Substance Use Conditions - PowerPoint Presentation

1. Substance Use Conditions and how Employment helps Christopher Moore, BPS, LADAC II, CPRSJohn Burke, BBA, CPRS

2. AgendaSection 1 – Scope of Problem Section 2 - StigmaSection 3 – Substance Use/RecoverySection 4 – Workforce Challenges Substance Use Disorders & How Employment Helps 2

3. IntroductionPresentation will discuss the current scope of substance abuse problems in the workforce, explore existing dynamics that exacerbate commonly encountered issues, and most importantly propose strategies for equipping workforce professionals to navigate the reality of substance use in the workforce effectively ensuring this priority population is best positioned for success. 3

4. Section 1 Scope of Problem

5. Scope of Problem The 2019 National Survey on Drug Use and Health (NSDUH) established that 20.4 million individuals 12 and older experienced some type of Substance Use Disorder and more than 9.5 million have a Co-Occurring disorder which involves both a SUD and mental illness. (Pre-pandemic data) ¹According to the Behavioral Health Impact assessment there are currently 49% of U.S. workers struggling with Alcohol and Substance Abuse. Around 20% report at least weekly usage. 5Of the 49% of workers who reported struggling with some level of addiction, the number of workers reporting lower productivity or missed work because of substance abuse has nearly doubled since 2019 with about one-third (36%) reporting that it has affected their work more since the pandemic began. 5 5

6. Impact of Substance Use Consequences of drug use for the individual often involve severe health problems, disability, and a failure to meet responsibilities at work, school, or home. Substance use is correlated with poverty, unemployment, homelessness, poor health, legal problems, etc. 3 Consequences of drug use for our existing systems (healthcare, labor market, community) – increased burden, crime, & deterioration. Absenteeism, loss of productivity, profit loss - over 49 billion dollars in the workforce. 6Day to day reality – 65% of workers report losing 10+ hours of productivity per week due to mental health issues and 57% report the same for substance abuse. 5 6

7. Generational Impact of Behavioral Health Issues 7

8. Additional Workforce Strains Absences without notification and/or excessive use of sick daysInconsistency/unreliability in keeping appointments and meeting deadlinesIncreased risk for accidents – on and off the job Mistakes attributable to inattention, poor judgement, or bad decisions Confusion or difficulty concentrating; diminished ability to recall details and instructions. Interpersonal conflict with co-workers Shirking of responsibility for errors or oversights Progressive deterioration in personal appearance and hygienePhysical effects of exhaustion, hyperactivity, slurred speech8

9. Section 2 Stigma

10. Stigma Stigma is defined as a set of negative beliefs that a group or society holds about a topic or group of people. Stigmatizing attribute can be any characteristic that conveys a social identity that is devalued in a particular social context. 7Stigma in the workforce is about pre-existing beliefs, attitudes, opinions, assumptions about certain groups of people. Based on previous exposure, attitudes of friends/family, social/religious relationships, media portrayals of people, social systems/structures, & prevailing social and cultural milieu. 4Inevitably personal belief frameworks influence how employers and/or employees perceive and treat colleagues with substance use. These frameworks are the result of one’s life experiences and are developed/shaped by interrelated factors. 4 10

11. Forms of Stigma Public Stigma – collective prejudice and discrimination towards a specific group of individuals Courtesy Stigma – stigma by association, public disapproval as a consequence of affiliation with a stigmatized individual or groupStructural Stigma – refers to policies or institutional actions that restrict; whether intentional or not; the opportunities of targeted groupsSelf Stigma – occurs when a member of a targeted group internalizes a public stereotype or prejudice Complex Stigma – when one identifies with multiple stigmatized groups 11

12. Impact of Stigma Stigma becomes internalized and then is an embedded aspect of how that person views and conducts themselves. Targets of stigma may experience feelings of shame, anger, worthlessness, hopelessness, social exclusion, and marginalization. Impacts mental/emotional/physical health of individual. 4 Stigmatized substance users are assumed as being less trustworthy, lacking competency, possibly dangerous, potentially criminal, no moral conviction, selfish, etc. 7Stigma manifests at work resulting in discrimination in hiring, promotion, accessing full employment benefits, as well as inequity in workplace policies and social interactions. Stigma in the workplace can negatively impact an employee's experience, performance, mental health, and career progression. 412

13. ??? Strong urges and cravings Fatigued, drowsiness, low energy, lethargic Feeling irritable, grouchy, or upset Difficulty concentrating; diminished attention span, brain fog Feeling anxious, sad, and/or depressed Jumpiness and/or restlessPhysical abnormalities – blood pressure, heart palpitationsHunger or increased appetite13

14. Section 3 Substance Use & Recovery

15. Substance Use Disorders Substance use disorders involve a complex interaction between biological, psychological, social, environmental, and spiritual aspect of a person’s life. Negative changes to one of these areas often create consequential changes to other areas of their personhood. 3Substance use disorders occur when the recurrent use of alcohol and/or drugs cause clinically significant impairment, including health problems disability, and failure to meet major responsibilities at work, school, or home. The DSM-5 classifies substance use disorders as mild, moderate, or severe and includes guidelines for clinicians to determine how severe a substance use disorder is depending on the number of symptoms. 4 Categories of Criteria – Impaired Control, Social Problems, Risky Use/Behaviors, & Physical Dependence15

16. Areas of Assessment Taking a substance in larger amounts or for longer than meant toWanting to cut down or stop using the substance but not managing toSpending a lot of time getting, using, or recovering from the use of substanceCravings and urges to use the substance Not managing to do what you should do at work, home, or school because of substance use Continuing to use, even when it causes problems in your relationshipsGiving up important social, occupational, or recreational activities Using substances again and again, even when it puts one in dangerContinuing use, even when knowing it causes physical or psychological problems caused or made worse by substance useNeeding more of the substance to achieve the same effectDevelopment of withdrawal symptoms which can only be relieved by continued use16

17. Substance use – not in a book Treatment for Substance Use disorders – areas of attack are thinking, feeling, & behavior. Presenting problems are more like results/outcomes. What can be observed (behavior) is a result of private internal processes and serves as an indication regarding the need for a deeper exploration of underlying causes and conditions. Behaviors should be understood as avenues of goal accomplishment. Four main functions of behavior – Escape/Avoidance – behaves in order to get out of doing something or experiencing something not desired Attention Seeking – behavior rooted at securing attention from others Seeking Access – behaves in ways in order to get a preferred item or participate in enjoyable activities Sensory Stimulation – behaves in specific ways because it feels good to them. 17

18. RecoverySAMHSA defines recovery as “a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential”. 6Individuals struggling with substance use, as well as those seeking to make positive changes, often lack critical insight into the nature of their problems, knowledge deficits exist related to the causes and conditions surrounding their problems, as well as struggle to see the obvious that may be so apparent to others. The concept of recovery is simply not a black and white construct in which there is a “one size fits all” solution. People are unique and upon unpacking their personal story we generally find their behavior, however undesirable, makes sense. Prevalence of trauma among substance use and mental health is alarming. 18

19. Section 4 Workforce Challenges

20. What Not to DoRigid Policies, extreme reactions, and harmful labeling Making assumptions is an ineffective means of trying to access the truth of a situation Shaming does not work. Criticism and harsh judgement do not motivate change but actually intensify substance use issues. Avoid isolating, excluding, or putting individuals in situations that stigma is reinforced Do not treat them as less than, throw substance use problems in their face, or interact with them in an obviously different manner after learning of substance use issues. Oversimplified solutions and placing unrealistic demands on the struggling individual 20

21. What to do See beyond the problem and keep the person in front of you. Holistic perspective/approach Seek to explore and understand existing factors surrounding substance use. Substance use always serves a functional purpose in user’s lives. Identifying functions allows for effective intervention planning that can decrease problem behaviors and increase appropriate behaviors. Acknowledge the unique needs of the individual – educational, skill development, support, time, etc. Recognize and utilize the ripple effect principle previously discussed – positive change in one area of life impacts other important areas. Change is an ongoing process and always involves a series of progress/setbacks. Utilize mishaps as necessary platforms for learning. Be mindful that recovery looks different for everyone, and the fundamental goal is improved functioning. Although abstinence may be ideal there can be progress related to goal attainment and functional improvement without the cessation of substance use. 21

22. Employment Challenges for substance users Need for developing critical knowledge and coping skills related to the underlying causes surrounding substance use. At-risk history (developmental, familial employment, employment, criminal, loss of parental rights) Unrealistic expectations and attitudes (toward job demands, personal competencies/capabilities, process of change, impulse control, delayed gratification, failure, etc.) History of violence/abuse (domestic, physical, sexual, and psychological abuse) Inadequate social supports (spousal, familial, peer group, community, institutional) Biases/stigma in the workplace, unfavorable work environment, lack of supportive services, lack of knowledgeable professionals 22

23. How it Helps Employment is one of the most widely acknowledged social determinants of health and well-being among the general population. Non-material benefits such as structure, positive social relationships, sense of accomplishment, enhanced esteem, etc. 2Employment is reported as a top life priority by people in recovery. People often can and want to work regardless of where there are within the stages of change model. 6Employment is one of the best predictors of positive outcomes for individuals with SUD. Individuals who are employed compared to those unemployed are more likely to demonstrate – lower rates of recurrence, higher rates of abstinence, less criminal activity, improved quality of life, significantly more positive treatment outcomes. 6A high percentage of substance users have profound levels of untapped potential only unleashed by special people who see beyond the limitations of the struggler and comprehends that what stands in front of them is a real person who is capable of so much more than what they’ve become. Want to know what happens when we look beyond the problem, meaningfully connect with people struggling with substance use, and afford them needed access to sustainability??? 23

24. Life Changing opportunity “Employment has helped me achieve financial goals but more importantly taught me how to interact with co-workers, taught me patience, and I am learning how to not act on impulse but to actually think things through before responding.” 24

25. RecommendationsExplore SAMHSA (Preparing Your Workplace), Society For Human Resource (Employing and Managing Persons with Addictions), Boston Medical Center (Employer Resource Library) Research Employment Interventions – Individual Placement and Support (IPS), Customized Employment Supports (CES), Therapeutic Workplace (TW), and Community Restitution Apprentice-Focused Training (CRAFT) Ensure familiarity with Motivational Interviewing, Harm Reduction, and existing resources related to support for substance use disorders.Create healthy dialogues among leadership related to enhancing the workplace environment towards a more supportive system. 25

26. References 1) 2019 National Survey of Drug Use and Health (NSDUH) Releases. SAMHSA.gov. (2020, September). https://www.samhsa.gov/data/release/2019-national-survey-drug-use-and-health-nsduh-releases. 2) Magura, S., & Marshall, T. (2020). The effectiveness of interventions intended to improve employment outcomes for persons with substance use disorder: An updated systematic review. Taylor & Francis. https://www.tandfonline.com/doi/full/10.1080/10826084.2020.1797810. 3) Richardson, L., & Epp, S. (2016). Substance use disorders, employment and the return to work. Handbooks in Health, Work, and Disability, 667–692. https://doi.org/10.1007/978-1-4899-7627-7_36 4) Roche, A., Kostadinov, V., & Pidd, K. (2019). The stigma of addiction in the workplace. The Stigma of Addiction, 167–199. https://doi.org/10.1007/978-3-030-02580-9_10 26

27. References 5) The Standard . (2020, November). Employee behavioral health is more important than ever. Behavioral Health Impact 2020 . https://www.standard.com/employer/behavioral-health-resource-center. 6) Substance use disorders recovery with a focus on employment and education. SAMHSA. (n.d.). https://www.samhsa.gov/resource/ebp/substance-use-disorders-recovery-focus-employment-education. 7) Wogen, J., & Restrepo, T. (2020). Human Rights, Stigma, and Substance Use. Health and Human Rights Journal . 27