A new initiative, known as the BIG (Brief Intervention Group) Initiative is bringing employee assistance programs together to intensify the fight against alcohol abuse in the workplace.
Although EAPs have their roots identifying and supporting workers with alcohol problems, it's estimated that they currently engage only about one out of every 20 seriously impaired workers.
Alcohol problems cause lost productivity, absenteeism, and excess emergency department and hospital use by those that are not engaged by EAPs - the other 19 out of 20 workers - adding $61 billion to the nation's health care bill per year.
While the workplace remains a logical focal point for help, since approximately 77% of individuals with a substance use disorder are employed, new efforts will be brought to bear to identify employees in trouble and bring them recovery resources.
The BIG Initiative involves all of the major national EAPs, most of the leading regional EAPs, more than 16 internal EAPs run by Fortune 500 companies, business groups (including the National Business Group on Health and the Partnership for Workplace Mental Health), EAP professional associations (EAPA, EASNA, Center for Clinical Social Work), and leading EAP consultants and researchers.
"Although we can compete for contracts, we share a commitment and a passion around the concept of EAP as a workplace-focused early intervention program that supports employers by providing early prevention for their employees that improves productivity and safety" explains Dennis Derr, Ed.D. SPHR, director EAP at Aetna Behavioral Health. "The BIG Initiative is about raising awareness and knowledge levels that if [brief intervention] is done properly, it has outstanding results. It is about creating a buzz, creating an understanding that this is something that needs to be a standard practice, and that's why the people were brought together to share ideas."
The work is underwritten by a grant to George Washington University from the National Highway Traffic Administration and the Center for Substance Abuse Treatment. The Institute for Healthcare Improvement-style campaign aims to make screening for alcohol problems and brief, immediate counseling the routine practice of the EAP industry in the U.S. and Canada within one year.
When employees abuse drugs or alcohol, they are three-and-a-half times more likely to be involved in a workplace accident, resulting in increased workers' compensation and disability claims, cite George Washington University researchers.
Further, one in five workers reports being injured or put in danger on the job because of a colleague's drinking, or having to work harder, redo work or cover for a co-worker as a result of a fellow employee's drinking.
Adult workers with substance abuse problems also miss more work, an average of 45% more days per year, than employees without a substance use disorder. They are also more likely to jump from job to job.
They seek emergency room attention 25% more often than their peers. In addition, they have health care costs more than twice that of the rest of the population.
The good news is that more employers are implementing EAPs to deal with alcohol-related problems among their employee population. In the past 15 years, the proportion of businesses with EAPs has more than doubled, from about 33% in 1995 to 75% in 2009, according to Society for Human Resource Management surveys. Still, these may not be sufficient in dealing with such a pervasive and complex problem.
"Alcohol- and substance-related problems present a clear threat to employers in terms of productivity loss, safety, employee engagement, use of supervisory time and health care costs," says John Pompe, manager of disability and behavioral health programs, Caterpillar Inc.
"The problem is that most employees with substance abuse problems go unrecognized and even more go untreated.Most employee assistance programs, which employers think are addressing this problem, do a very poor job of case-finding for alcohol and drug problems.In most instances, unless someone calls the EAP specifically to request alcohol or drug treatment, substance abuse problems will go unnoticed," he adds.
This is where the leaders of BIG Initiative believe they can help by asking one to three simple questions when an individual calls into an EAP hotline. "We have found that by simply asking alcohol consumption questions, we get gains of 500%-600% in the rates of people who the EAPs are identifying," says Eric Goplerud, Ph.D., Center for Integrated Behavioral Health Policy, Department of Health Policy, George Washington University Medical Center.
"With those simple questions, EAPs are identifying people that are at a much higher risk of having health complications or work, family or social complications. EAPs don't diagnose, they focus on solving problems," he says.
When employing screening and brief intervention in primary care situations, they found that this strategy reduces emergency department and hospital visits substantially, and it reduces cost by 15% per month after screening and brief intervention.
In emergency departments it reduces the likelihood of re-entry by 50%. For every nine brief interventions (which last approximately five to 15 minutes), the program reduced by one the number of DWI arrests in the year following the brief intervention.
According to Goplerud, research has discovered that alcohol screening and brief intervention is "the 4th most cost-effective preventive intervention that can be done in primary care, so what we're doing is adapting that to EAPs," he says.
"The bottom line for me is that mental health and substance abuse problems are common and present a significant cost burden to employers. These illnesses can seriously impact the lives of employees, who typically do not get the care they need. More so, purchasing an off-the-shelf EAP may not result in the benefits we hope for," says Pompe. "Employers who have not given consideration to the impact of mental health and substance abuse issues on their business are simply letting money sit on the table. Unfortunately, in too many cases, these problems don't remedy themselves over time. Employees may not spontaneously recover in the long-term. We also know that the health care system is not adequately addressing these complex health issues and the productivity impact that can follow. So a thoughtful behavioral health strategy needs to be a part of any HR, occupational medicine or benefits strategy. Small efforts and little money can actually go a long way," he concludes.
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