SAP services: a natural extension of EAPs: providing substance abuse professional services can make EA professionals better aware of the trends and treatments in the substance abuse area and increase their value to employers and employees alike.

The provision of substance abuse professional (SAP) services is an ideal growth opportunity for a "best practice" employee assistance program. SAP services are, after all, a natural extension of what our profession has been doing since its inception (with some modifications).

Long before drug-testing legislation had even been considered by federal and state legislatures, employers had identified substance abuse as a workplace issue and established EAPs to address it. Prior to World War II, businesses like Ford Motor Company had begun to focus on the negative effects of alcohol abuse on family life and workplace productivity During the war, as worker shortages developed, employers sought outside assistance (e.g., the Yale Plan for Business and Industry, a forerunner of EAPs) to further address the impact of alcohol on personal and work lives. Later, as more workplaces became unionized and EAPs began to proliferate, termination ceased being the preferred method for addressing declining work performance stemming from alcoholism. More recently, the rise of Alcoholics Anonymous and other 12-step programs, treatment centers, and social welfare programs influenced the development of a new perspective on alcohol abuse, one that emphasizes recovery and return to work.

As these developments progressed, EAPs established themselves as work place substance abuse experts and began to partner with key organizational players. These partnerships have enabled EAPs to exert significant influence on workers' health and wellness, workplace productivity, and business costs, all of which are inextricably linked. Having evolved from "helpers" performing one-to-one counseling in the background to sitting at the boardroom table where policy decisions are made, we are now in a pivotal position to educate employers about sound practices that affect what most of them agree is their most valuable resource--their employees.

INHERENT LIABILITY

About 75 percent of substance abusers are employed, and employers are painfully aware of both the obvious and hidden costs of their behaviors--increased absenteeism, lower productivity, higher accident rates, greater utilization of sick leave, and so on. Health care providers estimate that anywhere from 20 to 40 percent of all general hospital admissions can trace their complications to an untreated addiction, significantly contributing to the escalating costs of health care footed (largely) by employers.

It is well documented that EAPs can help lower these costs, both by identifying substance abuse early and by improving treatment outcomes. Positive treatment outcomes facilitated by EAPs have been reported by firms such as Gillette, Ramada, Warner, Marsh and McLennan, Tropicana, Southern Edison, and Sawyer Gas. Employers consistently document at least a 3:1 return for every dollar invested in an EAP, and it is this ratio and similar outcomes that support and promote our role as productivity experts in the workplace.

Assuming the role of an SAP can position an EAP to provide an even better return on an employer's investment and broaden the professional expertise of an EA practitioner, but it's a challenging task that entails new risks and responsibilities. Although EAPs are ideally positioned to assume the additional responsibilities of SAP work, they should do so only with a clear understanding of the differences between EA and SAP functions and the inherent liability in blending the two. The EA professional historically has had a clearly defined role, the basis of which is the confidential, therapeutic relationship with the employee. With the assumption of the SAP role, however, that relationship is subject to different constraints and responsibilities.

The U.S. Department of Transportation's regulations pertaining to drug and alcohol testing of employees in the transportation industry couldn't be more clear about this. As a substance abuse professional, you are an advocate for neither the employer nor the employee. Your function is to protect the public interest in safety by professionally evaluating the employee and recommending appropriate education/treatment, follow-up tests, and aftercare.

In the traditional employee assistance role, a recommendation for treatment is based on whether the employee's presenting symptoms meet diagnostic criteria for abuse or dependence. In the SAP role, however, there may be overriding safety concerns that warrant a recommendation for treatment even if the standard diagnostic criteria for abuse or dependence are not fully met.

To fulfill the role of a SAP, the EA professional must thoroughly understand 49 CFR (Code of Federal Regulations) Part 40, the federal roles governing drug and alcohol testing of employees in the transportation industry, and particularly the subparts relevant to the role of the SAP. The initial implementation of DOT rules did not require that SAPs be trained, but the rules revisions that took effect in August 2001 now require extensive training, the successful completion of an exam, and the acquisition of 12 continuing education units (CEUs) every three years to maintain eligibility to perform SAP/DOT work.

TASKS THAT ENTAIL RISKS

Our firm's internal EAP experience with second-chance agreements spans 15 years. Because of our understanding of the supports that are in place, the contract requirement, and our role, we achieve an 80 percent success rate of retaining employees referred for alcohol/drug policy violations. We have a clear understanding that the safety of everyone in our company (in the health care field) is the foremost consideration and that a drug-free workplace is ultimately in the best interest of all patients, employees, and visitors. This understanding has created a win-win situation for all and applies to the provision of SAP services to other employers.

Administrators of more risk-adverse EAPs will contend that the liability concerns are too great to provide SAP services, but we submit that our daily work is loaded with tasks that entail risk. EA professionals commonly find themselves making decisions when conducting ADA (Americans with Disabilities Act), child and elder abuse, and violent risk assessments. Additionally, we conduct critical incident stress debriefings and advise companies in the aftermath of threats and trauma.

Much of the liability risks facing EAPs conducting SAP work stems from the EA professional's failure to fully understand the SAP'S role. For example, the EA professional who misunderstands the Department of Transportation's return-to-duty process might easily be drawn into conducting a fitness-for-duty evaluation, but doing so goes beyond the SAP'S role as specified in the DOT rules and increases liability risk. DOT regulations require the employer to determine whether the employee should be returned to the job. SAPs can minimize their liability by basing their recommendations on the employee's compliance with the prescribed treatment plan and by avoiding speculation about the prognosis for continued recovery.

Not surprisingly, we've found that the term "substance abuse professional" is used quite loosely In addition to those who have taken the training and passed the qualifying exam, there are many people functioning as "non-DOT" SAPs. People in this role perform similar functions in that they assess presenting symptoms, make recommendations for further services, conduct case management duties, and generate plans for ongoing, unannounced testing.

The employees they're working with, however, may or may not perform safety-sensitive duties and are not in positions affected by DOT regulations. Their employer typically is enforcing a drug-free workplace policy which mandates that an employee who tests positive be assessed by a SAP before returning to duty. These "non-DOT" SAPs also provide drug-free education for supervisors and employees.

EXTENDING OUR REACH

As EA professionals we must ask ourselves: Do we really want to relinquish SAP work to, say, psychologists and social workers? Based on our experience, we believe SAP services are a good fit for EAPs. The U.S. Department of Transportation apparently agrees: In establishing minimum qualifications to become a SAP, the department recognized the certified employee assistance professional (CEAP) credential.

But because there are other credentials that qualify one to become a SAP, it may be erroneous to conclude that EA professionals are providing the majority of SAP. services. Though there is probably no accurate tally available of the percentage of SAP services being provided by EA professionals, it is significant to note that many of the providers registered on SAPlists.com, for example, are private practitioners.

EAPs that perform SAP duties become much more aware of current trends and treatments in substance abuse, which ultimately translates into providing higher-quality substance abuse services. Extending our reach to provide SAP services only strengthens our effectiveness and positions us to intervene against substance abuse where the greatest opportunity exists: the workplace.

Sue Tignor is d/rector of employee assistance program services for Mercy Health Partners in Toledo, Ohio. Linda Lindsey and Richard Hoernemann are employee assistance consultants for Mercy Health Partners.