Online Help for Employees with SUDs

Imagine discovering that your very small business is losing $70,000 a year. Would you want to fix it?

Obviously the answer is “Yes,” but most businesses ignore this specific leak until it becomes so terrible that everyone recognizes it. Are we talking about theft? No, we’re talking about drug and alcohol use among employees.

In the US alone, substance use costs employers about $160 billion per year through lost productivity, increased health care costs, absenteeism, and accidents (Goplerud et al., 2017). That’s between $2,700 and $13,500 per employee on average, depending on the specific job sector and considering that employees who struggle with both drugs and alcohol cost even more.

The problem is that, historically, identifying and helping those who struggle with these issues has been incredibly difficult and expensive. An average treatment episode in the US costs $10,000 (French et al., 2008) and success rates are so low that many individuals have to enter treatment multiple times to truly address their issue long term (Kelly et al., 2019), and that’s if those people are even willing to commit to treatment, which only 10 percent do (SAMHSA, 2021). For an employer, the added stress and conflict, monetary costs (even with insurance coverage), and loss of productivity make it simpler to ignore the problem until an employee becomes so dysfunctional as to require being terminated. However, employers then have to deal with the cost of training new staff and the loss of all that unique experience and knowledge.

For these reasons, employers have been stuck between a rock and a hard place: they ignore the problem and hope it goes away, or confront it and face the costs and disruption to the business. But technology is promising to change this equation forever and provide some much-needed relief—both to employers and employees for whom alcohol and drugs are a struggle—by providing affordable, easy-to-access solutions that are both effective and efficient. Let’s dive in deeper.

Treatment Options

Traditionally, getting help for alcohol and drug issues requires treatment. This treatment usually comes in two forms: intensive outpatient treatment or inpatient treatment. Inpatient treatment is the classic model we are all familiar with from movies and TV shows, and it involves thirty to ninety days in a residential or hospital setting with around-the-clock help and support. It’s effective at putting a stop to drinking or using for many while they’re receiving treatment and helps about 30 percent of individuals achieve a single year of abstinence (Ilgen et al., 2005; Suter et al., 2011). The problem is that inpatient treatment is incredibly expensive and disruptive to employment, costing as much as $90,000 or more per month (Lopez, 2019) and taking an employee away fully for as long as they are engaged in a program.

Intensive outpatient treatment is another option, with average cost as low as $1,200 per month (Lopez, 2019), and this option only slightly disrupts an employee’s ability to engage at work as it requires twelve to fifteen hours of commitment per week. However, some programs only offer daytime hours, and the added burden of receiving this help, even in the evening, certainly cuts into the ability to be fully present at work. Completion rates within these programs are substantially lower than during residential treatment (Elsheikh, 2007), but long-term abstinence is only slightly lower per year, at least for less severe alcohol use disorder cases (Bottlender & Soyka, 2005a, 2005b).

No matter their limitations, these programs have been the primary sources of help to date for those who struggle with alcohol or drugs, putting employers in a difficult position. They either have to pay the high price and lose their employee for an extended period with slightly better odds of success, or reduce the cost somewhat and allow the employee to participate partially but also lose some of the effectiveness and odds of success.

Now a new option has entered the fray: remote, online help for alcohol and drug use issues. While these options were available before 2020, the COVID-19 pandemic pushed remote solutions of all sorts to the forefront and the field of addiction is no different.

Unlike traditional recovery, remote recovery solutions can be accessed from anywhere at any time. This cuts down on work-related disruptions because employees can self-determine the best time frame for them to access the help. Additionally, the cost and logistical arrangements for technology-based solutions in the addiction space are substantially lower than those of traditional help, with a month of care costing as little as $20 and as much as $1,000 depending on the level of care and individual attention (“Find lifelong,” 2022). However, cost and convenience are far from the only advantages.

Alcohol and drug use treatment research has long revealed that long-term engagement in treatment is a primary predictor of success (Stark, 1992; Turner & Deane, 2016; Proctor & Herschman, 2014). Unfortunately, given the monetary and logistical complexities and limitations of traditional treatment, both patients and employers were hamstrung when it came time to create longer treatment occasions. It is very difficult for an employer to lose an employee for months, let alone a year or more. With remote, technology-enabled help, this is no longer an issue. Employees can stay involved for months or years with very efficient cost and time requirements in place. Additionally, engagement can be measured in real time and tied to performance assessments to encourage employee participation. This means more effective help with less real-world interference.

The Shame Issue

Finally, there is the coup de grâce of tech-enabled help: the shame involved in alcohol and drug issues. Let’s face it, employees don’t want to reveal they struggle and no employer wants to confront employees on these issues. Nevertheless, when high cost and obvious disruptions to work are part and parcel of the solution, it seems inevitable that people will try to avoid being identified at any cost. Indeed, research I conducted in 2011 revealed that, for approximately 50 percent of those who struggle with drugs and alcohol, shame was a primary reason for not pursuing professional help (Rapp et al., 2006). Participants in this research told us they wanted to handle the problem on their own, they didn’t want to share it with others, and they were embarrassed and ashamed of it.

Historically, there wasn’t much that could be done about this. But when employees can privately log into a system from a laptop, tablet, or phone—and keep the video camera off, maintaining anonymity to receive the help they need without having to speak to a supervisor or HR representative—an incredible thing happens: people actually reach out for help.

I have seen this over and over; people who have historically been reluctant to seek help become emboldened to try something they know won’t require them to “out” themselves. As they gain trust in their helpers, their Zoom videos come on and as they get better the shame washes away. Within months, they function better and are involved in a community while drinking less and feeling more hopeful and content. Since the help is flexible and doesn’t require much from them logistically, they engage more when it’s needed and less when it’s not.

Conclusion

This new approach for addiction help will never fully replace the traditional model. Instead, it will allow inpatient and intensive outpatient providers to focus on the clients that are best served by those models (i.e., patients who need stabilization or live in environments that provide high risk and/or instability). In the meantime, remote and tech-enabled care will be able to help the millions who are able to remain functional in the real-world, allowing them to address their issues without leaving their jobs or greatly affecting their employment.

Let’s run some numbers based on the example I mentioned at the beginning of this article. For the small business presented earlier, with ten employees struggling with drugs and alcohol and costing the business an average of $70,000 per year, the shift is meaningful. Not only will the business owner save money, but almost no productivity will be lost from those ten employees, allowing them to improve their quality of life while retaining their jobs. That’s a win-win for everyone!

References

• Bottlender, M., & Soyka, M. (2005a). Efficacy of an intensive outpatient rehabilitation program in alcoholism: Predictors of outcome six months after treatment. European Addiction Research, 11(3), 132–7.
• Bottlender, M., & Soyka, M. (2005b). Outpatient alcoholism treatment: Predictors of outcome after three years. Drug and Alcohol Dependence, 80(1), 83–9.
• Elsheikh, S. (2007). Factors affecting long-term abstinence from substance use. International Journal of Mental Health and Addiction, 6(3), 306–15.
• “Find lifelong freedom from addiction with IGNTD.” Retrieved from: https://www.igntd.com/
• French, M. T., Popovici, I., & Tapsell, L. (2008). The economic costs of substance abuse treatment: Updated estimates and cost bands for program assessment and reimbursement. Journal of Substance Abuse Treatment, 35(4), 462–9.
• Goplerud, E., Hodge, S., & Benham, T. (2017). A substance use cost calculator for US employers with an emphasis on prescription pain medication misuse. Journal of Occupational and Environmental Medicine, 59(11), 1063–71.
• Ilgen, M., McKellar, J., & Tiet, Q. (2005). Abstinence self-efficacy and abstinence one year after substance use disorder treatment. Journal of Consulting and Clinical Psychology, 73(6), 1175–80.
• Kelly, J. F., Greene, M. C., Bergman, B. G., White, W. L., & Hoeppner, B. B. (2019). How many recovery attempts does it take to successfully resolve an alcohol or drug problem? Estimates and correlates from a national study of recovering US adults. Alcoholism: Clinical and Experimental Research, 43(7), 1533–44.
• Lopez, G. (2019). The rehab racket: Investigating the high cost of addiction care. Vox. Retrieved from https://www.vox.com/2019/9/6/20853284/drug-addiction-treatment-rehab-cost-vox
• Proctor, S. L., & Herschman, P. L. (2014). The continuing care model of substance use treatment: What works, and when is “enough,” “enough”? Psychiatry Journal, 2014, 692423.
• Rapp, R. C., Xu, J., Carr, C. A., Lane, D. T., Wang, J., & Carlson, R. (2006). Treatment barriers identified by substance abusers assessed at a centralized intake unit. Journal of Substance Abuse Treatment, 30(3), 227–35.
• Stark, M. J. (1992). Dropping out of substance abuse treatment: A clinically oriented review. Clinical Psychology Review, 12(1), 93–116.
• Substance Abuse and Mental Health Services Administration (SAMHSA). (2021). Key substance use and mental health indicators in the United States: Results from the 2020 National Survey On Drug Use And Health. Retrieved from https://www.samhsa.gov/data/sites/default/files/reports/rpt35325/NSDUHFFRPDFWHTMLFiles2020/2020NSDUHFFR1PDFW102121.pdf
• Suter, M., Strik, W., & Moggi, F. (2011). Depressive symptoms as a predictor of alcohol relapse after residential treatment programs for alcohol use disorder. Journal of Substance Abuse Treatment, 41(3), 225–32.
• Turner, B., & Deane, F. P. (2016). Length of stay as a predictor of reliable change in psychological recovery and well-being following residential substance abuse treatment. Therapeutic Communities, 37(3), 112–20.

Adi Jaffe

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Adi Jaffe, PhD, is a world-renowned expert on mental health, addiction, relationships, and shame. He was a lecturer in the psychology department at UCLA for the better part of a decade and was the executive director and cofounder of one of the most progressive mental health treatment facilities in the country until he started IGNTD, a smart, personalized, adaptive recovery system. Dr. Jaffe’s work and research focuses on changing the way people think about and deal with mental health issues. He is passionate about reducing the role of shame in destroying lives and aims to greatly reduce the stigma of mental health in this country.

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