Comprehensive drug programs most effective

Random testing won’t solve all problems

If you want your work-site drug abuse program to succeed, experts warn you to offer more than the stick — dangle a carrot, too.

"We try to emphasize the importance of comprehensive programming," notes Margaret Beaudry, MA, director of research with Washington, DC-based Drug Strategies, a nonprofit research organization. "The best kind of combination includes testing when appropriate, early identification and referral into assessment services like EAPs [employee assistance programs], giving employees the option to use treatment benefits on demand, and a ‘last-chance’ agreement [i.e., a letter giving an employee the option to seek treatment, or be dismissed]."

Beaudry and others warn that random drug testing is an effective tool for identifying problem employees, but not for encouraging them to come forward for help.

Tim D. Plant, LCSW, MSW, MBA, senior vice president with the Center City, MN-based Hazelden Foundation, a nonprofit provider of recovery and education services, agrees emphatically. While noting that everybody wants a safe and healthy place to work, he also acknowledges that drug abuse in general, and testing in particular, can be uncomfortable and even controversial subjects for employees.

"Drug testing can be highly effective when it’s part of a comprehensive drug-free workplace program rather than something that stands alone," he explains. It is important, he says, that employees understand that they will be treated fairly, offered help and education, and won’t automatically be dismissed. (For a look at how to minimize your legal exposure when testing employees for drug abuse, see the related story on p. 5.)

While there are no hard statistics on how many "drug-free" workplaces there are in the United States, "I can tell you that the vast majority of most large and medium-sized companies are conducting one form of drug testing or another," says Daryl Grecich, a spokesman for the Washington, DC-based Institute for a Drug-Free Workplace.

Grecich adds that there has been a significant increase in the number of companies that incorporate drug testing into company drug policy. "In the early 1980s, only 3% of the Fortune 200 tested for drugs," he notes. "Today, over 98% do."

The anatomy of a program

Beaudry says the components of a comprehensive program should follow these basic guidelines:

• Education: Teach employees how to recognize substance abuse problems in themselves and in other employees, and how to seek help.

• Testing: Judicious testing, when appropriate, should be used as a tool for early referral to your EAP or a health professional. "It’s viewed by employees as punitive if you don’t also offer something supportive like an EAP," Beaudry explains.

• Treatment through your employee benefits package: "Negotiate a benefits package with your health plan that includes a full continuum of care, including follow-up," she advises.

Clear policies supported by disciplinary action: This includes a "last-chance" agreement, a written document that basically states that the employer recognizes the fact that the employee has a disease, but also believes he or she requires ongoing treatment and testing. It also states that if the employee doesn’t meet those demands, the employer does not have to continue employing him or her.

‘Before’ and ‘after’: Keys to success

Two key factors — education and comprehensive benefits — offer employers a tremendous untapped potential for savings, say Plant and Beaudry. Education can limit costs through prevention and/or early intervention, while extended follow-up care, ironically, will also mean a much healthier bottom line.

A recent survey by Hazelden showed that while 68.4% of the employees responding said they would feel comfortable talking to fellow employees about drug abuse, fewer than 20% have ever actually approached another employee. (See accompanying chart, inserted in this issue.) "This is the most significant finding of the survey," says Plant. On one level, he says, this gap between willingness and action is due to the fact that employees believe the process is more complicated than it really is. "A simple conversation can turn a person’s life around," he says.

Wellness and EAP professionals can help employees overcome this reluctance through basic education, says Plant. This can include brochures, videos, and optional or required orientation programs. Getting communication materials to family members is also critical.

"I encourage health and wellness programs to do something about drug abuse before it causes obvious problems in the workplace — that’s where the real savings are," he says.

Beaudry says follow-up benefits could be another significant source of savings. "There’s an absence of coverage in many private plans, including many HMOs, of outpatient, long-term follow-up services," she notes. "It’s extremely inexpensive, and really necessary."

Most plans cover detoxification, recognizing it as a medical necessity, but that’s not sufficient, Beaudry insists. "And detox is actually quite pricey, while outpatient group counseling might be free, or as little as $5 to $10 per visit."

There’s a widely held myth that employees in outpatient programs always relapse, says Beaudry. "It [follow-up treatment] actually does improve long-term outcomes," says Beaudry, whose organization just completed an extensive study on substance abuse treatment and program utilization. "In addition, long-term health care costs of families of substance abusers are reduced after treatment," she adds. "When one person gets it together, other family members tend to pursue preventive measures themselves."

[Editor’s note: For more information about drug abuse programs and utilization, contact Margaret Beaudry at: Drug Strategies, 2445 M St. NW, Suite 480, Washington, DC 20037. Telephone: (202) 663-6090. Fax: (202) 663-6110.]