Summary: The opiate epidemic and other traumatic life circumstances cause considerable mental and emotional harm to many. Employees experiencing and thus suffering from such difficulties will present a variety of issues in the workplace some obvious and others subtle. CxOs and HR can and should develop plans and programs to address these issues quickly thereby mitigating some of the impact on the firm while at the same time strengthening the company culture and overall employee loyalty.
Note to the reader: This article is not about addicts or those directly suffering from an illness, but rather those impacted as parents, spouses, or children. Though this article primarily focuses on addiction, the ideas presented map to other traumas such as terminal illness, extreme financial difficulty, divorce, or death of a child.
Impacts on the firm
Social and cultural reality
Here in 2017, it is a social reality that the opioid epidemic is going to affect everyone. It is very unusual to meet anyone in the United States who does not personally know someone who is addicted or a family who has lost an addict to fatal overdose. In just the two years ended December 31, 2016, the United States buried 116,000 victims of drug overdose. The current trajectory of accidental death due to overdose predicts more than 80,000 victims will die in 2017. These are only the deaths mind you. Some estimates suggest that for every overdose death, five others are prevented with the opioid antidote Narcan. For each death and for each overdose, there are a set of parents, sometimes a spouse, and occasionally children. This last statement implies that there are as many as 400,000 individual addicts overdosing per year and more than 1 million family members experiencing the tragedy of an overdose directly. On the largest scale. there are as many as 5 million active opioid addicts all with parents, spouses, and kids. The addicts are putting their loved ones through a living hell. This hell comes to the office every day in the form of a suffering human being trapped in a life never envisioned or designed.
Certainly, your own personal experiences support the likelihood of such high numbers as everyone knows someone in this tragic life circumstance. A proactive strategic analysis of the opioid epidemic’s impact should be considered by every company and organization. We are all affected; therefore, our employees and customers are affected. It would be impractical to pretend there is immunity from this crisis.
Affected Employee (and team) Productivity
There are three primary impact phases that addiction has on a parent or spouse. The first phase is filled with fear and anxiety; the second is filled with traumatic stress due to a tragic event such as an overdose or death; the third is filled with regret and depression.
The time prior to a terminal ending to addiction, another addiction cycle, or some other illness is one of anticipation and expectation, usually of the worst outcome – death. During this period, the employee is riddled with fear, unending worry, and overwhelming anxiety. Though there is very little they can do to change the situation they find themselves in, almost always the employee obsesses over how he or she can alter the eventual outcome. As the terminal end approaches the employee will become more and more concerned with the ever-evasive solution and less and less concerned with anything else – most especially their job performance or their employer’s well-being. When it comes to an addicted loved one, nothing else matters. Parents become addicted to the addiction.
Usually, even though it is expected, the terminal event – death, overdose, or incarceration is an extremely traumatic event. Addicts don’t die or overdose on a hospital bed surrounded by loved ones. Addicts die dramatically in bathrooms and hotel rooms, and unfortunately are usually discovered by their loved one – your employee. Rarely is the scene one of a peaceful passing. The images observed by the person discovering the body are forever etched into memory and will haunt their consciousness. Common language cannot describe the emotional conditions caused by these circumstances. The diagnoses are known as Traumatic Stress Disorder ((P)TSD), Major Depressive Disorder, and Major Anxiety Disorder. In my experience, the person, their personality, their ego, their sense of purpose, everything they are (were) is drowned out by a never-ending and completely overwhelming series of waves and pulses driven by negative emotions. When this occurs – there is no room, no capacity for the person to function professionally. In fact, there is very little capacity to function at all. At this point – the situation is truly dire.
At some point, usually well beyond the terminal ending, the affected employee will begin to emerge from the emotional overwhelm that had possessed them for so long. Traumatic Stress Disorder (TSD) evolves into Post Traumatic Stress Disorder (PTSD). The employee will have cycles where they seem to function normally followed by severe episodes of depression. These episodes are driven by the proverbial “woulda, coulda, and shoulda,” where in their mind they could have changed the outcome if only they would have done something different. Sadness, regret, guilt, and self-resentment pervade their minds.
These three phases of emotional disorder may span five, ten, fifteen years or more. During this time, the employee’s productivity and potential are greatly diminished. They cannot perform “normally” let alone up to expectations so long as the distraction of an impending or recent tragedy is ravaging their lives. These victims of traumatic life circumstances would give anything to be “normal” again. Although there is no possible return to “what they used to be,” they will ostensibly wait until they return to their “old selves.” Many will wait in total despair for the rest of their lives for a return to the “old normal” never realizing their existence is now and forever in a “new normal.”
Employees in any of these categories will rarely fulfill any expectations their employer may have of them. Often times their performance drops drastically, project completion becomes sporadic, attendance and punctuality suffer. It may appear to the unbiased observer that these once wonderful employees are just going through the motions at half speed. Occasionally, the employee will use work as a distraction from the terror of their reality, and during these times of denial, it will seem they have returned to their former performance level. Managing employees in these situations is frustrating, especially if they have had a successful tenure behind them.
In today’s social media-driven culture, everyone has an opinion and is more than willing to publicly share it. The protections granted by monitor and keyboard have allowed many a common man or woman to don a robe and swing a gavel in judgment of anything and anyone at any time. Read any post on drug addiction (or any other vice) and there are generally three groups of respondents – sympathizers, judges, and mediators. On any given controversial topic, nearly all people fit into just one of these archetypes. In the workplace, few will express what they truly believe on anything; but the absence of expression does not equate to an absence of sympathy, indifference, or judgment.
No executive or professional parent will readily admit openly to suffering with an addict at home. Even in the most ravaged areas of the country, there is a very strong stigma around addiction that “forces” parents and spouses into a life of repressive isolation. These parents likely know that admission of their home situation would influence their peer’s and manager’s opinions of them and their families. They also realize that many in the workplace believe that “addiction is a choice,” and that addicts get “what they ask for.” As the addiction advances and the parent’s life becomes more unstable and miserable, tensions may arise on workgroups and teams and even in the c-suite. The cohesion necessary for the success of the team breaks down and as more personal information makes its way into the office, more team members begin to take sides. The loss of cohesion is inevitable so long rumors drive the conversation and “judges” openly state their position on the topic while seeking more and more peers to support their personal point of view on the matter.
Benefit Expenses for the Afflicted/Addicted (Insured family member)
There was a time not long ago when the cost of benefits and the related drivers were a relatively guarded secret held only by the CxO and HR staff. In today’s environment, with healthcare politicized and divisive, employees are more aware than ever of the types of situations and risk profiles that result in an increase in their health benefit costs. In smaller companies where mental health and addiction coverage are provided, premiums, company allocations, and employee out-of-pocket are going to increase. Further, repeated overdoses resulting in ER visits and sometimes intensive care (with life support) drive the major medical premium.
The financial impacts are obvious for employer and employee. There are additional “costs” to consider as well. The “coffee pot chatter” at re-enrollment time inevitably will include a discussion about so-and-so’s kid driving up premiums for everyone because he is an addict and cannot stay clean for more than a few months. Dissension and division percolate and drive down productivity while driving up the total cost of doing business.
Benefit Expense for the Employee (and spouse)
As indicated earlier, the employee (and their spouse), suffering from anxiety, trauma, and depression, will almost always need psychiatric, psychological, and long-term therapeutic care. These are not easy circumstances to understand or process for anyone. Initially, visits to the psychiatrist might be every two weeks while medications are initiated and dosages increased and then stabilized. Counseling with the psychologist will be at least weekly for the foreseeable future. CxOs and HR professionals should have very limited expectations with respect to the pace of recovery. Often, successful recovery consists only of the absence of negative emotions and this only after 12-18 months of therapy. A return to full-potential and productivity should not be an initial or hasty objective. Regardless, it will take time and money to help the employee recover and the costs should not be understated.
Strategic Project Risk
Employees who become distracted by the anxieties of family drug use, the tragedy of overdose, and the depression of death, are not fully attentive to much of anything. Many times, their minds are ensnared in either the fear of the inevitable or the regret of the actual. When not obsessed with the life of the addict, they are likely distracting themselves with some mind-numbing activity. Rarely are they fully engaged in any project at work, let alone a strategic initiative. While the grips of emotional and mental disorder progress, these employees become less and less capable of any meaningful contribution. Meanwhile – the employee does not realize any drop-in performance. No individual recognizes their own mental breakdown until well after it has ripped their life apart. By then it is too late for them, and too late for the company to intervene.
Impact on the High Potential/High Productivity Employees (HiPot/HiPro)
A healthy and stable HiPot/HiPro employee is generally energetic, enthusiastic, and engaging with an unnerving desire to make her company successful. Often, she may believe and even project that the success of her team or workgroup can be determined by her sheer volition. Always optimistic, few circumstances in the office can deter her from her belief that her company will succeed.
Can you imagine the HiPot/HiPro being different at home? She probably isn’t. In fact, no matter how many difficult life circumstances run through her family, she fully believes that her own desire, persistence, intellect, and influence will make-up for any shortcomings in her spouse, her marriage, or her children’s shortcomings. No matter how bad the situation, she will figure it out. Interestingly, she is almost always right.
Opioid addiction and its eventual outcomes are not discrete situations that come and quickly dissipate like a late phone bill or an ill parent. Drug use starts innocently with subtle indicators of a larger problem. By the time she finally decides that the addict’s difficulties are more than just a phase, or a medicinally treated disorder like ADHD, several years have elapsed and have taken their toll on the HiPot/HiPro and her outlook.
However, it isn’t until family valuables begin to disappear, checks are forged, jail sentences are ordered, or legal and medical bills begin to pile up that she begins to grow weary to the point where her boundless enthusiasm is dampened. Just like at work, she doubles her efforts and her attention to the problem at hand, convinced that she is strong enough for everyone in the family. She will make up for the other’s shortcomings and things will turnout – she is in total control – therefore the family is safe and secure. At work, perhaps some notice a small change in the number of extra hours she spends at the office, or find her mascara running because she had been crying. When asked if there is an issue she shuns the idea and mentions something about “her cousin” in Nevada.
Things at home begin to improve and her belief in herself is reinforced – but only temporarily. Shortly after a minimal improvement, the addicted loved one again falls to the power of his drug of choice. The HiPot/HiPro is befuddled. She does not understand how her power and influence is not overcoming the simple personal problem of family addiction. Again, she re-doubles her efforts at home; if only she worked on it a little harder! Her hours at the office decrease as does her performance. Management may feel she is just having a temporary setback at home.
It’s been 5 years; and though she is still an important part of the company, her star is no longer rising. Her focus and concentration are not what they used to be in the office – and it is there that it appears that she is not as dedicated or committed as she once was. The truth is she is beginning to panic on a regular basis. She fears the worst for her addicted child and is at a loss for what to do. She is terrified to answer the phone or a knock at the door. She reminds herself that she absolutely cannot say anything at the office or anywhere else – for the shame and humiliation would ruin her reputation and ultimately her career. She must keep this living nightmare to herself and continue to work on it until she solves it – then she can return her full attention to her career.
Her productivity is way down. Her propensity to make mistakes is up. She is distracted and seems to only be going through the motions. She refuses to answer questions about what’s wrong or what the company can do to help her. In her mind, she is still in total control of all of her outcomes – at work and at home. She is forcing it; the harder she tries the further away she moves from conquering the demon. She is now wrapped way too tight and minor issues have the potential to break her down. Yet, she hides it all so very well.
On the inside, she is terrified. Fear never leaves her alone as she imagines her child going to prison, killing someone in an accident, and overdosing. She also fears for the safety of others in her family, for her family’s reputation, and for her own reputation. She is emotionally paralyzed. Her public demeanor? It is all fake.
When her child finally succumbs to the deadly nature of his disease, the HiPot/HiPro is traumatized. She failed. Not only did she bury her child, but she failed to prevent the necessity to do so. For a person like this, there is nothing worse. Not only did she fail, she was not in control either. Too often, these overwhelming feelings of complete and total failure, are being felt for the first time. The world as she knows it crashes in upon her. She loses confidence. The enthusiasm, optimism, and can-do attitude that defined her entire philosophy on life are shown to be delusional. She begins to believe that all of the pessimists whom she conquered throughout her career were actually right, and she was wrong. She feels like she is at the bottom of a deep dark pool. She is overwhelmed with emotions; so many that she cannot process all of them. Her physical body is actually in deep unrelenting pain. There is nothing she can do – she is completely and totally helpless.
To make matters worse, even though her addicted child is dead, she cannot escape the regret of not doing something else to save him. She will second guess her decisions for the rest of her life. There is no way out for the parent of an addicted child; when the addict lives parents live in constant fear; once they are dead, parents live with constant guilt and regret.
What should the firm do?
The threats, risks, and the overall impact of the opioid epidemic will vary from firm to firm. Some firms will be heavily affected while others may not be affected at all. Geography, demographics, industry classification, and the number of employees will all factor into the risk profile. However, until the assessment is done, the firm will not have an understanding of potential consequences.
Obviously, the outcome of the assessment will drive any proactive measures the firm should consider. In the event proactive measures are indicated, the following suggestions may guide the development of the firm’s response.
Although the implementation of a hard and fast policy is impractical, management should not find itself in a situation where every situation is treated uniquely, or non-uniformly. A framework of guidelines should be drafted and considered as an essential part of the 2018-2021 HR strategy and budget.
Substantial thought should be invested in how the firm will (or not) help the employee navigate the difficulties associated with the three phases of fear and anxiety, trauma, and depression. If a firm can get proactively in front of the employee’s likely emotional deterioration, there is a strong likelihood that the employee’s eventual disorder will not be as severe, as prolonged, or as impacting on the firm’s performance or on the employee’s career.
A milestone-driven, management sponsored, and HR measured program should be implemented so that as soon as an employee is identified as a potential candidate decisive action can be taken for the benefit of all involved parties. Key activities to be implemented are psychiatric treatment, psychological therapy, a 12-step family recovery program, as well as opportunities to reduce anxiety and depression through better nutrition, lifestyle balance, temporarily (and mandatory) reduced hours, achievable objectives (not stretch goals), exercise, and yoga/meditation. If the employee recovers, it will only happen once all of the aforementioned areas are optimized. There are no quick fixes; recovery takes work.
HR should implement an “all-hands” training aimed at educating all employees of the realities of addiction in the family and at reducing the lines of demarcation between sympathizers, mediators, and judges. Topics should include information regarding the disease of addiction versus the choice of using narcotics, the impact an addicted family member has on the fellow employees and thus on the workplace, what employees can do if they are personally affected, what employees can do if they want to help a fellow employee, and access to 24×7 information via mental health benefits and the employee assistance program (EAP).
Employees should be offered the full support of the firm and the firm’s management during this very personal crisis. If an employee comes forward seeking help, or if a fellow employee recommends help, then the affected employee should be invited to enter the newly developed program without judgment or prejudice. Once the employee enters the program, their progress in meeting the milestones as well as their job performance should be used jointly in determining their overall progress toward managed objectives.
A HiPot/HiPro suffering with an addict at home will be easy to spot – eventually. The success of any proactive intervention is dependent on the early identification of a potential problem. Management should create a list of key early indicators that would trigger a performance-management oriented meeting where family addiction questions can be asked and answered in an environment of trust and mutual empathy as described during the all-hands training. Management should also use formal and informal performance meetings with each employee to probe the area of family addiction while assuring the employee of complete confidence, empathy, and programmatic support.
Ideally, every employee affected by addiction at home would enter the program prior to any signs of significant work-related issues. Unfortunately, there is nothing ideal about addiction. Even the best education and most observant managers will miss early warning signs. Therefore, HR should have a plan in place to provide immediate assistance to a seriously affected employee. EAP is a great generic solution for many run-of-the-mill situations, however, the intensity of emotional disorder associated with addiction is a specialized area where pin-point treatment is required in an urgent timeline. The firm should, if possible, have an arrangement in place with a local resource having experience working with families of opioid addicts. I hate to diss EAP – but too often the providers with availability are not qualified to help a person suffering from PTSD, Major Depressive Disorder, and overwhelming emotions as a result of an addiction at home.
Anonymity is paramount in 12-step programs and rightfully so. However, it is not practical to believe that an employee participating in the addicted family member recovery program will remain anonymous in the office. Therefore, unconditional and empathetic support from all colleagues should be the firm’s overall objective. The more open a corporate culture is in accepting addiction as an illness (like cancer, or heart disease, etc.) the more likely employees will be in coming forward and asking for help. Opioids number one ally when it comes to secretly spreading across our society is the shame and humiliation felt as a result of the “stigma” too many have regarding addiction.
Specialized Professional Addiction Treatment is hard to come by in many of America’s metropolitan areas. Waiting lists for treatment are long and if appointments are available they are often made months in advance. For those in the midst of battling addiction or its ugly outcomes waiting even one week for help could be fatal. Proactive firms should investigate local mental health providers in advance and make arrangements to have affected employees in their offices in less than 10 calendar days. Additionally, HR should keep and maintain a list of 12-step recovery meetings, with names and numbers of willing participants, whom affected employees could call on for immediate and urgent support. Finally, if the addicted family member is still alive, HR should have a list of inpatient and outpatient treatment centers that employees could consider when looking for help for their addicted loved one.
What are some potential outcomes?
The proactive firm that openly accepts and addresses the reality of the drug epidemic unfolding in our society will inevitably derive some competitive advantage over similar firms that have family addiction problems but remain in denial. These advantages span the entire value chain of the firm as the corporate culture improves, productivity is managed, and expenses are controlled and predictable. Here are some potential outcomes to consider in the strategic assessment:
This article is intended to generate discussion on the topic of trauma in the workplace and methods and strategies to address problems associated with having resources who are human.
Best Selling Author, Heroin, Living and Dying with an Addict You Love
Founder, The Sandalwood Wellness Center, LLC