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Rehabilitating workers hooked on drugs.

The typical drug-abusing worker uses three times the normal amount of sick benefits and is five times more likely than other employees to file a workers' compensation claim. e is involved in accidents 3.6 times more often, is late three times more often and has had 2.5 times as many absences of eight days or more. These statistics were revealed in a 1987 report by the National Institute on Drug Abuse (NIDA), which concluded that despite the problems American companies face in the 1990s such as economic recession and the challenge of foreign competition, none is as severe as the impact of drug and alcohol abuse in the workplace.

Employee substance abuse, which ranges from drinking too much to using cocaine and pain relievers, adversely affects as much as 25 percent of the U.S. workforce. The NIDA report states, "Drug abuse cost the U.S. economy $60 billion in 1983 ($33 billion of which is attributed to unrealized productivity), or nearly 30 percent more than the $47 billion estimated for 1980." In 1991 dollars, that figure would be in excess of $110 billion per year.

Research shows that the workplace is affected in many ways by employee drug use, with absenteeism cited as the most chronic problem. Employees with drug dependency problems are estimated to have an absentee rate from four to eight times greater than that of the unaffected population. Other problems range from industrial accidents, increased medical expenses, insubordination, theft and deteriorating product or service quality. Thus, even if an employee's abuse never causes a work-related accident, a drug-impaired worker is costly.

According to a recent William M. Mercer survey of chief executive officers, state governors and mayors of the 64 largest U.S. cities, 22 percent of the respondents thought substance abuse is a significant problem today compared to five years ago. Moreover, more than half of them estimated that 6 percent to 15 percent of their organization's active employees are substance abusers.

It is odd that the majority of these employers do not apply risk management techniques to control the cost of drug abuse. For example, only 24 percent of those polled have preferred provider arrangements with substance abuse or alcoholism treatment facilities. Similarly, only 37 percent of the respondents use utilization review to manage substance abuse treatment expenses even though it is a widely accepted method of containing medical costs. Despite this unfocused approach, many employers are truly interested in establishing drug and alcohol testing and assistance programs.

Managed Drug Abuse Health Care

According to Blue Cross and Blue Shield Association studies, 40 percent of an employer's total health care costs go to substance abuse benefits. As employers become aware of the impact of substance abuse services, they want to control them. Unfortunately, these companies generally end up redesigning benefits to reduce limits, especially for inpatient services, rather than improving delivery of substance abuse care.

When imposing controls to cut drug abuse, most employers look first to cost-sharing provisions that encourage employees to substitute outpatient for inpatient treatment. Some employers place annual maximums on separate drug rehabilitation benefits with low limits. Others make inpatient rehabilitation settings and emergency care subject to higher coinsurance or deductibles.

Although redesigning benefits may c employer costs, it does not reduce and control the costs of drug abuse health care. Rather, cost-sharing forces employees to Pay for therapy out of their own pocket without treatment. Furthermore, it may result in false savings when overall impact on employees' performance and total health care utilization is taken into account. However, there is a growing belief that alternative health care systems and utilization review procedures can also be used to reduce substance abuse costs without limiting benefits or access to appropriate care. More specifically, a preferred provider organization whose members specialize in substance abuse can be formed or case managers can be hired to review an abuser's condition and prescribed treatment.

Directed Provider Selection

Many employers are realizing that their employees should not be allowed to shop alone for drug abuse treatment facilities. The consequences of poor provider selection translate into higher costs. For example, top clinics with inpatient stays cost $6,000 to $20,000 a month. Instead, employers should establish a preferred substance abuse provider organization or a physician network that has impressive treatment outcome records and extends discount rates to employers in return for a volume of referred clients.

For example, United Airlines shuttles its employees with substance abuse problems to a handful of designated highquality treatment programs throughout the world.

Using preferred providers for alcohol and drug treatment usually does not pose a problem for most employees, since few cling to a specific substance abuse treatment facility with the same fervor reserved for the family doctor. In fact, many employees welcome a reliable, clinical resource referral if their request is confidential. Indeed, many firms that require their employees to call an employee clinic or physician referral service before treatment begins state that employees view this approach as a benefits plan enhancement.

Case Management Review

Although PPOs avail quality substance treatment programs to employees, they do not guarantee that costs will be controlled by alternatives to traditional inpatient fixed length-of-stay admissions. Therefore, another party is needed to manage each admission, thus ensuring maximum efficiency of each day of treatment by using the most appropriate and medically necessary treatment site. The entity acts as the watchdog over the system or hires an independent review organization specializing in substance abuse.

In response, a new approach to treating drug abusers is emerging: managed substance abuse health care. Under this plan, the employer works with the managed care company to cover special circumstances and change in therapy plans as they arise. The result is that treatment is handled on a case-by-case basis, as is done for medical and surgical cases. This avoids the shortsightedness of treating all addictions alike and incurring full expense on each case, regardless of the level of treatment needed.

Because individual case management channels services according to cost and effectiveness, it provides a more precise patient-provider match and often uses medically accepted facilities, counselors and techniques that cost less than licensed or certified facilities and doctors. Moreover, treatment is always covered under the benefit plan.

When patient steering and case management are coupled with a preferred substance abuse provider organization, the program is equivalent to a managed substance abuse health care plan, which distinctly differs from the group plan. Despite long-standing biases that freedom to choose doctors should be left unhindered or that types of care should not be carved out of the employee benefits plan, employers should make designing a separate managed care program for offering substance abuse treatment a priority. Otherwise, costs will continue to make their mark on the corporate bottom line.

Even the best conceived managed care plan can fall prey to financial factors that override diagnostic considerations. If the system becomes just a cheap way of delivering services without clearly defined evaluation mechanisms, quality care will often be sacrificed. For example, emphasis on outpatient care should not hinder necessary inpatient treatment. Only this approach can produce long-term cost control strategies and better treatment services.

Employee Assistance Programs

Employee Assistance Programs (EAPS) are emerging as the principal providers and managers of drug abuse health care. They are unique because they not only manage but also provide services, except for inpatient treatment, a feature employers can appreciate because it eliminates the referral step in many cases, thereby saving money. Whereas traditional EAPs assessed performance problems and then referred the employees to appropriate community resources for treatment, most programs today offer short-term treatment or counseling sessions to reduce benefits utilization. Some EAPs are even beginning to serve the dual role of service provider and case manager under a more managed care approach.

More important, employers believe EAPs work. According to a recent survey conducted by Hoffman-LaRoche, a New Jersey-based drug and research company, 49 percent of 102 company respondents said that since beginning their EAP programs, absenteeism and job accidents have dropped 21 percent and 17 percent, respectively. In addition, they say productivity increased 14 percent, and employee morale improved 11 percent.

This perception of success, however, has little quantifiable support. Only four of the study's 102 respondents actually conducted a cost-benefit analysis, with results ranging from $3 million in savings for one company with more than 5,000 employees to no identified savings for another company with less than 500 employees. Moreover, the findings indicate that EAPs have been ineffective and drug abuse has increased. Nevertheless, if EAPs can recapture their original mandate, they may be the answer for reducing the incidence and cost of alcoholism and other drug abuse in the workplace.

Organizational Arrangements

The two major types of EAPs are the in-house or outside model and the affiliate type. Most companies refer individuals to an outside contractor, especially companies that are interested in sponsoring an EAP but not managing it. Yet a company can justify having its own in-house counseling staff if it employs 1,500 to 2,000 workers. However, outside resources are usually preferred to in-house staff to maintain confidentiality.

Today large employee assistance consultants are becoming the major providers of care in the field. In locations where the EAP does not have its own employees, subcontracted professionals, or affiliates, are normally used to provide services. However, this arrangement often complicates care coordination and compromises its quality, especially since there is no accreditation process for certifying this type of program.

Obviously, for an identified chemically dependent worker, an effective EAP carefully investigates the various treatment programs available and recommends what is most appropriate. However, many programs and treatment centers do not distinguish between types of drugs or between drug and alcohol abuse. Indeed, some EAPs treat alcoholics as they would cocaine addicts, but employees, and their particular dependencies, are different, and the treatment should reflect their differences. A successful EAP requires top-management support, training for company supervisors, written company policies, adequate health care coverage, specific disciplinary actions for poor job performance, understandable procedures, good counselors and specified criteria for return to work if treatment requires hospitalization.

A substance abuse assistance plan should above all be abstinence-based, since employees cannot control their use of drugs and alcohol without abstaining. The plan should also be multidisciplinary, consisting of family therapists, psychiatrists and alcohol experts who can treat the varied dimensions of substance abuse addiction. Finally, a program should be certified by the Joint Commission on Accreditation of Healthcare Organizations or the Commission on Accreditation of Rehabilitation Facilities.

An EAP focused solely on substance abuse is often relegated to low priority in a corporation. However, drug abuse programs can save corporations thousands of dollars and supervisory personnel immeasurable frustration. Small corporations can form consortiums and share the same community-based services. Large companies usually find that in-house or outside programs are most effective. However, to realize long-term savings and success, employers should objectively assess their EAPs and, if necessary, hire outside evaluators to determine program effectiveness.

Does Testing Work?

For all the debate and employer enthusiasm over drug testing, there is little evidence that testing actually deters drug use. Moreover, in cases where testing seems to benefit, it is difficult to factor out the other anti-drug forces at work. For example, evidence shows that companies benefit by not hiring drug users in the first place, although it is not clear whether pre-employment testing and drug screening helps achieve this goal. In the largest reported study of its kind, the U.S. Postal Service took urine samples from 5,500 job applicants, but did not use the results in making hiring decisions and did not relay the findings to local managers.

When the post office staff psychologist checked six months to a year later, workers who had tested positive turned out to be absent 41 percent more often and were fired 38 percent more often then workers who tested negative. Even after adjusting for differences of age, sex and race, the psychologist found that pre-employment drug testing was a significant indicator of an employee's reliability. Today the Postal Service implements pre-employment drug tests nationwide.

Despite uncertainty, however, many employers and employees support workplace testing. A recent Gallup poll found that 28 percent of companies with 5,000 or more employees conduct drug tests, and most workers said they favored random testing. According to a survey conducted by Business & Legal Reports Inc., large employers are likely to test for drugs and test applicants.

In addition, companies are under growing legal pressure to implement drug testing. Nine states have laws encouraging pre-employment and scheduled tests such as postaccident and reasonable cause tests but not random testing, except in safety-sensitive jobs. President Bush's anti-drug strategy calls for testing federal employees and urges other employers to do the same. In fact, the 1988 Federal Drug-Free Workplace Act requires federal contractors to adopt drug testing policies or risk losing their government contracts.

Setting Up a Program

The only way to quickly identify drug users is through a detection program. The obvious drawback to testing, however, is the various legal actions that may be filed by employees against the program. Unfortunately, the benefits to worker health and safety are often eclipsed by strong opposition.

Legal challenges have centered around the right to privacy, freedom from unreasonable searches, the right to due process, negligence law and contract law. Opponents to testing programs usually raise issues of the right to privacy and freedom from unreasonable searches protected by the Fourth Amendment. Urine testing and use of dogs to detect drugs have upheld challenges when deemed reasonable and when the employer was justifiably concerned about worker health and safety and conducted the search respectful of personal privacy and the worker's dignity.

The Fifth and Fourteenth amendments are also raised whenever due process is questioned. Such arguments usually state that tests are inaccurate, results are not related to work performance or the employee was punished without an adequate opportunity to contest the results. Employee negligence actions generally contend that the employer was negligent in hiring a substance abuser who harms another employee; the employer was negligent in failing to conduct a drug screening procedure with due care; or the employer was negligent in reporting test results. Most contractual claims arise from allegations of non-compliance with employment or union contracts. Even if there is a rule in contracts banning drugs and alcohol on the job, a testing program to enforce the rule must be negotiated through collective bargaining.

More employers are developing education and training programs to increase awareness of drug health and safety hazards. Along with general education, supervisors must be better trained to spot the signs of drug use, which include personality changes, paranoia, mood swings, frequent absenteeism, financial problems, tremors and even a sniffling nose without accompanying cold or flu symptoms. Another step that some employers have taken to identify drug dealers and users at work is to conduct undercover investigations. Because employers are obligated to make their businesses drug-free and safe, undercover operations may be necessary to fight criminal activity. However, this should be done only as a last resort.

Above all, an employer should consider its role in society. In the absence of state statutes requiring rehabilitation, the employer should set an example in the community by dealing sensitively and compassionately with drug-impaired workers. Many times individuals with substance abuse histories who have undergone rehabilitation are fully able to perform as well as people drawn from the general population. If drug-dependent employees complete a solid treatment program, employers should recognize them as assets to the company. Despite recent U.S. Supreme Court decisions affirming employee testing under certain circumstances, drug screening faces heated challenges. To help private industry set up its own programs, senators Orrin Hatch, R-UT, and David Boren, D-OK, have proposed a bill that would protect employees from abuses and employers from lawsuits by establishing minimum federal standards for workplace testing. Yet in the absence of comprehensive federal guidelines, employers establishing a drug testing program should adhere to the following principles, which have evolved through study and have been sustained in court. Review Laws and Legal Precedents. Determine what the obligations are under any federal statutes, state laws and/or common law that can have implications for drug testing. Demonstrate Need. Document a relationship between job performance and substance abuse. For example, substantiate specific complaints, names, dates and corroborative observations pertaining to absenteeism and poor performance. Testing is expensive, time consuming and troublesome, so make sure the need for it is justified. Determine the Role of Employee Assistance Programs. Define what role the company employee assistance program should play in the program. Supervisors should learn how to recognize signs of abuse. However, they should document signs, not diagnose workers. involve Unions. If necessary, modify employment and union contracts to reflect the company's intent regarding drug testing. Usually, the program's success is enhanced if the unions are brought on board early. Develop a Policy. Develop a specific drug testing policy and program in consultation with parts of the company that may be affected, including top management, legal advisers, human resource managers, risk managers, security staff and occupational health and safety personnel. Most important, teach managers and supervisors to follow the policy. Communicate Policy. Notify employees of the policy prior to the program's implementation date. Review with them the penalties that will be imposed for specified violations. Develop Rules for Off-the-Job Conduct. Make sure employees are notified of any off-the-job rules. For example, any employee who deals cocaine outside of work will be subject to discipline. Decide How to Test. Determine which employees will be tested and on what basis. Start with pre-employment testing because it is fairly well accepted and then proceed to testing employees who are suspected of having a drug or alcohol abuse problem. Finally, make sure the people who administer the tests and perform laboratory analyses are qualified to do so. Notify Employees. Notify employees of positive test results and provide them an opportunity to contest disciplinary actions taken on the basis of those results. Any initial positive result should be followed up with a confirmatory test using an independent methodology. Keep Results Confidential. Do not release positive test results until their accuracy has been verified by a confirmatory test and, if possible, by corroborating evidence of substance abuse. Do not apprise anyone of the results who does not need to know. Even if all these steps are implemented, problems may still arise. The employer must continually monitor the application of the policy, making revisions as laws change and as improvements in testing methods and laboratory procedures become available. Edward A. Pouzar is a consultant with Betterley Risk Consultants Inc. in Worcester, MA
COPYRIGHT 1991 Risk Management Society Publishing, Inc.
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1991 Gale, Cengage Learning. All rights reserved.

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Title Annotation:includes related article on drug testing guidelines
Author:Pouzar, Edward A.
Publication:Risk Management
Date:Mar 1, 1991
Words:3116
Previous Article:Managing economic crises before the boom goes bust.
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