Does Treatment Work?

(Summer 2016 [updated Fall 2019]) The rate of positive workplace tests has increased six years in a row and is at its highest rate since 2004. However, since many employers don’t test for some of the most widely abused drugs (i.e., prescription painkillers) and not all workers are tested, the actual number of employees who are currently misusing substances is likely grossly underreported.

Not just numbers on a report, this phenomenon causes a direct hardship for employers trying to fill and maintain positions. The resounding “can’t find enough workers who can pass pre-employment tests,” cry can be heard from employers throughout Ohio and beyond.

Additionally, evidence-based science on addiction has shed new light on the employability of individuals who have misused substances or who have been diagnosed with a substance use disorder. Fueled by the workforce crunch and this new understanding, many employers want help transforming their drug-free workplace (DFWP) program into a drug-responsible program. For example, what should be considered when responding to positive tests:

• Should we maintain a zero-tolerance policy even though it might mean we are short-staffed, lose people who we’ve invested time and energy in training, or who have critically needed and specialized skills?
• Do we offer second or “fair” chances – sending employees for substance use assessments and, if needed, treatment and allow them to return to work once cleared?
• What are the safety, productivity, financial and liability implications of firing or referring?
• How much responsibility can, or should, we take to not “pass a druggy” along to other businesses in the community and instead support a good employee experiencing substance misuse?

At the root of many of these discussions are two questions, “Is substance use disorder preventable?” and “Does treatment work?”

The majority of people who test positive at work do not have a substance use disorder.  But they could possibly develop one.  So, requiring individuals who test positive to get a medical assessment and holding them accountable for behavior that prevents them from developing a substance use disorder, is easily manageable.

But to understand that treatment for employees with a substance use disorder can work, it’s important to acknowledge that addiction is a “chronic, relapsing brain disorder characterized by compulsive drug seeking and use despite harmful consequences. It is considered a brain disease because drugs change the brain; they change its structure and how it works.” (National Institute of Drug Abuse [NIDA]).  This makes the disease of addiction similar to heart disease, diabetes and cancer.

So does treatment work? Yes. But there are considerations and variables behind this answer that are more complex than a simple “yes” or “no,” not unlike complex issues related to the treatment of other types of behavioral-related diseases.

Does treatment for heart disease, for example, work? It depends on several variables:

• How far has the disease progressed?
• Does the treatment match the patient’s type and severity of heart disease?
• Is the medical provider adequate?
• Are the best and most up-to-date treatment methods being utilized?
• Is the patient willing and able to follow through with their part of the treatment plan – like losing weight and exercising more?

This line-up of questions is directly transferable to discussing treatment for the disease of addiction.

And just as there are definite factors that influence the success (or failure) of treatment for both heart disease and addiction, it’s also important to recognize that the measures of “success” must be realistic and appropriate for each disease.

Because we know neither addiction nor heart disease can be cured, the first goal of treatment is to manage the symptoms. In the case of addiction, the drug use and any related withdrawal symptoms need to stop. When the symptoms are under control, then treatment shifts to addressing the medical, physiological and behavioral changes that will put the disease into remission.

Treatment continues for a lifetime, with the goal of maintaining long extended periods of remission.  A patient with heart disease will always have to manage his/her blood pressure and the treatment regime may include medication, surgery and certain lifestyle changes. The life-long treatment for addiction could include counseling, self-help groups and/or medication.

Realistically, with any chronic illness, symptoms may reappear after periods of remission.  Patients might relapse. The person being treated for heart disease might experience chest pains. The person being treated for addiction might experience an urge to use – and even succumb to that urge. But that doesn’t mean treatment doesn’t work.

According to the National Institute of Health, relapse rates between drug addiction and other chronic illnesses are similar.

NIDA indicates, “The chronic nature of the disease (addiction) means that relapsing to drug abuse is not only possible, but likely, with relapse rates similar to those for other well-characterized chronic medical illnesses such as diabetes, hypertension, and asthma, which also have both physiological and behavioral components. Treatment of chronic diseases involves changing deeply imbedded behaviors, and relapse does not mean treatment failure. For the addicted patient, lapses back to drug abuse indicate that treatment needs to be reinstated or adjusted, or that alternate treatment is needed.”

Where does that leave the employer whose deciding whether it makes business sense to send an employee for help versus terminating after a positive test? It’s important to understand substance misuse treatment and acknowledge the possibility of relapse. It’s also vital that the needs of the employer are met; that is, to have a workforce free from the effects of alcohol and other drugs to maintain a safe and productive workplace.

First of all, an employer should recognize their sphere of influence, i.e., what they can do to influence the success of treatment. Not all treatment is alike. If an employer refers an employee for a substance abuse assessment and, if needed, treatment, the counselor to whom they refer must be proficient. For example, the counselor must

• Have access to a variety of evidence-based treatment modalities including individual and group counseling, education, self-help groups, medication and supportive services (e.g., transportation, childcare, housing).
• Help the person quit and teach strategies for preventing future relapse.
• Be culturally sensitive to the employee in terms of gender, age, race or ethnicity, sexual identification.
• Facilitate change around four dimensions that, according to research, support a life in recovery:
  1. Health – not using alcohol and other drugs
  2. Home – having a safe and stable place to live
  3. Purpose – having meaningful daily activities, such as employment
  4. Community – having health and supportive relationships

Employers should not assume every counselor is proficient in treating substance abuse and should insist that the counselor holds licenses and credentials specific to the treatment of addiction.

There are other things employers can do to increase the likelihood that treatment will be successful:

• Train supervisors to intervene early. They are not doing the addict any favor by ignoring substance abuse-related symptoms like poor work performance. It’s doubtful they’d ignore signs of a heart attack.
• Treat addiction like a medical condition and lean on the expertise of professionals. Keep morals and character out of it.
• Hold employees accountable to assistance or participation agreements.
• Administer return-to-duty and follow-up testing consistently and according to counselor recommendations.
• Use employee education as a method of preventing problems from occurring.

When pondering whether or not treatment “works,” remember that it’s easy to see evidence of relapse — the employee misses work, gets arrested for DUI or possession, acts erratically and can be difficult to live or work around. But someone effectively managing their disease – the addict who is in remission – looks like every other healthy, functioning adult. They are appropriately caring for children, paying their bills on time, maintaining healthy relationships, attending community functions, and functioning as productive and valuable employees.