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Working on Addiction in the Workplace

Home » Harvard Health Blog » Working on addiction in the workplace – Harvard Health Blog POSTED JUNE 30, 2017, 6:45 AM , UPDATED JULY 26, 2017, 9:42 AM
John F. Kelly, PhD, Contributor

When unaddressed, alcohol and other drug use disorders in the workplace are costly and dangerous for organizations, as well as individuals. There are many good examples of successful programs and resources available that can help, and with over 22 million Americans currently in recovery from alcohol and other drug use disorders, creating a drug-free workplace is entirely possible.

More than 70% of individuals with alcohol or illicit drug use continue to maintain employment, as many employees with alcohol or other drug problems can continue to remain “functioning.” Companies and organizations can no longer ignore the realities and repercussions of alcohol and other drugs in the workplace.

“Functioning” employees are costly in many ways

Addiction costs American businesses and organizations an average of $81 billion in lost profits every year. This is due to losses in productivity, high turnover rates, theft in the workplace, increases in absenteeism, utilization of sick time, and decreases in quality of work. Out of the 70% of employees that engage in substance use and maintain employment, over 42% report feeling a decrease in productivity as a result. Although job losses directly related to alcohol or other drug use are usually associated with more persistent and severe levels of substance use disorders, the use of these substances negatively impacts individual job attendance and performance long before lob loss occurs.

In addition, alcohol and other drug use increases the number of occupational injuries and fatalities, and affects the health and well-being of the employees. In emergency room visits for workplace related injuries, breathalyzer tests detected alcohol in 16% of cases. Over 10% of workplace fatalities involve alcohol. A subtler but just as important effect is the lethargy and short-term residual cognitive impairments that can follow a night of heavy drinking. This can increase the risk of injury for employees and their colleagues.

Beyond detriment to the bottom line of the organization and the health of employees, alcohol and other drug use can affect the attitudes and culture of an organization, lower morale, and decrease motivation, engagement, and trust.

Steps toward a drug-free work environment

There are many ways in which employers can create a drug-free work environment. Employers can educate themselves and employees on not only identifying the signs and symptoms of alcohol and drug use, but also the necessary steps to take when one suspects that a coworker may need help. Through education and clear drug-free workplace policies, employers can aim to increase awareness and clarify expectations.

Developing an employee drug testing program is another way to help create a drug-free work environment. Currently, over 50% of organizations require pre-employment drug screenings for all new hires, especially in high-risk industries such as mining, construction, and public safety. State laws generally allow organizations to randomly drug test employees once hired, however states have varying rules regarding these practices.

Employee Assistance Programs (EAPs) have been found to be highly effective resources for addressing addiction issues, but many organizations, especially smaller ones, do not have these programs available. EAP programs work to encourage and support addiction treatment and recovery through confidential assessments, short-term counseling, and resource referrals.

And it is worth it

Treatment for addiction, facilitated within or by the workplace, has been shown to be successful in increasing employees’ legal, mental, and social functioning, as well as decreasing absenteeism rates, workplace conflict, and productivity problems upon return from treatment. Investing in employee treatment yields high returns, with an estimated gain of 23% among employees with an income of $45,000 per year or an estimated gain of 64% for employees earning $60,000 per year.

With this ever-growing public health crisis, more and more lives are being affected both inside and outside of the workplace. Organizational involvement is now more important than ever. This involvement by employers is rapidly transforming to be less about punishing employee misconduct, and more focused on finding creative ways to provide education and resources for employees, to support them in seeking out lifesaving treatment for themselves or a loved one. Taking steps to address addiction is truly an opportunity to humanize the workplace and help reduce suffering and avoid painful, sometimes deadly, consequences.



Fentanyl: The Dangers Of This Potent “Man-Made” Opioid

As we watch the devastation of the opioid crisis escalate in a rising tide of deaths, a lesser known substance is frequently mentioned: fentanyl. Fentanyl’s relative obscurity was shattered with the well-publicized overdose death of pop star Prince. Previously used only as a pharmaceutical painkiller for crippling pain at the end of life or for surgical procedures, fentanyl is now making headlines as the drug responsible for a growing proportion of overdose deaths.

So what is fentanyl and why is it so dangerous?

Fentanyl is a synthetic opioid, meaning it is made in a laboratory but acts on the same receptors in the brain that painkillers, like oxycodone or morphine, and heroin, do. Fentanyl, however, is far more powerful. It’s 50-100 times stronger than heroin or morphine, meaning even a small dosage can be deadly.

Its potency also means that it is profitable for dealers as well as dangerous for those who use it, intentionally or unintentionally. Increasingly heroin is being mixed with fentanyl so someone who uses what they think is heroin may in fact be getting a mixture with — or even pure — fentanyl. More recently, pills made to look like the painkiller oxycodone or the anxiety medication Xanax are actually fentanyl. This deception is proving fatal. It would be like ordering a glass of wine and instead getting a lethal dose of pure ethanol. While many people don’t know they are getting fentanyl, others might unfortunately seek it out as part of the way the brain disease of addiction manifests itself into compulsively seeking the next powerful high.

Helping people who use fentanyl

The way to help patients who are using fentanyl is the same as for other forms of opioid use disorder: to provide effective addiction treatment. However, the first and most important step is helping patients stay safe and stay alive until we can get them that treatment.

It’s worth remembering that dead people don’t recover.

To stop the deaths, we must provide immediate access to lifesaving treatment on demand. While any opioid use is risky, fentanyl has raised the stakes. Every single episode of fentanyl use carries the risk of immediate death. This highlights the need to change how we think about treatment. Many of the traditional models of addiction treatment were designed for alcohol use disorder. Misuse of alcohol can be fatal, but it usually takes many years or even decades to kill someone. In contrast, opioid addiction is imminently fatal, so waiting for treatment is and should be considered unacceptable. We must try to initiate treatment at every opportunity — in the emergency department, at the hospital bed, or even on the street. The best evidence we have shows that a combination of medication and psychosocial treatments is most effective for opioid use disorder. A study of MassHealth patients found that patients on medication treatments like methadone or buprenorphine are 50% less likely to relapse. Other studies have shown that patients treated with these medications are 50% (or more) less likely to die. And yet significant stigma and misunderstanding still exists around these medications. We have treatment programs (and doctors) that don’t offer these medications and patients who are doing wonderfully in recovery thanks to them, but who are also scared to speak out and say they are on medication because the stigma is so pervasive.

Even with our best efforts, it can take time for some people to be open to treatment. In those cases, our priority is to keep them alive and to keep working with them on their readiness to consider treatment. This requires access to naloxone, the antidote to overdoses. But it also includes other education and harm reduction services. People who have loved ones who are actively using and those who are using themselves need to know how to stay safe. There is very concrete education that can reduce the risk of overdose and we need to ensure it is getting to those at the greatest risk.

Moving forward

In Massachusetts alone, deaths due to fentanyl overdose have risen to 57% between 2015 and the first half of 2016. These deaths are yet another symptom of the broader epidemic of opioid addiction. Just as deaths from AIDS are due to untreated HIV, deaths from overdose are frequently due to untreated addiction. Prince’s death is a reminder that opioid addiction is a disease that can and does affect people from all economic classes and all walks of life.

Featured Image: New Hampshire State Police Forensic Lab


Home » Harvard Health Blog » Fentanyl: The dangers of this potent “man-made” opioid – Harvard Health Blog, Sarah Wakeman, MD, FASAM, Medical Director, Massachusetts General Hospital Substance Use Disorder Initiative, Contributor

Is Addiction a “Brain Disease?”

There are many good reasons to emphasize the biological underpinnings of substance use disorders. Perhaps most important, the biologic basis of this chronic disease is a strong argument for parity: that is, treating (and funding treatment for) addiction on par with other “biologic” diseases.

The stigma and shame of addiction has much to do with the perception that people with substance use disorders are weak, immoral, or simply out for a good time at society’s expense. Understanding that addiction impairs the brain in many important ways may reduce such stigma. What’s more, the specific type of brain dysfunction may help identify a range of effective interventions and preventions. For example, during adolescence, the brain is at its most plastic — and vulnerable. This is a time when caution and intervention may prove most valuable. The earlier the drug exposure or trauma to the brain, the greater the damage.


Women usually welcome news that the gender gap in pay or leadership positions is closing. But lately we’ve been learning that women are also gaining parity in another respect: alcohol consumption. A new study from researchers at the National Institutes of Health indicates that the rate of drinking in general, and binge drinking in particular, is rising faster among women ages 60 or older than among their male contemporaries.

When the researchers analyzed data from National Health Interview Surveys from 1997 through 2014, they found that the proportion of older women drinkers increased at a rate of 1.6% a year, compared with 0.7% for older men. Binge drinking (defined as imbibing four or more drinks within two hours) increased by 3.7% annually among older women, but held steady among older men. The results were reported online March 24, 2017, by Alcoholism: Clinical and Experimental Research.


Breaking Free From Addiction

COVER STORYBreaking free from addiction

By one of the later relapses, Sheff, a journalist, had already begun researching a book about addiction and had interviewed some of the world’s leading experts on the biology of addiction and treatment.

“I was frantic,” he says. “I called the guy who knows more about meth than anyone in the world, and I asked him ‘Where can I send my son?’ And he had no idea. He was stunned. He asked colleagues, other researchers, and they didn’t know either.”

Sheff did find a treatment program for his son, but not through his scientist contacts — he found it through a friend, another father with an addicted child.


What is Suboxone and how does it work?

big-bottle-suboxone-addiction-treatment-1140x640Suboxone, a combination medication containing buprenorphine and naloxone, is one of the main medications used for medication-assisted therapy (MAT) for opiate addiction. Use of MATs has been shown to lower the risk of fatal overdoses by approximately 50%. Suboxone works by tightly binding to the same receptors in the brain as other opiates, such as heroin, morphine, and oxycodone. By doing so, it blunts intoxication with these other drugs, it prevents cravings, and it allows many people to transition back from a life of addiction to a life of relative normalcy and safety.

A key goal of many advocates is to make access to Suboxone much more widely available, so that people who are addicted to opiates can readily access it. Good places to start are in the emergency department and in the primary care doctor’s office. More doctors need to become “waivered” to prescribe this medication, which requires some training and a special license. The vast majority of physicians, addiction experts, and advocates agree: Suboxone saves lives.

Common myths about using Suboxone to treat addiction

Unfortunately, within the addiction community and among the public at large, certain myths about Suboxone persist, and these myths add a further barrier to treatment for people suffering from opiate addiction.



Recently, Massachusetts Governor Charlie Baker introduced “An Act Relative to Combatting Addiction, Accessing Treatment, Reducing Prescriptions, and Enhancing Prevention” (CARE Act) as part of a larger legislative package to tackle the state’s opioid crisis. The proposal would expand on the state’s existing involuntary commitment law, building on an already deeply-troubled system. Baker’s proposal is part of a misguided national trend to use involuntary commitment or other coercive treatment mechanisms to address the country’s opioid crisis.

The CARE Act and involuntary hold

Right now, Section 35 of Massachusetts General Law chapter 123 authorizes the state to involuntarily commit someone with an alcohol or substance use disorder for up to 90 days. The legal standards and procedures for commitment are broad; a police officer, physician, or family member of an individual whose substance use presents the “likelihood of serious harm” can petition the court.


By Veronica Emilia Nuzzolo, M.Ed., Ph.D.

Understanding The Self-Defeating Personality

Self-defeating personalities display consistent patterns of detrimental behavior resulting in problematic situations and failed relationships.

self destruct

Artist Unknown, saved from Google Images

These personalities create disappointing environments, become stagnant, and fail to accomplish important life goals. These individuals lack self-esteem, self-awareness, and self-acceptance. They are riddled with guilt and shame, and according to the definition of personality disorder, do have maladaptive processing methods that create problematic patterns of relating, perceiving and behaving. Their behavior does create problems in their daily lives, in their personal relationships, (preferring to stay and suffer in a bad relationship, rather than move forward in a healthy one, or to be alone,) and their off-putting behavior does diminish their ability to function in society. Social interaction is a significant component of any healthy relationship and is imperative when trying to establish relationships at a deeper level. The self-defeating personality, the consummate victim will be a people pleaser, will attempt to be optimistic, will attempt to lovingly commit, and then will wholeheartedly invest in sabotage.  Their inability to love or even like themselves often leads to inappropriate choices and related conditions such as substance abuse, eating disorders, and gambling addictions, making any healthy relationship impossible.


Perfectly Imperfect

By Veronica Emilia Nuzzolo,  M.Ed., Ph.D.perfect

The humanistic perspective of psychology is the work of Carl Rogers and Abraham Maslow and focuses on the relationship of the individual to society (social), considers the ways in which people view themselves in relation to others (interpersonal), and considers how one see’s his or her place in the world (growth potential). (more…)

Leadership Through Crisis

By Veronica Emilia Nuzzolo, MBA, MAOP

Organizations experience times of crisis.  During a crisis situation leadership is expected to guide and continue to move the organization forward.  The expectations of  leaders change during a crisis. (more…)

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