Statistics Canada. Despite this, it remains largely untreated due to a combination of lack of knowledge about the limits of safe drinking. Roughly 85 per cent of people with substance use disorders weren’t told by their family, co-workers or even doctors that they might have a problem, said Rothon, and many people don’t understand what problematic drinking looks like. 

The coronavirus pandemic has had a profound impact on people living with substance use disorders. Rothon said many of her patients relapsed due to an increase in stress and/or financial instability, along with a dwindling number of outlets to work off their stress, such as going to the gym or connecting with loved ones. Women in particular were deeply affected, with 41 per cent reporting an increase in their alcohol or drug consumption during the pandemic, according to a September 2020 study from global think tank RAND Corp. and the Indiana University School of Public Health.

As well, a third of workers admitted to drinking or using drugs while on the job during the pandemic, according to a survey by alcohol treatment resource Alcohol.org.

Stone said the pandemic has presented the perfect opportunity for employers to address substance use in their workforce. “The time is now. Substance use is at an all-time high, the impacts are clear and the tools are now available for plan sponsors to take a more sophisticated, modern approach to treating substance use just like we’ve done for other chronic illnesses.” 

Read: As substance abuse rises amid pandemic, employers can help