The Journal of Primary Prevention, Vol. 15, No. 2, 1994
Primary Prevention and the Workplace Judith R. Vicary, Ph.D. 1,2
For many years the workplace has been a major setting in which help is provided for employees with alcohol and drug abuse problems. Historically these efforts have focused on intervention and treatment--secondary and tertiary programming. Now it is time for primary prevention to be included to a much greater degree. From early AA groups organized by fellow workers to the National Institute on Alcoholism and Alcohol Abuse (NIAAA) and its occupational alcoholism programs in every state, the business world has for many years provided resources to intervene with employees and their substance abuse; it has become increasingly recognized that alcohol and other drug use behaviors are costly, in both economic and human terms, to a company, its customers and its employees in general. Another important milestone has been the development of employee assistance programs (EAPs), which train supervisors to document and confront employees' work performance and direct them to consultation, assessment and help through a company or union sponsored EAP. In more recent years, this approach has become "broadbrush," that is, it encompasses a range of often interrelated problems affecting an employee's work productivity. These can include family and marital problems, mental health issues, gambling, and various other disorders, as well as substance abuse. Traditionally EAPs focused on intervention and treatment. A few companies included some primary prevention activities, but the development of the health promotion and wellness movement, as well as escalating health care costs, have spurred a focus on primary prevention. Drug and alcohol abuse prevention grew as a field in the 1970's and 1980's, but the target audience was primarily youth. However, it became 1College of Health and Human Development, Penn State University. 2Address correspondence to Dr. Judith R. Vicary, S-152 Henderson Bldg., Penn State University, University Park, PA 16802. 99 9 1994 Human SciencesPress,Inc.
100
Vicary
obvious that many of these youngsters grew up and took their substance attitudes and behaviors regarding alcohol and other drugs with them to the workplace, a fact that underscores the need for all levels of prevention to be included in corporate programming; hence the development of expanded EAPs and health promotion (HP) or wellness services. Although there are a number of models of service provision, it is clear that primary prevention is now an integral part of many EAPs as well as HPs, with educational programs and materials playing a central role. It is important to recognize that, while education is one major focus, there is a great deal more than can, and is, being done by businesses to prevent the onset or development of alcohol and other drug problems for employees, their families, and their communities. Some of these activities are specifically directed at substance abuse, such as seminars on "Drug Education for Parents," while others are more generic in their focus, e.g., support and coaching for youth sport teams. In workplace programs, as in the total field of prevention itself, there is no absolute line between prevention, intervention and treatment activities. In a historical public health perspective, prevention is seen as a continuum of care, from preventing a problem before it starts (primary) to early intervention when the problem develops (secondary), to treatment for an established problem (tertiary). Interestingly, the same activities may have a multiple or overlapping effect, depending on the audience being reached. For example, a supervisor's confrontation of an employee's chronic absenteeism and tardiness may serve a tertiary function in getting that person into treatment, while the spouse receives secondary prevention help, before his or her dysfunctional reactions are well developed, e.g., poor parenting or health problems. At the same time, primary prevention may be carried out to assist the children in the family, getting them both to understand their parents' problems and behaviors, and to get involved in positive activities and behaviors, an approach that may even prevent their becoming substance abusers later in life. This multifaceted approach suggests a more interactive and overlapping model of prevention. In Figure 1 below, primary prevention is shown specifically affecting and relating to all stages of a total prevention effort. At each stage of substance use and abuse primary prevention can and should be initiated, with the recognition that many such activities and programs will address several levels of the problem simultaneously. For example, a health promotion program may help an individual in an ongoing, follow-up post treatment plan while other program participants may be the focus of primary prevention efforts aimed at averting possible health problems.
101
Primary Prevention and the Workplace Fig. 1 C O N T I N U U M O F P R O B L E M B E H A V I O R - SUBSTANCE A B U S E BEFORE BEHAVIOR BEGINS
I
EARLY STAGES
INTERVENTIONASSESSMENT
TREATMENT- FOLLOW-UP RE-ENTRY ON-GOING
IS E C O N D A R Y P R E V E N T I O N I
[TERTIARY P R E V E N T I O N ]
PRIMARY PREVENTION
]
Professionals working in the substance abuse field have traditionally been identified, and funded, as prevention or treatment personnel, although their responsibilities often encompassed both categories. However, it is apparent that primary prevention should take place at all stages in addressing substance abuse or a range of other problem behaviors, and programming is changing to more accurately reflect this. Prevention deals with three types of causes, that is, predisposing, enabling, and reinforcing factors. For example, the knowledge, attitudes, beliefs and values which are included in predisposing factors may all be affected by well designed school-based educational prevention programs, as well as by family efforts to instill knowledge and values about alcohol and other drug use. The availability of personal or community-based skills and resources, or the lack of these, can, respectively, reduce or support enabling factors. Research has shown that enhancing personal skill development and building community opportunities and resources, for example, helps to reduce risk and to strengthen protective or resiliency factors. Finally, reinforcing factors can include social or physical benefits, whether perceived or real, actual or intangible, of substance use or non-use. Peer acceptance of not using drugs, or social norms that validate "don't drink and drive" messages, are examples of positive social reinforcement. Alcohol and other drug abuse prevention has, in expanding its focus beyond youth, included in its target audiences the family, the peer group (friends), school or work colleagues, and the community at large. In addition, the strategies of prevention have been enlarged. The methodologies of primary prevention, in going beyond information and educational approaches, now include social and life skills training; positive alternatives; norms and standards; and community mobilization. Each of these approaches can be used with all of the audiences listed above. And, most
102
Vicary
01
~
Z
0
0
0 0 ~-
O~
0
eq
Z
z
Z
o
Z
~
~
~
Primary Prevention and the Workplace
103
importantly, prevention is no longer the sole responsibility of the schools. Prevention is appropriate--and necessary--for all age groups, and should be developmentally planned for each audience. Research has shown that a consistent message, repeated over time, in multiple settings---that is, a comprehensive approach--is most successful. To that end, the worksite is a necessary and critical arena in which to nurture prevention programming. Each of the categories of prevention strategies can be accomplished through business, industry and labor efforts, in addition to school, church and agency programs (Figure 2). For example, a Human Resources or Personnel Department, in offering courses in communications skills, or managerial training, is providing life skills training. Companies often sponsor employee sports teams or health club memberships, excellent examples of positive alternatives. When these include youth sports activities family members also benefit; if the teams are open to any youth, the audience is expanded to the community level. At the corporate level, a written substance abuse policy communicated to all employees serves to set norms and standards for behavior, affecting workers on both an individual and work setting level. Finally, for community mobilization, the Center for Substance Abuse Prevention community partnerships, for example, are developing neighborhood- or areawide coalitions. These groups include business representation, and activities sponsored by or conducted through the workplace. While employees and their families benefit, so too does the community at large. Many companies have initiated programs for local schools, where employees serve as tutors or mentors. In some cases youth employment opportunities have also been developed. Community mobilization has also been used to clean up playgrounds and parks, sponsor alcohol-free community events or conduct anti-drug media campaigns. In summary, it is clear that the workplace, through the efforts of business, industry and labor groups, in concert with community-based prevention organizations, can be an important partner in primary prevention efforts. The challenge is for the prevention field to join with employee assistance and health promotion practitioners, as well as other professional groups, in developing the support and programming for this important sector of our communities. There is a place and a need for all these groups to get involved and work together in primary prevention.
Primary Prevention and the Workplace Judith R. Vicary, Ph.D. 1,2
For many years the workplace has been a major setting in which help is provided for employees with alcohol and drug abuse problems. Historically these efforts have focused on intervention and treatment--secondary and tertiary programming. Now it is time for primary prevention to be included to a much greater degree. From early AA groups organized by fellow workers to the National Institute on Alcoholism and Alcohol Abuse (NIAAA) and its occupational alcoholism programs in every state, the business world has for many years provided resources to intervene with employees and their substance abuse; it has become increasingly recognized that alcohol and other drug use behaviors are costly, in both economic and human terms, to a company, its customers and its employees in general. Another important milestone has been the development of employee assistance programs (EAPs), which train supervisors to document and confront employees' work performance and direct them to consultation, assessment and help through a company or union sponsored EAP. In more recent years, this approach has become "broadbrush," that is, it encompasses a range of often interrelated problems affecting an employee's work productivity. These can include family and marital problems, mental health issues, gambling, and various other disorders, as well as substance abuse. Traditionally EAPs focused on intervention and treatment. A few companies included some primary prevention activities, but the development of the health promotion and wellness movement, as well as escalating health care costs, have spurred a focus on primary prevention. Drug and alcohol abuse prevention grew as a field in the 1970's and 1980's, but the target audience was primarily youth. However, it became 1College of Health and Human Development, Penn State University. 2Address correspondence to Dr. Judith R. Vicary, S-152 Henderson Bldg., Penn State University, University Park, PA 16802. 99 9 1994 Human SciencesPress,Inc.
100
Vicary
obvious that many of these youngsters grew up and took their substance attitudes and behaviors regarding alcohol and other drugs with them to the workplace, a fact that underscores the need for all levels of prevention to be included in corporate programming; hence the development of expanded EAPs and health promotion (HP) or wellness services. Although there are a number of models of service provision, it is clear that primary prevention is now an integral part of many EAPs as well as HPs, with educational programs and materials playing a central role. It is important to recognize that, while education is one major focus, there is a great deal more than can, and is, being done by businesses to prevent the onset or development of alcohol and other drug problems for employees, their families, and their communities. Some of these activities are specifically directed at substance abuse, such as seminars on "Drug Education for Parents," while others are more generic in their focus, e.g., support and coaching for youth sport teams. In workplace programs, as in the total field of prevention itself, there is no absolute line between prevention, intervention and treatment activities. In a historical public health perspective, prevention is seen as a continuum of care, from preventing a problem before it starts (primary) to early intervention when the problem develops (secondary), to treatment for an established problem (tertiary). Interestingly, the same activities may have a multiple or overlapping effect, depending on the audience being reached. For example, a supervisor's confrontation of an employee's chronic absenteeism and tardiness may serve a tertiary function in getting that person into treatment, while the spouse receives secondary prevention help, before his or her dysfunctional reactions are well developed, e.g., poor parenting or health problems. At the same time, primary prevention may be carried out to assist the children in the family, getting them both to understand their parents' problems and behaviors, and to get involved in positive activities and behaviors, an approach that may even prevent their becoming substance abusers later in life. This multifaceted approach suggests a more interactive and overlapping model of prevention. In Figure 1 below, primary prevention is shown specifically affecting and relating to all stages of a total prevention effort. At each stage of substance use and abuse primary prevention can and should be initiated, with the recognition that many such activities and programs will address several levels of the problem simultaneously. For example, a health promotion program may help an individual in an ongoing, follow-up post treatment plan while other program participants may be the focus of primary prevention efforts aimed at averting possible health problems.
101
Primary Prevention and the Workplace Fig. 1 C O N T I N U U M O F P R O B L E M B E H A V I O R - SUBSTANCE A B U S E BEFORE BEHAVIOR BEGINS
I
EARLY STAGES
INTERVENTIONASSESSMENT
TREATMENT- FOLLOW-UP RE-ENTRY ON-GOING
IS E C O N D A R Y P R E V E N T I O N I
[TERTIARY P R E V E N T I O N ]
PRIMARY PREVENTION
]
Professionals working in the substance abuse field have traditionally been identified, and funded, as prevention or treatment personnel, although their responsibilities often encompassed both categories. However, it is apparent that primary prevention should take place at all stages in addressing substance abuse or a range of other problem behaviors, and programming is changing to more accurately reflect this. Prevention deals with three types of causes, that is, predisposing, enabling, and reinforcing factors. For example, the knowledge, attitudes, beliefs and values which are included in predisposing factors may all be affected by well designed school-based educational prevention programs, as well as by family efforts to instill knowledge and values about alcohol and other drug use. The availability of personal or community-based skills and resources, or the lack of these, can, respectively, reduce or support enabling factors. Research has shown that enhancing personal skill development and building community opportunities and resources, for example, helps to reduce risk and to strengthen protective or resiliency factors. Finally, reinforcing factors can include social or physical benefits, whether perceived or real, actual or intangible, of substance use or non-use. Peer acceptance of not using drugs, or social norms that validate "don't drink and drive" messages, are examples of positive social reinforcement. Alcohol and other drug abuse prevention has, in expanding its focus beyond youth, included in its target audiences the family, the peer group (friends), school or work colleagues, and the community at large. In addition, the strategies of prevention have been enlarged. The methodologies of primary prevention, in going beyond information and educational approaches, now include social and life skills training; positive alternatives; norms and standards; and community mobilization. Each of these approaches can be used with all of the audiences listed above. And, most
102
Vicary
01
~
Z
0
0
0 0 ~-
O~
0
eq
Z
z
Z
o
Z
~
~
~
Primary Prevention and the Workplace
103
importantly, prevention is no longer the sole responsibility of the schools. Prevention is appropriate--and necessary--for all age groups, and should be developmentally planned for each audience. Research has shown that a consistent message, repeated over time, in multiple settings---that is, a comprehensive approach--is most successful. To that end, the worksite is a necessary and critical arena in which to nurture prevention programming. Each of the categories of prevention strategies can be accomplished through business, industry and labor efforts, in addition to school, church and agency programs (Figure 2). For example, a Human Resources or Personnel Department, in offering courses in communications skills, or managerial training, is providing life skills training. Companies often sponsor employee sports teams or health club memberships, excellent examples of positive alternatives. When these include youth sports activities family members also benefit; if the teams are open to any youth, the audience is expanded to the community level. At the corporate level, a written substance abuse policy communicated to all employees serves to set norms and standards for behavior, affecting workers on both an individual and work setting level. Finally, for community mobilization, the Center for Substance Abuse Prevention community partnerships, for example, are developing neighborhood- or areawide coalitions. These groups include business representation, and activities sponsored by or conducted through the workplace. While employees and their families benefit, so too does the community at large. Many companies have initiated programs for local schools, where employees serve as tutors or mentors. In some cases youth employment opportunities have also been developed. Community mobilization has also been used to clean up playgrounds and parks, sponsor alcohol-free community events or conduct anti-drug media campaigns. In summary, it is clear that the workplace, through the efforts of business, industry and labor groups, in concert with community-based prevention organizations, can be an important partner in primary prevention efforts. The challenge is for the prevention field to join with employee assistance and health promotion practitioners, as well as other professional groups, in developing the support and programming for this important sector of our communities. There is a place and a need for all these groups to get involved and work together in primary prevention.
