Wellness programs have rarely seen drug and alcohol use, and potential abuse from a point of prevention. This is akin to waiting until a person has a BMI of 35 before we begin to work with them on their weight management issues. Substance use, like all other issues, has various acuity levels. Sometimes, left untreated, a person who begins by having a glass of wine at night, ends ups drinking three or more glasses a night and eventually becomes a full blown alcoholic. Occasional drug use can easily turn into heavy drug use but rarely does it go from recreational to misuse immediately.
Substance use (and we are not saying substance misuse) has a high prevalence rate and has serious implications in terms of current and future health care costs, productivity costs, morale costs, turnover and employee conflict issues. Often that person who starts drinking wine every night wonders: “Should I slow down or cut back a little.” This is the critical time when a prevention/treatment program is appropriate. This person is not going to go to the EAP or attend an AA meeting. They are looking to understand the issue and how to prevent that from occurring. And then, once people do become misusers, often they also do not use the EAP or go to AA meetings anyway. This is particularly true of the millennial demographic.
Today, substance wellness is a critical but missing piece of wellness programs that can have significant impact on your population. It should be considered both a prevention and treatment program across acuity levels rather than a treatment-only program for severe misusers. 21st century substance wellness is not your father’s AA or EAP model.
What problems are we trying to solve here?
- Higher than expected and higher than known prevalence rate for drug and alcohol use. Employers are often surprised at the level of alcohol and drug use inside their organizations. An estimated 11% of an employer’s population is having difficulty controlling their alcohol and drug use and 50% of employees are at various lower acuity levels who may become a problem if not handled properly and provided with early support.
- There are both direct and hidden costs associated with alcohol and drug use. Direct costs can be both health care expense costs and productivity loss costs. But the productivity cost can also be aggravated by morale, employee turnover and employee conflict issues.
- Low participation rates in both EAP programs and treatment programs like AA. People simply do not participate in either EAP or AA programs commensurate with the prevalence rate of alcohol and drug use within an organization. People do not like the stigma of going down the dark hallway of EAP or even phoning in for support. Participation at AA meetings brings the same sorts of issues and is further complicated by the fact that the employee has to go somewhere.
- We tend to think treatment, not prevention. Organizations wait too long to provide support; because individuals do not self-identify or the organization does not recognize the nature of the concern. Like everything else, there are multiple acuity levels with respect to substance use. It is better to be proactive than reactive.
- Efficacy of treatment for more severe cases needs to improve. Even when people seek treatment for alcohol and drug use, the efficacy of such programs is not nearly where we want it to be.
- High relapse rates. This, of course, relates to the last issue. But relapse among alcohol and drug use is higher than it is for physical activity or weight management. This could be due to the fact that the solutions offered for those challenges are more encompassing and easier to access.
- Organizations need to control their program costs. No organization has unlimited funds for any program. So keeping program implementation and use costs to an acceptable level is always important.
- It is necessary to scale a program to the needs of the organization yet keep the program confidential for employees. With current prevalence rates of alcohol and drug use in populations, employers and health plans are always concerned with implementing a program that will not get over-run by participants and not be able to keep up.
The Six Best 21st Century Practices
There are six best practices for substance wellness that must be considered in order to deal with these issues. These are:
1. Think well, not just treatment.
First off, organizations must get out in front of this issue and think wellness and prevention, not just treatment for severe cases. And doing this requires both strategic and tactical shifts in thinking. Just as a person does not go immediately from a BMI of 25 to a BMI of 35, nor does a person go immediately from a causal drinker or drug user to an alcoholic or drug misuser. We need to ensure that employees understand that we are now thinking prevention and not treatment. Their mentality has to be changed as well. (see promotion below)
2. Understand and focus on participant requirements.
Think about the person first. Fundamentally the program needs to be both private and confidential so that no one knows when someone is in it. There are whole groups of people who don’t want to go to meetings or to even talk to someone in their EAP. They want a program that works for them when and how they are ready. If that happens to be 9:30 PM then that’s when it is. Convenience is critical. And, of course, they want assurances that the program that they are investing in is going to work for them. They need pretty quick gratification or they won’t continue. Thinking about user requirements immediately helps you understand why classic EAP programs have low participation rates and people do not attend AA meetings.
3. Understand and focus on corporate requirements.
If a program is not based on clinical guidelines with proven efficacy rates, it is not worth considering. Your next consideration is scale. If you are dealing with an issue that can have a 12% to 20% prevalence rate, you need to think about how you can deliver such a program across a broad swath of your population. Then, of course, you begin to think about cost. How much will it cost to deliver such a program? Treatment programs can run from $100 per person for basic wellness up to $30,000 for intensive treatment at a facility like Hazelden. Also, you need to consider the cost benefit analysis of medical expenses, productivity loss, morale, and turnover and employee conflict issues associated with people who evolve to higher acuity levels.
This may be the most important issue of all. Most people think substance abuse, not substance wellness. We need to carefully manage the messaging with this kind of program or most people will be put-off and not participate. So keeping the messaging lighter, yet serious is a requirement. Employees and plan members must understand that this is not just a substance abuse program but a program that helps them manage and better control their drug and alcohol use.
5. Integrating digital coaching with analog coaching.
The best way to deal with this is to integrate the two approaches into a singular program. This allows for the scale that you need and the added efficacy of the one-on-one encounter. However, there are still people who will not talk about this issue to another human. And, younger people are more comfortable with electronic chat than phone or in-person conversations. The other advantage to chat is that it allows for convenience for the employee in that it can be used when and if the employee wants to use it
6. Conclusion, the program must:
- Have high efficacy
- Appeal to user requirements for confidentiality, convenience and privacy
- Get much better participation rates across all acuity levels
- Be reasonably priced (cost effective)
- Be able to scale across the population and even multiple locations.
Putting all this together requires a broad spectrum of capabilities. A program that meets all of these requirements will need to be both digital and analog, built on careful clinical guidelines and also have a new and different approach to promotion.
So what can we expect in terms of outcomes? The first thing to measure is participation. Next we need to consider user satisfaction. We also need to measure efficacy on an individual and population basis. And remember that we are not trying to get usage to nothing but to get usage to the individual’s goals. So, comparing post-program goals to baseline goals is the best measure.
We all know that this is a tough issue. Partying is fun. And while most people have good intentions, we must recognize that people may fall off the wagon and we need to build their resilience skills to handle that.
Using the six best practices for 21st century substance wellness can have a dramatic impact on your organization and costs.
- Higher participation rates
- Scalable at lower cost
- Reduce medical, productivity and human performance expenses
- Prevent issues before they occur
- Improves employee loyalty
Questions to Ask Yourself
- Do we know our prevalence rate of alcohol and drug use?
- Are we committed to this issue or are we afraid of it?
- Do we know what this population is costing us?
- Are we happy with our participation rates in EAP?
- Do we know how to promote substance wellness?
In summary drug and alcohol use is rising in importance to employers and health plans. These organizations understand that participation levels in standard programs and success rates are abysmal. As an organization, they need to do a better job of getting out ahead of this issue and think more prevention and not treatment-only. They need to focus more on privacy, confidentiality and convenience in order to more effectively engage the participant. New thinking is required and a new approach offering both digital and analog support is needed to maximize both participation and efficacy. So, the more forward thinking employers and health plans are implementing a “21st century approach to substance wellness.