Combating ./llcoholism the Workplace DALE MASI
HEALTH AND SOCIAL WORK,
Vol. 4, No. 4, November 1979
0360-7283/79/0404-0041 $0.50 p 1979 National Association of Social Workers, Inc.
This article describes occupational assistanceemployee assistance programs, which are designed to combat alcoholism in industry. The author, who administers various types of programs, describes the history, conceptual framework, and essentaal ingredients of a successful program. Relevant legislation, as well as implications for social work, is discussed.
P
RESIDENT CARTER'S BUDGET for 1979 was sharply criticized because it reduced funding for human services. Claiming a need to balance the budget, Carter defended his action. It is revealing, however, that when the Department of Health, Education, and Welfare (HEW) allocated its funds, an additional sum of $45 million was appropriated for former Secretary Califano's priorities in alcoholism. Secretary Harris has also recently indicated her support of the initiatives. Of these priorities, two expand the field of occupational alcoholismemployee assistance programs (0A-EAPs). One of these two calls for increased numbers of OA-EAPs in industry, and the second calls for a model OA-EAP to be developed for employees of HEW. Concurrently, the final draft of the five-year plan proposed by the Na-
42
ALCOHOLISM IN THE WORKPLACE
43
tional Institute on Alcohol Abuse and Alcoholism (NIAAA) lists the development of OA-EAPs as its first and main goal. Specifically, NIAAA aims to have 50 percent of the work force covered by such programs by 1984. This article defines OA-EAPs, describes their conceptual framework, discusses their historical development, and provides essential ingredients of programs the author has administered. The author is under contract to staff typical programs for over fifty companies in the Boston area. These programs are located in six different offices and have been in operation for the past six years. The programs emanate from the Boston College Alcohol and Drug Training Project, which is under the aegis of NIAAA. Funding is provided by NIAAA and by host companies. The author, a faculty member of Boston College, directs the projects, and social work students receive field placements in the six offices. At inception, programs are dependent on the staff of the Boston College project for direction. However, the object of the project is for individual programs to become autonomous. Consequently, those programs connected with the Boston College project discussed in this article range along a continuum from dependent to independent. CONCEPTUAL FRAMEWORK Contrary to popular belief most active alcoholics are employed. Consequently, OA-EAPs are designed to reach the problem drinker in the workplace while reducing the costs of poor work performance and absenteeism. Originally called occupational alcoholism programs, the term "employee assistance-employee coun-
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seling program" has gradually become more frequent. For purposes of this article the acronym OA-EAP will be used to designate the programs Rather than training supervisors to look for symptoms of alcoholism, the programs focus primarily on workers' job performance and attendance. Although not all persons having problems with job performance suffer from alcoholism, NIAAA estimates that over 50 percent do. Moreover, the National Council on Alcoholism (NCA) estimates that approximately one out of every ten to thirteen employees, or 8 to 10 percent of the labor force, has a problem with alcohol and that costs to the economy vary from $8 to $15 billion a year, with two-thirds of the loss attributable to absenteeism. 1 Because it is a progressive disease, alcoholism often takes ten to fifteen years before reaching its middle stages and affecting job performance. Frequently, an employee in the middle stages of alcoholism is a valued worker and more often than not occupies a position of responsibility in a supervisory, middle-management, or top-executive category. Therefore, treatment of these employees becomes a matter of importance to a company. Stanford Research Institute, in a study on alcoholism in industry, estimates that by treating workers with a drinking problem industry saven about $6,000 per alcoholic employee per year. 2 More important than costs, though, is the fact that the highest recovery rates for alcoholism are found in programs in offices and factories rather than in clinics or hospitals. This success may be attributable to two points. First, during its middle stage, attempts to detect and treat alcoholism are most successful. Second, job status and income may mean more to many alco-
ALCOHOLISM IN THE WORKPLACE
45
holics than has been realized previously. According to NCA, the average alcoholic will give up his or her family five years before he or she loses a job. 3 Other reasons for the need to treat alcoholic workers in the workplace include the following: n The primary mechanism in alcoholism is denial. The alcoholic will not voluntarily seek help and will continue to deny and cover-up the problem. There needs to be a confrontation, which often precipitates a crisis. The crisis may enhance the individual's motivation "to do" something about the drinking, thereby increasing his or her responsiveness to treatment efforts. Rather than having to "hit bottom," as Alcoholics Anonymous (AA) states, confrontation with a supervisor at work can provide a chance for the worker to obtain treatment before losing his or her job. nThe relationship between the employer and employee provides a legitimate reason for confrontation and intervention when deteriorating job performance is documented since the employee is contracted to perform a specific job. 1f a worker is not performing to capacity, then the employer has a right to take action. nSteady employment often becomes the basis for the denial of problem drinking. Supervisors and others at work are in the important position of perceiving the problem and contributing to its solution since families are often pressured by the stigmas of alcoholism and may be unable to deal with the problem. Management at the workplace can help eradicate the stigma, however, by insisting that the employee obtain help rather than waiting until dismissal is the only answer. 4 Roman recently described the following assumptions for implementing OA-EAPs: 1. Identification by a supervisor of an employee
46
HEALTH AND SOCIAL WORK
who exhibits poor job performance is the most clearcut mechanism for identifying an individual with an underlying drinking problem. 2. Alcoholism should be regarded as a medical problem in the workplace and should be treated as such. 3. Regular disciplinary procedures for poor performance should be suspended while an employee with an identified drinking problem conscientiously seeks assistance. 4. An employee's return to adequate job performance should be the criterion for judging a successful outcome of treatment. 5 In addition, as OA-EAPs have expanded, outreach strategies have been developed for reaching families whenever possible. Because insurance coverage usually includes family members, programs are ready to assist those members of an employee's family who have drinking problems, provided they seek assistance. In addition, OA-EAPs also treat employees whose family contains an active alcoholic. Employees who fall into this category also show problems with job performance. A husband at work may be terribly preoccupied about an alcoholic wife at home with the children. As alcoholism increases among senior citizens, adult children can become preoccupied at work worrying about their parents. Current caseloads reflect these employees who are now seeking help. These people are often referred to as "other victims of alcoholism." At the congressional hearings on "Family Members of Alcoholics" held in 1977, Josie Coutoure, Executive Director of The Other Victims of Alcoholism, estimated that there are four persons directly affected by every alcoholic. These "other vic-
ALCOHOLISM IN THE WORKPLACE
47
tims" frequently use mental health facilities, as well as the services of physicians, to try to cope with the stress of living with an active alcoholic. Recent studies sampling utilization rates of Health Maintenance Organizations by "other victims" show a significant drop in the use of medical and psychiatrie services after the alcoholic family member receives treatment. 6 In the past year, OA-EAPs with the Boston College project have included an intensive alcohol history on all incoming clients and have kept separate statistics for the category "other victims." It is through this means that many of these "other victims" surface. Frequently, these people seek help for nonalcohol-related problems such as marital problems, and they blame themselves for causing problems in the relationship. Skillful interviewing and sensitivity to alcohol problems by staff often uncover a spouse at home who has a long history of alcohol abuse. The "other victim" often denies the reality of the disease, however, and this denial can be as strong as that of the alcoholic. Because there is growing awareness of the needs of "other victims," Congress proposed last year that a considerable portion of NIAAA's budget be allocated for their treatment. The proposal, however, was not passed by the legislators. Several treatment facilities in Europe visited by the author in June 1978 had separate treatment facilities for "other victims." These clients are treated whether the alcoholic comes for treatment or not. Because "other victims" are entering treatment more often and because more interest is being shown in their behalf, it is clear that the disease affects more persons than may have ever been estimated.
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HISTORICAL DEVELOPMENT In the 1940s, Consolidated Edison, Kemper Insurance, Eastman Kodak, and Dupont Corporation started some of the earliest programs to treat alcoholism. Most programs originated in the companies' medical departments. Before implementation of these efforts, dismissal resulted if an employee's alcoholism became intolerable on the job. But despite the demonstrated effectiveness of these programs, with recovery rates as high as 60 to 70 percent, new ones did not immediately proliferate. In 1959, there were only 50 programs in major corporations in the United States. In 1971, the number grew to 300; in 1973, it was 600; and today the number is approximately 2,250. 7 In 1972, in his first Caravan Survey, Roman revealed that 25 percent of the Fortune 500 company executives surveyed indicated that their company had some type of program to identify and provide assistance to employees with drinking problems. 8 Of this group, 51 percent reported that the program enjoyed strong support from top management, 39 percent indicated moderate support, and 10 percent indicated no support. By 1976, in the updated Caravan Survey, Roman reported that the level of management support in those companies with programs had changed significantly: 66 percent of the executives reported strong support, 31 percent indicated moderate support, and only 3 percent reported no support. 9 Undoubtedly, the single factor giving impetus to the concern for alcohol problems was the passage of P.L. 91-616, the Federal Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment, and Rehabilitation Act (the Hughes Act)." Passed by the Ninety-
ALCOHOLISM IN THE WORKPLACE
49
first Congress in 1970 and further amended in 1973, it mandated the following two key provisions that further developed OA-EAPs: n NIAAA established an occupational branch that granted each state $50,000 to fund two occupational program consultants. The responsibility of these consultants is to develop OA-EAPs in the private and public sectors. Most states maintained these positions even after funding ended, and some, such as California and New York, fund over a dozen consultants. The occupational branch also funds demonstration projects. Notable models have been the OA-EAP of the Air Line Pilots Association, the University of Missouri grant for faculty and staff, the AFL-CIO project in Appalachia, and most recently the efforts in organized baseball to reach employees with drinking problems. n Section 201 of P.L. 91-616 mandated the Civil Service Commission to establish an office, now called the Office of Personnel Management, to develop and maintain, in cooperation with the secretary of HEW and other federal agencies, appropriate prevention, treatment, and rehabilitation programs for alcohol tabuse and alcoholism among federal employees. Letter No. 792-4 of the Federal Personnel Manual dated July 7, 1971, required agencies to establish employee assistance programs. The Department of Defense and each of the military services have also mandated such programs for military and civilian employees. In addition, these programs are included as line items in the departments' budgets. Since 1971, the federal government's interest in alcoholism has continuel. In 1973, Congress passed the Rehabilitation Act. Section 504 guarantees the rights of handicapped persons. Since the Attorney General
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defined alcoholism and drug addiction as a handicap, the law gave further impetus to OA-EAPs. In 1976, Attorney General Bell stated that as long as an employee is qualified to hold a position, care must be taken before any removal can take place. Good faith is shown by companies having OA-EAPs. Affirmative action departments charged with monitoring compliance with the mandates of the Rehabilitation Act are now working closely with OA-EAPs. In addition, last year Congress proposed the Hathaway Amendment, which called for all federal contractors with contracts of $2,500 or more to have an occupational alcoholism program for employees. Although the amendment did not pass, it had a fair amount of support and most likely will be proposed again.
INGREDIENTS OF A PROGRAM Generally there are nine specifics that are considered essential parts of OA-EAPs. Since critica' areas such as job performance, referral by supervisor, union involvement, and confidentiality are dealt with, it is important that programs include the following aspects: 1. A written company policy must be available that describes how the company views alcoholism, that is, as a disease. In addition, the procedures for dealing with alcohol abuse in the work setting must be explained. An outline of the policy usually includes a company's basic philosophy and explains the company's willingness to assist employees. The policy specifies time off for hospitalization and includes description of coverage by medical insurance. It also explains the role of the supervisor as the central reference point of the program.
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51
2. Involvement of both labor and management when writing the policy is necessary in the unionized industries. Both must support the policy as well. In the written document, the union's role should be defined, along with the rights of the employee and the function of the union steward. 3. A company-wide educational program must be established so that employees are aware of the company's policy. 4. Training for supervisors must be furnished, including definitions and an explanation of the policy or law in the case of federal employees. During training, role-playing of the confrontation interview is common. Especially useful are the films The Dryden File, produced by Milbauer Corporation, New York, New York, and Alcohol and the Working Woman, produced by Motivational Media, Los Angeles, California. 5. Access to a professional who is capable of interviewing troubled employees as well as diagnosing and appropriately referring them is required. 6. Resources for treatment that will work cooperatively with referrals by professionals are needed. 7. Procedures for compiling records, making reviews, and performing follow-ups must be developed. 8. A clear description of a confidentiality policy that is also enforced must be delineated. 9. An evaluation component of the entire program (not previously included) is becoming more necessary. MODEL PROGRAMS There are different administrative approaches to programs, each with a variety of ramifications. Too often
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companies follow traditional formats and do not experiment for their own setting. The author has found that different companies require different administrative approaches. The following are some examples that she has experienced: In-House Programs. The vast majority of programs are in-house programs administered under the company's auspices by a coordinator with a counseling staff. The programs are housed in either the medical or personnel department. The New England Telephone Company program, one of those working with Boston College, is an example of an in-house program located in the medical department; the Boston College Faculty-Staff Assistance Program is an example of a program housed in the personnel department. Most in-house programs do intake, then refer employees to a treatment program. A few, however, do have in-house counseling. It is the author's opinion that when professionals are employed, on-going counseling can be effective if provided in the work setting. Boston College's programs provide on-going counseling. The programs with on-going counseling also make referrals for certain cases in need of long-term psychotherapy that cannot be undertaken in the work setting. Polaroid Corporation is another company that provides counseling in the workplace. Contraces. If a company does not want to establish a program, it can enter into a contract with a university, a human service provider, or a hospital to provide the program either on the company premises or off. For example, Boston College has a contract with the John F. Kennedy (JFK) Federal Regional Center in Boston to provide OA-EAPs for employees of thirty federal agencies. On-site counseling takes place in the
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53
building itself, and office space is provided by the contractor. Human Affairs, Inc., on the other hand, is an example of an outside contractor that generally provides services off-site. There are pros and cons to both approaches. Serious thought should go into deciding which model should be used. In companies in which confidentiality is a particularly sensitive issue, outside contracting can be more effective. Consortiums. Over 70 percent of Americans work for small companies (defined as less than 1,000 employees). Yet each small company can hardly be expected to support its own OA-EAP staff. Thus, a cooperative approach is needed and can be very useful. Three of the programs affiliated with the Boston College project are consortiums. Each is slightly different and a description of each will show the variations of this arrangement. 1. The JFK Federal Regional Center includes thirty federal agencies. The occupational health consultant is the coordinator of the OA-EAPs for each agency and acts as the liaison between the agencies and the author who is the project director. 2. Taunton EAP, Inc., was formed out of the needs of ten smalt companies, including Rand-McNally, Reed and Barton Silver, a local hospital, a utility company, and a bank, all located in Taunton, Massachusetts, a city 50 miles south of Boston. These companies joined forces to form their program five years ago under the coordination of the Executive Director from the Chamber of Commerce. First, the author met with the presiidents of the various companies and described OAEAPs. Each company signed up for the program and appointed a personnel director as the agent for the
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company. The personnel directors, in turn, formed the Advisory Committee for the program. The staff of the Boston College project works closely with this committee, in particular. Program coordinators from the Boston College project go into each company to train supervisors and to run educational programs. The caseworkers to whom employees are referred work in the local hospita], and all clients are counseled there. 3. The Brockton Consortium in Brockton, Massachusetts, another city outside of Boston and a larger, more populous neighbor of Taunton, was formed by a group of companies that approached both Boston College and the Chamber of Commerce in Taunton seeking to join the Taunton Consortium. In September 1978, a program for eight companies was formed in Brockton, and already the likelihood exists that more companies will be added. Representatives from these companies along with members of Taunton EAP, Inc., now compose the Taunton-Brockton Consortium. The program is housed in the local Catholic Charities office, and this social agency is one of the participating members. At the present time, a planning team of one faculty member and five interns from the Boston College project provides consultation to the cities of Malden and Medford to develop a similar consortium of companies with the chambers of commerce in these cities. Nonprofit Employers. When one thinks of occupational settings, the nonprofit employer is often forgotten. For example, educational institutions are the second largest category of employer in Massachusetts. Hospitals, universities, and social agencies also employ a substantial number of people. OA-EAPs are develop-
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55
ing slowly in hospitals. In the fall of 1977, a group of five planning students was placed in a block field arrangement for four months under the supervision of the author. These students developed a plan for an OAEAP for eight of the Harvard teaching hospitals and schools. Universities generally have moved faster than hospitals in setting up OA-EAPs. For example, each year the program at the University of Missouri hosts a national conference of university OA-EAP administrators. The fourth conference was held during the summer of 1979 and to date more than forty university representatives have been in attendance each year. Rutgers and MIT exemplify two universities having full-time administrators with MSWs in charge of their OA-EAPs. Social agencies, the third type of nonprofit enterprise, are lagging behind the other two in developing programs, but no doubt they will soon start developing such services for employees. Labor Unions. Labor unions have various methods of implementing and administering OA-EAPs. They may administer the program directly, or they may cooperate with management in running the program through a joint labor-management committee. In 1976, 28 percent of the programs in unionized companies were run through the joint endeavor of unions and management.t? Unions generally support a company's OA-EAP, even if the support is only tacit. Leo PerIis, Director of the AFL-CIO Community Services, points out that the AFL-CIO, which represents 14.5 million workers and is associated with 110 national and international unions and more than 60,000 locals, supports OA-EAPs established in plants to deal with employees who experience problem drinking. Per-
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lis gives the following ingredients as composing a good cooperative relationship between unions and management when operating an OA-EAP: 1. Union-management committee on alcoholism. 2. Jointly agreed guidelines on methodology. 3. Training of union and management representatives from top to bottom on jointly agreed policies, programs, and procedures. 4. Provision for keeping alcoholism outside the arena of controversial negotiations whenever possible. 5. The inclusion of procedures for handling alcoholism in the collective bargaining agreement. 6. Provision of insurance coverage for alcoholism as a disease. 7. Protection of job security and seniority. 8. Establishment of counseling and referral procedures. 9. Respect for established grievance and arbitration procedures under the union contract. 10. Concentration on alcoholism. 11. Involvement of both labor and management in community-wide efforts to establish adequate facilities for treatment and recovery of alcoholics."
ISSUES AND DIRECTIONS Any new field brings with it controversy and questions. Treating problem drinkers in the workplace is no exception, and there has been much discussion around OA-EAPs and their approaches. Unions and management have joined forces to help treat employees for alcoholism rather than see jobs lost. Both unions and management also believe that constructive confrontation with an employee is often necessary.
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The author sees several issues confronting workers in this field that need to be addressed immediately. If these issues are not resolved, the development of programs will continue without the involvement or input that can be provided by professionals, particularly social workers. These issues include the following areas: Need for Research and Evaluation. Many of the concepts now used in OA-EAPs should be rigidly tested. New models need to be developed, for example, one new approach for women in OA-EAPs that the author designed." Too often companies use only models designed for someone else's employees rather than develop a specific program of their own. In addition, there is insufficient allowance for evaluation of programs now in operation. Role of Professional vs. Nonprofessional. The recovered alcoholic has traditionally staffed OA-EAPs. Slowly, social workers, educational counselors, and psychologists are moving into these positions. There is much misunderstanding on both sides, and some resolution concerning roles will have to take place. Perhaps this will occur soon since the Association for Labor Management Administrators and Consultants on Alcoholism (ALmAcA ), which is the national organization for occupational alcoholism staff, just elected a social worker to its national presidency. Training. The author thinks that training is the single most important need in the field of occupational alcoholism counseling. Programs will continue to be questioned concerning their professional credentials if staff do not have appropriate education, particularly in the area of alcoholism. There is a need to recruit and train personnel specifically for positions as coordinators and counselors. Also essential, however, is the need
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to develop courses about the workplace covering such topics as industrial relations and personnel management. The field of occupational alcoholism poses many challenges for the social work profession. The special skills of social workers can be brought into the workplace. There should be recognition, however, of the need for special training for social workers in the areas of alcohol, drugs, and the workplace. As more companies set up OA-EAPs, an entirely new client population can be reached. Carvel Taylor, a social worker who directs the OA-EAP at CNA Insurance Company, said that in her first year she saw 500 employees who had never been to a psychiatrist, psychologist, or social worker. What a challenge faces us!
About the Author Dale Masi, DSW, is Director, Employee Counseling Services, U.S. Department of Health, Education, and Welfare, Washington, D.C., and is on an Intergovernmental Personnel Act (IPA) appointment from the Graduate School of Social Work, Boston College, Chestnut Hill, Massachusetts.
Notes and References 1. Patricia Thomas, "Alcoholism Gets a Treatment from Business," Business Insurance, 21 (December 1971), pp. 15-18.
ALCOHOLISM IN THE WORKPLACE
2. Occupational Alcoholism Programs in United States Companies, Report No. 572 (Stanford, Calif.: Stanford
Research Institute, 1976). 3. Thomas, op. cit. 4. R. Smart, "Employed Alcoholics Treated Voluntarily and Under Constructive Coercion: A Follow-up Study," Quarterly Journal on Alcohol Studies, 35 (1974), pp. 196-209. 5. Paul Roman, The Current Status of Occupational Alcoholism Programs: Review and Documentation (New Orleans, La.: Tulane University, 1978), p. 3. 6. Health Maintenance Organizations, study financed by the National Institute on Alcohol Abuse and Alcoholism (Washington, D.C.: U.S. Department of Health, Education & Welfare, 1978). 7. B. Hayward, W. Schleinger, and J. Hallan, Occupational Programming: A Review of the Literature (Raleigh, N.C.: Human Ecology Institute, 1975), p. 5. 8. Paul Roman, "Executives and Problem Drinking," in M. Shafetz, ed., Proceedings of the Third National Conference of the National Institute of Alcohol Abuse and Alcoholism (Washington, D.C.: U.S. Government Printing
Office, 1973). 9. Paul Roman, Occupational Alcoholism Programming in Major American Corporations, the 1976 Executive Caravan Survey (New Orleans, La.: Tulane Center for Monitoring of Occupational Alcoholism Programming, 1977). 10. Roman, Current Status of Occupational Alcoholism Programs, p. 13. 11. Leo Perlis, as quoted in Carol Schromm, Alcoholism and Its Treatment in Industry (Baltimore, Md.: Johns Hopkins University Press, 1977), pp. 71-72. 12. Dale Masi, "The Employed Woman Alcoholic: Her Problem, Solutions and Outreach Strategies," LaborManagement Journal on Alcoholism (March—June 1977).
HEALTH AND SOCIAL WORK,
Vol. 4, No. 4, November 1979
0360-7283/79/0404-0041 $0.50 p 1979 National Association of Social Workers, Inc.
This article describes occupational assistanceemployee assistance programs, which are designed to combat alcoholism in industry. The author, who administers various types of programs, describes the history, conceptual framework, and essentaal ingredients of a successful program. Relevant legislation, as well as implications for social work, is discussed.
P
RESIDENT CARTER'S BUDGET for 1979 was sharply criticized because it reduced funding for human services. Claiming a need to balance the budget, Carter defended his action. It is revealing, however, that when the Department of Health, Education, and Welfare (HEW) allocated its funds, an additional sum of $45 million was appropriated for former Secretary Califano's priorities in alcoholism. Secretary Harris has also recently indicated her support of the initiatives. Of these priorities, two expand the field of occupational alcoholismemployee assistance programs (0A-EAPs). One of these two calls for increased numbers of OA-EAPs in industry, and the second calls for a model OA-EAP to be developed for employees of HEW. Concurrently, the final draft of the five-year plan proposed by the Na-
42
ALCOHOLISM IN THE WORKPLACE
43
tional Institute on Alcohol Abuse and Alcoholism (NIAAA) lists the development of OA-EAPs as its first and main goal. Specifically, NIAAA aims to have 50 percent of the work force covered by such programs by 1984. This article defines OA-EAPs, describes their conceptual framework, discusses their historical development, and provides essential ingredients of programs the author has administered. The author is under contract to staff typical programs for over fifty companies in the Boston area. These programs are located in six different offices and have been in operation for the past six years. The programs emanate from the Boston College Alcohol and Drug Training Project, which is under the aegis of NIAAA. Funding is provided by NIAAA and by host companies. The author, a faculty member of Boston College, directs the projects, and social work students receive field placements in the six offices. At inception, programs are dependent on the staff of the Boston College project for direction. However, the object of the project is for individual programs to become autonomous. Consequently, those programs connected with the Boston College project discussed in this article range along a continuum from dependent to independent. CONCEPTUAL FRAMEWORK Contrary to popular belief most active alcoholics are employed. Consequently, OA-EAPs are designed to reach the problem drinker in the workplace while reducing the costs of poor work performance and absenteeism. Originally called occupational alcoholism programs, the term "employee assistance-employee coun-
44
HEALTH AND SOCIAL WORK
seling program" has gradually become more frequent. For purposes of this article the acronym OA-EAP will be used to designate the programs Rather than training supervisors to look for symptoms of alcoholism, the programs focus primarily on workers' job performance and attendance. Although not all persons having problems with job performance suffer from alcoholism, NIAAA estimates that over 50 percent do. Moreover, the National Council on Alcoholism (NCA) estimates that approximately one out of every ten to thirteen employees, or 8 to 10 percent of the labor force, has a problem with alcohol and that costs to the economy vary from $8 to $15 billion a year, with two-thirds of the loss attributable to absenteeism. 1 Because it is a progressive disease, alcoholism often takes ten to fifteen years before reaching its middle stages and affecting job performance. Frequently, an employee in the middle stages of alcoholism is a valued worker and more often than not occupies a position of responsibility in a supervisory, middle-management, or top-executive category. Therefore, treatment of these employees becomes a matter of importance to a company. Stanford Research Institute, in a study on alcoholism in industry, estimates that by treating workers with a drinking problem industry saven about $6,000 per alcoholic employee per year. 2 More important than costs, though, is the fact that the highest recovery rates for alcoholism are found in programs in offices and factories rather than in clinics or hospitals. This success may be attributable to two points. First, during its middle stage, attempts to detect and treat alcoholism are most successful. Second, job status and income may mean more to many alco-
ALCOHOLISM IN THE WORKPLACE
45
holics than has been realized previously. According to NCA, the average alcoholic will give up his or her family five years before he or she loses a job. 3 Other reasons for the need to treat alcoholic workers in the workplace include the following: n The primary mechanism in alcoholism is denial. The alcoholic will not voluntarily seek help and will continue to deny and cover-up the problem. There needs to be a confrontation, which often precipitates a crisis. The crisis may enhance the individual's motivation "to do" something about the drinking, thereby increasing his or her responsiveness to treatment efforts. Rather than having to "hit bottom," as Alcoholics Anonymous (AA) states, confrontation with a supervisor at work can provide a chance for the worker to obtain treatment before losing his or her job. nThe relationship between the employer and employee provides a legitimate reason for confrontation and intervention when deteriorating job performance is documented since the employee is contracted to perform a specific job. 1f a worker is not performing to capacity, then the employer has a right to take action. nSteady employment often becomes the basis for the denial of problem drinking. Supervisors and others at work are in the important position of perceiving the problem and contributing to its solution since families are often pressured by the stigmas of alcoholism and may be unable to deal with the problem. Management at the workplace can help eradicate the stigma, however, by insisting that the employee obtain help rather than waiting until dismissal is the only answer. 4 Roman recently described the following assumptions for implementing OA-EAPs: 1. Identification by a supervisor of an employee
46
HEALTH AND SOCIAL WORK
who exhibits poor job performance is the most clearcut mechanism for identifying an individual with an underlying drinking problem. 2. Alcoholism should be regarded as a medical problem in the workplace and should be treated as such. 3. Regular disciplinary procedures for poor performance should be suspended while an employee with an identified drinking problem conscientiously seeks assistance. 4. An employee's return to adequate job performance should be the criterion for judging a successful outcome of treatment. 5 In addition, as OA-EAPs have expanded, outreach strategies have been developed for reaching families whenever possible. Because insurance coverage usually includes family members, programs are ready to assist those members of an employee's family who have drinking problems, provided they seek assistance. In addition, OA-EAPs also treat employees whose family contains an active alcoholic. Employees who fall into this category also show problems with job performance. A husband at work may be terribly preoccupied about an alcoholic wife at home with the children. As alcoholism increases among senior citizens, adult children can become preoccupied at work worrying about their parents. Current caseloads reflect these employees who are now seeking help. These people are often referred to as "other victims of alcoholism." At the congressional hearings on "Family Members of Alcoholics" held in 1977, Josie Coutoure, Executive Director of The Other Victims of Alcoholism, estimated that there are four persons directly affected by every alcoholic. These "other vic-
ALCOHOLISM IN THE WORKPLACE
47
tims" frequently use mental health facilities, as well as the services of physicians, to try to cope with the stress of living with an active alcoholic. Recent studies sampling utilization rates of Health Maintenance Organizations by "other victims" show a significant drop in the use of medical and psychiatrie services after the alcoholic family member receives treatment. 6 In the past year, OA-EAPs with the Boston College project have included an intensive alcohol history on all incoming clients and have kept separate statistics for the category "other victims." It is through this means that many of these "other victims" surface. Frequently, these people seek help for nonalcohol-related problems such as marital problems, and they blame themselves for causing problems in the relationship. Skillful interviewing and sensitivity to alcohol problems by staff often uncover a spouse at home who has a long history of alcohol abuse. The "other victim" often denies the reality of the disease, however, and this denial can be as strong as that of the alcoholic. Because there is growing awareness of the needs of "other victims," Congress proposed last year that a considerable portion of NIAAA's budget be allocated for their treatment. The proposal, however, was not passed by the legislators. Several treatment facilities in Europe visited by the author in June 1978 had separate treatment facilities for "other victims." These clients are treated whether the alcoholic comes for treatment or not. Because "other victims" are entering treatment more often and because more interest is being shown in their behalf, it is clear that the disease affects more persons than may have ever been estimated.
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HISTORICAL DEVELOPMENT In the 1940s, Consolidated Edison, Kemper Insurance, Eastman Kodak, and Dupont Corporation started some of the earliest programs to treat alcoholism. Most programs originated in the companies' medical departments. Before implementation of these efforts, dismissal resulted if an employee's alcoholism became intolerable on the job. But despite the demonstrated effectiveness of these programs, with recovery rates as high as 60 to 70 percent, new ones did not immediately proliferate. In 1959, there were only 50 programs in major corporations in the United States. In 1971, the number grew to 300; in 1973, it was 600; and today the number is approximately 2,250. 7 In 1972, in his first Caravan Survey, Roman revealed that 25 percent of the Fortune 500 company executives surveyed indicated that their company had some type of program to identify and provide assistance to employees with drinking problems. 8 Of this group, 51 percent reported that the program enjoyed strong support from top management, 39 percent indicated moderate support, and 10 percent indicated no support. By 1976, in the updated Caravan Survey, Roman reported that the level of management support in those companies with programs had changed significantly: 66 percent of the executives reported strong support, 31 percent indicated moderate support, and only 3 percent reported no support. 9 Undoubtedly, the single factor giving impetus to the concern for alcohol problems was the passage of P.L. 91-616, the Federal Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment, and Rehabilitation Act (the Hughes Act)." Passed by the Ninety-
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first Congress in 1970 and further amended in 1973, it mandated the following two key provisions that further developed OA-EAPs: n NIAAA established an occupational branch that granted each state $50,000 to fund two occupational program consultants. The responsibility of these consultants is to develop OA-EAPs in the private and public sectors. Most states maintained these positions even after funding ended, and some, such as California and New York, fund over a dozen consultants. The occupational branch also funds demonstration projects. Notable models have been the OA-EAP of the Air Line Pilots Association, the University of Missouri grant for faculty and staff, the AFL-CIO project in Appalachia, and most recently the efforts in organized baseball to reach employees with drinking problems. n Section 201 of P.L. 91-616 mandated the Civil Service Commission to establish an office, now called the Office of Personnel Management, to develop and maintain, in cooperation with the secretary of HEW and other federal agencies, appropriate prevention, treatment, and rehabilitation programs for alcohol tabuse and alcoholism among federal employees. Letter No. 792-4 of the Federal Personnel Manual dated July 7, 1971, required agencies to establish employee assistance programs. The Department of Defense and each of the military services have also mandated such programs for military and civilian employees. In addition, these programs are included as line items in the departments' budgets. Since 1971, the federal government's interest in alcoholism has continuel. In 1973, Congress passed the Rehabilitation Act. Section 504 guarantees the rights of handicapped persons. Since the Attorney General
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defined alcoholism and drug addiction as a handicap, the law gave further impetus to OA-EAPs. In 1976, Attorney General Bell stated that as long as an employee is qualified to hold a position, care must be taken before any removal can take place. Good faith is shown by companies having OA-EAPs. Affirmative action departments charged with monitoring compliance with the mandates of the Rehabilitation Act are now working closely with OA-EAPs. In addition, last year Congress proposed the Hathaway Amendment, which called for all federal contractors with contracts of $2,500 or more to have an occupational alcoholism program for employees. Although the amendment did not pass, it had a fair amount of support and most likely will be proposed again.
INGREDIENTS OF A PROGRAM Generally there are nine specifics that are considered essential parts of OA-EAPs. Since critica' areas such as job performance, referral by supervisor, union involvement, and confidentiality are dealt with, it is important that programs include the following aspects: 1. A written company policy must be available that describes how the company views alcoholism, that is, as a disease. In addition, the procedures for dealing with alcohol abuse in the work setting must be explained. An outline of the policy usually includes a company's basic philosophy and explains the company's willingness to assist employees. The policy specifies time off for hospitalization and includes description of coverage by medical insurance. It also explains the role of the supervisor as the central reference point of the program.
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2. Involvement of both labor and management when writing the policy is necessary in the unionized industries. Both must support the policy as well. In the written document, the union's role should be defined, along with the rights of the employee and the function of the union steward. 3. A company-wide educational program must be established so that employees are aware of the company's policy. 4. Training for supervisors must be furnished, including definitions and an explanation of the policy or law in the case of federal employees. During training, role-playing of the confrontation interview is common. Especially useful are the films The Dryden File, produced by Milbauer Corporation, New York, New York, and Alcohol and the Working Woman, produced by Motivational Media, Los Angeles, California. 5. Access to a professional who is capable of interviewing troubled employees as well as diagnosing and appropriately referring them is required. 6. Resources for treatment that will work cooperatively with referrals by professionals are needed. 7. Procedures for compiling records, making reviews, and performing follow-ups must be developed. 8. A clear description of a confidentiality policy that is also enforced must be delineated. 9. An evaluation component of the entire program (not previously included) is becoming more necessary. MODEL PROGRAMS There are different administrative approaches to programs, each with a variety of ramifications. Too often
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companies follow traditional formats and do not experiment for their own setting. The author has found that different companies require different administrative approaches. The following are some examples that she has experienced: In-House Programs. The vast majority of programs are in-house programs administered under the company's auspices by a coordinator with a counseling staff. The programs are housed in either the medical or personnel department. The New England Telephone Company program, one of those working with Boston College, is an example of an in-house program located in the medical department; the Boston College Faculty-Staff Assistance Program is an example of a program housed in the personnel department. Most in-house programs do intake, then refer employees to a treatment program. A few, however, do have in-house counseling. It is the author's opinion that when professionals are employed, on-going counseling can be effective if provided in the work setting. Boston College's programs provide on-going counseling. The programs with on-going counseling also make referrals for certain cases in need of long-term psychotherapy that cannot be undertaken in the work setting. Polaroid Corporation is another company that provides counseling in the workplace. Contraces. If a company does not want to establish a program, it can enter into a contract with a university, a human service provider, or a hospital to provide the program either on the company premises or off. For example, Boston College has a contract with the John F. Kennedy (JFK) Federal Regional Center in Boston to provide OA-EAPs for employees of thirty federal agencies. On-site counseling takes place in the
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building itself, and office space is provided by the contractor. Human Affairs, Inc., on the other hand, is an example of an outside contractor that generally provides services off-site. There are pros and cons to both approaches. Serious thought should go into deciding which model should be used. In companies in which confidentiality is a particularly sensitive issue, outside contracting can be more effective. Consortiums. Over 70 percent of Americans work for small companies (defined as less than 1,000 employees). Yet each small company can hardly be expected to support its own OA-EAP staff. Thus, a cooperative approach is needed and can be very useful. Three of the programs affiliated with the Boston College project are consortiums. Each is slightly different and a description of each will show the variations of this arrangement. 1. The JFK Federal Regional Center includes thirty federal agencies. The occupational health consultant is the coordinator of the OA-EAPs for each agency and acts as the liaison between the agencies and the author who is the project director. 2. Taunton EAP, Inc., was formed out of the needs of ten smalt companies, including Rand-McNally, Reed and Barton Silver, a local hospital, a utility company, and a bank, all located in Taunton, Massachusetts, a city 50 miles south of Boston. These companies joined forces to form their program five years ago under the coordination of the Executive Director from the Chamber of Commerce. First, the author met with the presiidents of the various companies and described OAEAPs. Each company signed up for the program and appointed a personnel director as the agent for the
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company. The personnel directors, in turn, formed the Advisory Committee for the program. The staff of the Boston College project works closely with this committee, in particular. Program coordinators from the Boston College project go into each company to train supervisors and to run educational programs. The caseworkers to whom employees are referred work in the local hospita], and all clients are counseled there. 3. The Brockton Consortium in Brockton, Massachusetts, another city outside of Boston and a larger, more populous neighbor of Taunton, was formed by a group of companies that approached both Boston College and the Chamber of Commerce in Taunton seeking to join the Taunton Consortium. In September 1978, a program for eight companies was formed in Brockton, and already the likelihood exists that more companies will be added. Representatives from these companies along with members of Taunton EAP, Inc., now compose the Taunton-Brockton Consortium. The program is housed in the local Catholic Charities office, and this social agency is one of the participating members. At the present time, a planning team of one faculty member and five interns from the Boston College project provides consultation to the cities of Malden and Medford to develop a similar consortium of companies with the chambers of commerce in these cities. Nonprofit Employers. When one thinks of occupational settings, the nonprofit employer is often forgotten. For example, educational institutions are the second largest category of employer in Massachusetts. Hospitals, universities, and social agencies also employ a substantial number of people. OA-EAPs are develop-
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ing slowly in hospitals. In the fall of 1977, a group of five planning students was placed in a block field arrangement for four months under the supervision of the author. These students developed a plan for an OAEAP for eight of the Harvard teaching hospitals and schools. Universities generally have moved faster than hospitals in setting up OA-EAPs. For example, each year the program at the University of Missouri hosts a national conference of university OA-EAP administrators. The fourth conference was held during the summer of 1979 and to date more than forty university representatives have been in attendance each year. Rutgers and MIT exemplify two universities having full-time administrators with MSWs in charge of their OA-EAPs. Social agencies, the third type of nonprofit enterprise, are lagging behind the other two in developing programs, but no doubt they will soon start developing such services for employees. Labor Unions. Labor unions have various methods of implementing and administering OA-EAPs. They may administer the program directly, or they may cooperate with management in running the program through a joint labor-management committee. In 1976, 28 percent of the programs in unionized companies were run through the joint endeavor of unions and management.t? Unions generally support a company's OA-EAP, even if the support is only tacit. Leo PerIis, Director of the AFL-CIO Community Services, points out that the AFL-CIO, which represents 14.5 million workers and is associated with 110 national and international unions and more than 60,000 locals, supports OA-EAPs established in plants to deal with employees who experience problem drinking. Per-
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lis gives the following ingredients as composing a good cooperative relationship between unions and management when operating an OA-EAP: 1. Union-management committee on alcoholism. 2. Jointly agreed guidelines on methodology. 3. Training of union and management representatives from top to bottom on jointly agreed policies, programs, and procedures. 4. Provision for keeping alcoholism outside the arena of controversial negotiations whenever possible. 5. The inclusion of procedures for handling alcoholism in the collective bargaining agreement. 6. Provision of insurance coverage for alcoholism as a disease. 7. Protection of job security and seniority. 8. Establishment of counseling and referral procedures. 9. Respect for established grievance and arbitration procedures under the union contract. 10. Concentration on alcoholism. 11. Involvement of both labor and management in community-wide efforts to establish adequate facilities for treatment and recovery of alcoholics."
ISSUES AND DIRECTIONS Any new field brings with it controversy and questions. Treating problem drinkers in the workplace is no exception, and there has been much discussion around OA-EAPs and their approaches. Unions and management have joined forces to help treat employees for alcoholism rather than see jobs lost. Both unions and management also believe that constructive confrontation with an employee is often necessary.
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The author sees several issues confronting workers in this field that need to be addressed immediately. If these issues are not resolved, the development of programs will continue without the involvement or input that can be provided by professionals, particularly social workers. These issues include the following areas: Need for Research and Evaluation. Many of the concepts now used in OA-EAPs should be rigidly tested. New models need to be developed, for example, one new approach for women in OA-EAPs that the author designed." Too often companies use only models designed for someone else's employees rather than develop a specific program of their own. In addition, there is insufficient allowance for evaluation of programs now in operation. Role of Professional vs. Nonprofessional. The recovered alcoholic has traditionally staffed OA-EAPs. Slowly, social workers, educational counselors, and psychologists are moving into these positions. There is much misunderstanding on both sides, and some resolution concerning roles will have to take place. Perhaps this will occur soon since the Association for Labor Management Administrators and Consultants on Alcoholism (ALmAcA ), which is the national organization for occupational alcoholism staff, just elected a social worker to its national presidency. Training. The author thinks that training is the single most important need in the field of occupational alcoholism counseling. Programs will continue to be questioned concerning their professional credentials if staff do not have appropriate education, particularly in the area of alcoholism. There is a need to recruit and train personnel specifically for positions as coordinators and counselors. Also essential, however, is the need
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to develop courses about the workplace covering such topics as industrial relations and personnel management. The field of occupational alcoholism poses many challenges for the social work profession. The special skills of social workers can be brought into the workplace. There should be recognition, however, of the need for special training for social workers in the areas of alcohol, drugs, and the workplace. As more companies set up OA-EAPs, an entirely new client population can be reached. Carvel Taylor, a social worker who directs the OA-EAP at CNA Insurance Company, said that in her first year she saw 500 employees who had never been to a psychiatrist, psychologist, or social worker. What a challenge faces us!
About the Author Dale Masi, DSW, is Director, Employee Counseling Services, U.S. Department of Health, Education, and Welfare, Washington, D.C., and is on an Intergovernmental Personnel Act (IPA) appointment from the Graduate School of Social Work, Boston College, Chestnut Hill, Massachusetts.
Notes and References 1. Patricia Thomas, "Alcoholism Gets a Treatment from Business," Business Insurance, 21 (December 1971), pp. 15-18.
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2. Occupational Alcoholism Programs in United States Companies, Report No. 572 (Stanford, Calif.: Stanford
Research Institute, 1976). 3. Thomas, op. cit. 4. R. Smart, "Employed Alcoholics Treated Voluntarily and Under Constructive Coercion: A Follow-up Study," Quarterly Journal on Alcohol Studies, 35 (1974), pp. 196-209. 5. Paul Roman, The Current Status of Occupational Alcoholism Programs: Review and Documentation (New Orleans, La.: Tulane University, 1978), p. 3. 6. Health Maintenance Organizations, study financed by the National Institute on Alcohol Abuse and Alcoholism (Washington, D.C.: U.S. Department of Health, Education & Welfare, 1978). 7. B. Hayward, W. Schleinger, and J. Hallan, Occupational Programming: A Review of the Literature (Raleigh, N.C.: Human Ecology Institute, 1975), p. 5. 8. Paul Roman, "Executives and Problem Drinking," in M. Shafetz, ed., Proceedings of the Third National Conference of the National Institute of Alcohol Abuse and Alcoholism (Washington, D.C.: U.S. Government Printing
Office, 1973). 9. Paul Roman, Occupational Alcoholism Programming in Major American Corporations, the 1976 Executive Caravan Survey (New Orleans, La.: Tulane Center for Monitoring of Occupational Alcoholism Programming, 1977). 10. Roman, Current Status of Occupational Alcoholism Programs, p. 13. 11. Leo Perlis, as quoted in Carol Schromm, Alcoholism and Its Treatment in Industry (Baltimore, Md.: Johns Hopkins University Press, 1977), pp. 71-72. 12. Dale Masi, "The Employed Woman Alcoholic: Her Problem, Solutions and Outreach Strategies," LaborManagement Journal on Alcoholism (March—June 1977).
