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A Tale of Two Epidemics: Substance Abuse Disorder and COVID-19

Nearly half of employees are drinking on the clock while working from home. Is this a temporary sign of the times, or should employers (and society) be prepared for long-term repercussions?

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covid-19 substance abuse

As the global COVID-19 death toll surges amid mass reopenings and quarantine fatigue, employers are struggling to address skyrocketing rates of depression, anxiety, and substance abuse that have surfaced or worsened along with it.

Under normal circumstances, approximately one-fifth of employees suffer from mental health disorders and nearly half of Americans have a family member of close friend who’s been addicted to drugs and alcohol.

We are not living under normal circumstances.

Today, 60 to 70 percent of employees are suffering from mental health issues. This pandemic—and its ensuing unemployment rates, social isolation, and health and economic repercussions—has spurred anxiety, loneliness and overwhelm in just about everyone. Some are struggling with fear or loneliness. Others are finding it extremely difficult to cope with full-time childcare/homeschooling responsibilities while working full-time. Millions are facing devastating job losses and financial insecurity.

Meanwhile, nearly half of all employees are admitting to drinking while on the clock. One in three American employees said they’re more likely to drink alcohol while in isolation, and one in five respondents have resorted to stockpiling alcohol.

Is this trend a temporary sign of the times? Or should employers be prepared for long-term repercussions?

COVID’s impact on mental health and addiction

Depression alone costs employers more than $100 billion per year, making mental health a crucial consideration for managers and organizations alike. Substance abuse, meanwhile, is estimated to cost employers more than $442 billion per year in absenteeism, increased healthcare expenses, and lost productivity.

The COVID pandemic arrived on the coattails of another deadly U.S. epidemic. Between 1998 and 2018, approximately 450,000 people died from an opioid overdose, and an estimated 88,000 people die from alcohol-related causes each year. Alcohol abuse is the third leading preventable cause of death in the U.S.

The silver lining, if there is one, is that there’s been a significant uptick in conversations normalizing and addressing mental health in recent years. But the stigma around substance abuse remains. Despite the fact that the American Medical Association officially diagnosed addiction as a disease decades ago (it’s genetically heritable, chronic, and prone to relapse), many people continue to see substance abuse as a moral or ethical failure. This makes it even more challenging for those struggling to ask for help.

By the numbers, it appears this recent pandemic has given rise to a new wave of (potentially situational) substance abuse, and the increase in jobless rates will certainly make it more difficult for those without insurance to seek treatment. But COVID is also exacerbating existing cases where substance abusers were “functional” and contributing to the relapse of others who were in active recovery.

Addiction thrives off of isolation, which is concerning in a world of social distancing. There are more than 22 million Americans in recovery from substance use disorder (SUD), many of whom rely on recovery communities such as group treatment/halfway houses and 12-step meetings such as Alcoholics Anonymous (AA). Social support is critical, as social isolation is a well-documented risk factor for relapse. Most 12-step meetings have moved online to reduce disease transmission, but as anyone who has participated in any social Zoom setting can attest, it’s a poor substitute for in-person interaction. Many recoverees have stopped attending online sessions due to the meetings feeling “chaotic” and “not the same.”

Meanwhile, as we’ve seen, people who are isolated and stressed—which describes nearly everyone during a pandemic—often turn to substances to alleviate discomfort. Those in recovery are likely to face heightened urges to use substances and are at a much greater risk for relapse. In fact, in a recent survey of people in recovery, 78% reported higher stress levels, 20% reported an increase in cravings, and 17% reported having already relapsed since the pandemic’s start.

This small study likely foreshadows an increase in relapse rates, and this pandemic may prove to be a perfect storm catapulting the substance abuse epidemic to even greater heights. People are living in fear and uncertainty, facing unemployment and social unrest, with limited access to community support systems.

It’s reasonable to expect that the impact on mental health and SUD will require a comprehensive public health response from employers. 

What this means for employers

While it may be tempting to assume that your organization doesn’t have a substance abuse problem, statistically, that’s highly unlikely. According to the federal Substance Abuse and Mental Health Services Administration (SAMHSA), the U.S. is home to an estimated 22.4 million illicit drug users over the age of 18, and 70 percent of them are employed full or part time.

Meanwhile, the 2015 National Survey on Drug Use and Health found an average of 8.7 percent of full-time employees used alcohol heavily in the past month, 8.6 percent used illicit drugs in the past month, and nearly 1 in 10 were dependent on or abused alcohol or illicit drugs in the past year. In many of these cases, employers have no clue. Many of these employees likely fall under the vague definition of “functional”, meaning that their substance use isn’t disruptive enough to cause debilitating consequences or be obvious to others.

But with an increase in stress, reduced resources, and months of isolation, it’s likely that the symptoms and dependency for “functional” employees will get worse.

The Kaiser Family Foundation recently reported that 45% of adults in their survey reported that the pandemic was harming their mental health, and—as mentioned above—nearly half of all employees have reported drinking during work hours during the pandemic. Experts widely expect that workers returning to work will have new or worsened mental health and addiction issues.

Considering the preexisting $442 billion price tag for employers, it’s in everyone’s best interest to place a high priority on addressing this under-discussed repercussion from the COVID pandemic.

Business leaders, HR leaders, and managers all have important roles to play.

Best practices for addressing SUD at work

Due to the nature of and stigmas associated with substance abuse, many affected are reluctant to seek help. Concerns about confidentiality, job security, and social standing often translate to reluctance in utilizing treatment resources, including employee assistance programs and inpatient/outpatient facilities.

For HR, developing internal policies, empathetically guiding employees toward available resources, and enforcing policies are vitally important. Training managers on both the early signs of psychological struggle as well as how to intervene are crucial. Some employers are also experimenting with offering additional paid time off to recuperate, using afternoons off for homeschooling or mental health breaks, etc.

Like all chronic diseases, SUD gets worse over time and is often easier to treat in earlier stages. Trained managers who can spot and cautiously address earlier signs of concern may be able to avoid waiting until a failed drug test, accident, or incident forces HR’s hand, benefitting both the employee and the organization.

Implementing a three-pronged approach for COVID-19

Employers must be ready to face this secondary epidemic. I propose a three-pronged approach to attenuate the impacts and, hopefully, drive increased long-term support for SUD in our organizations.

Ensure most basic needs/security are met, including social support

Business leaders, HR professionals and managers can all work together to help their employees feel safe and protected. First and foremost, communication is key—don’t underestimate the impact of an honest, authentic email from the CEO explaining the state of the business and steps being taken to protect jobs and the bottom line. Consider setting up resources for employees to donate to other employees whose spouses have lost income or whose health has been impacted. Seek opportunities for teams to join together, being mindful of Zoom fatigue, or send small gifts, notes, or emails to let your people know that you’re thinking of them and that you care.

Provide low-intensity interventions and spark conversations and trainings to reduce stigma

The stigma surrounding substance abuse is a primary reason many people refuse to seek help. By sharing some of the above studies, statistics, and resources, business leaders can initiate conversations and help struggling employees not feel so alone. Furthermore, widely advertise low-intensity interventions, such as anonymous webinars or third-party counseling services, and find a way to mention how well-utilized these services are within the organization to further reduce the shame of needing them.

This is also the time to ensure managers are trained to recognize and address potential substance abuse. The focus should always be genuine expressions of support and concern, and managers must remember that they are not chemical dependency specialists and cannot accurately speculate or diagnose. Rather, the manager’s role is to address any misconduct, poor performance, or change in behavior, and to offer compassionate referrals to substance abuse professionals, EAPs, or facilities, if the employee themselves admits a problem.

Encourage mental health and substance abuse treatment for those who need it

Just as a cancer patient might require chemo, sometimes SUD patients require long-term care. Keep in mind that, under the ADA, alcoholism and drug addiction are covered disabilities, as are many mental health disorders such as anxiety and PTSD. Due to the extenuating circumstances of COVID-19, employees affected by SUD or mental health may need more time off to address their health. Return-to-work policies should reflect this. If an employee has unpaid FMLA leave available, this can be a great resource to help them focus on their health and attend counseling or treatment as needed. If not, consider whether it would be a reasonable accommodation to allow more time off.

Ultimately, just as employers are beginning to recognize the importance of discussing and prioritizing mental health in the workplace, SUD should always be prioritized in employee wellness initiatives. Despite the lingering stigma, substance abuse is not a moral failure—it’s a disease, and should be treated as such.

It’s likely affecting a significant portion of your workforce—and your business—whether you know it or not.

But you have the power to make a very real difference.

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