Holiday, Economic Stress Create Climate for Substance Abuse

By: Diane E. Lewis, Globe Staff, 12/8/02

It started with a glass of chardonnay.

Soon, said Ann Sweeney, she was drinking bottles of wine. Increasingly disgruntled, she isolated herself from her family until, months later, her husband gave her an ultimatum: Quit drinking or lose your family.

Sweeney, who asked that her real first name not be used, got help. Two years ago, after completing a four-day detoxification program at Faulkner Hospital in Jamaica Plain, she checked into the Center for Women's Recovery at the Hanley-Hazelden Center in West Palm Beach, Fla.

''When my husband said get help or I am taking the kids, it destroyed my world as I knew it,'' recalled Sweeney, a registered nurse in Boston. ''But the amazing thing is that it also forced me to recreate my life. It helped me look at the effect alcohol was having.''

Twenty million of the nation's 107 million workers abuse drugs or alcohol, according to the US Department of Labor. The holidays and an ongoing economic downturn could cause those numbers to rise, especially among the unemployed, say specialists.

''When companies cut back, workers feel more pressured and their drinking or drug use increases,'' said psychologist Bruce Cedar, president of CMG Associates in Newton. ''The temptation to drink or use drugs is even greater during the holiday season because of stress.''

For employers, the costs of substance abuse are staggering. This year, for example, US companies will lose an estimated $242 billion due to lower productivity, absenteeism, and accidents stemming from addictions, reports the National Institutes of Health.

With the holidays approaching, some workplace consultants are advising that companies take a closer look at policies governing conduct at office parties. Mindful that a free-flowing bar can loosen inhibitions, others plan to distribute ''chits'' in return for drinks in an effort to limit alcohol consumption, said CMG's Cedar.

Maggie Pinkham, general counsel and vice president of Associated Industries of Massachusetts, which represents 7,500 companies, said AIM is suggesting that members get to know ''the subtle signs'' of substance abuse. These signs include absenteeism, moodiness, irrational behavior or flashes of anger.

''Sometimes it is the very quiet employee that you have to worry about,'' said Pinkham. ''That person could be keeping everything bottled up inside. Because of the economy, he may be wondering, 'Am I going to be laid off?' So, we are telling management to be prepared to have open communications with people, even if it's bad news. Give them an 800-number for them to call and talk to someone. Arm them with resources.''

At the same time, awareness of workplace policies regarding substance abuse is fairly high. More than 76 percent of full-time workers age 18 to 49 knew their employer had a written policy, according to a 2000 survey by the Substance Abuse and Mental Health Services Administration. Workers in government, transportation, communications, public utilities, and manufacturing reported the highest rates of awareness.

Having a supervisor who understood her alcohol addiction helped Donna Corrente, now director of women's services at Hanley-Hazelden. ''When I quit 23 years ago, I found the holidays difficult, but I was fortunate. My supervisor did not pressure me into going to holiday parties. So, I stayed away,'' she said.

Others may require more support from a structured inpatient treatment program. Although 40 percent of those who complete such programs remain sober or off drugs for at least a year after treatment, long inpatient stays are becoming rare. In fact, Sweeney was luckier than most: her employers' insurance plan paid for 28 days of her four-month inpatient treatment. Today, employee insurance plans are less likely to pick up the tab than they were 15 years ago. Instead, many employers favor short-term programs, and some are imposing time limits.

Currently, 68 percent of US employers offer employee assistance programs (EAPs) that link workers to a range of benefits, including counseling. By contrast, 31 percent offer rehabilitation services, according to the Society for Human Resource Management in Alexandria, Va.

''The insurance world has changed the way we treat addictions at the worksite,'' said Dr. Harry Sobel of Sobel & Raciti Associates, which provides EAP services to 70 New England companies. ''The approach has gone from long-term inpatient to short-term detoxification programs followed by outpatient counseling and Alcoholics Anonymous. Most managed care behavioral health programs do not authorize long-term stays.''

Some big, self-insured companies are still offering up to 30 days inpatient treatment for chemical dependencies, with caps, according to Dr. Paul Wernick, a consultant at Watson Wyatt Worldwide in Minneapolis. ''Some are saying 30 inpatient days per lifetime or per year,'' he said. ''Outpatient services are now about 30 visits per year.''

''Companies are migrating away from stated periods of recovery,'' noted Raymond Werntz, president of the Consumer Health Education Council at the Employee Benefit Research Institute. ''They are more concerned about solving problems than artificial boundaries. This is not an area where one size fits all.''

But some say the changes are having a negative impact on workers. They maintain that more workers are likely to relapse or slip through the cracks, especially during a recession when corporate restructurings can lead to longer hours and increased responsibilities and firms are more likely to outsource behavioral services.

''Historically, EAPs were able to help large numbers of people get into recovery and there were decreases in interpersonal problems as a result,'' said Kenneth R. Collins, president of Kenneth R. Collins & Associates in Orinda, Calif., which evaluates behavioral health services and employee assistance programs. ''Now, people are not being identified to the extent that they were in the past, and they are less likely to be authorized for residential day treatment.''

Collins, in a study of 75 EAP programs, found an overall utilization rate of 7 percent at companies with on-site programs. By contrast, the average utilization rate for firms with off-site programs was just 4.5 percent.

Sweeney, 47, says she could not have recovered in a few weeks. She says her time away helped her confront emotional issues that had led to her addiction. Sweeney is still working for the same hospital, which encouraged her to take time off.

''One of the things that made my recovery successful is that I did have time to recover,'' she said. "It made a difference. For the first time, I was able to focus on myself.''

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