Employers Addressing Substance Use Disorders Save By
Detecting and Dealing With Substance Use Problems Early
Substance use disorders occur along a continuum. Many people don't seek treatment on their own until they have serious problems and are in acute need of medical care. But finding and treating substance use disorders before they get out of hand are much more effective and less costly to businesses and to workers.
An effective start is asking about alcohol and drug use. Screening makes early intervention possible. Each year, companies and government agencies sponsor a National Alcohol Screening Day. In 2009, it was on April 9th. Thousands of physicians, and hundreds of companies large and small offer educational materials and confidential screening for alcohol problems.
More than 20 countries, including the U.S., use a simple 10-question test, the Alcohol Use Disorders Inventory Test (AUDIT), to identify problem drinkers. The online AUDIT provides immediate feedback to the user, comparing his use against national guidelines and suggesting what can be done. You can use a confidential, online or a printable AUDIT. Other brief questionnaires are also widely used to identify problem drinking: CAGE, MAST, TWEAK, CRAFFT or the NIAAA Screen for Heavy Drinking. Screening can be as simple as asking the first three questions on the AUDIT on company-sponsored health risk appraisals:
- How often do you have a drink containing alcohol?
- How many drinks containing alcohol do you have on a typical day when you are drinking?
- How often in the last month do you have six or more drinks on one occasion?
For males, more than 14 drinks per week, or one or more times of heavy drinking, suggests possible hazardous drinking; for females, more than seven drinks in a week, or one occasion drinking four or more drinks, suggests possible hazardous use. Questions about alcohol use can be part of Health Risk Appraisals (HRAs) or standard intake forms for corporate wellness programs that ask employees about a broad range of health concerns such as glaucoma and hypertension. Your Employee Assistance Program or employee health unit can use the AUDIT or similar alcohol questions when employees seek help for stress, depression, marital difficulties and other problems that can be alcohol-related.
The World Health Association suggests screening for a variety of substance abuse issues using the ASSIST (Alcohol, Smoking, and Substance Involvement Screening Test). The ASSIST is a tool that measures domains such as lifetime use, past 3-month use, and related substance abuse problems. Specific substances covered by the ASSIST include: tobacco, alcohol, cannabis, cocaine, amphetamine type stimulants, sedatives, hallucinogens, inhalants, opioids, and other drugs.
The CAGE has also been adapted to include questions that assess general substance use. Like the original version of this measure, the CAGE-AID has only four questions, and has been shown to indentify people with substance use problems. A link to both the original CAGE and the CAGE-AID can be found here.
An additional brief tool that measures drug abuse, dependence, and related problems is the DAST (Drug Abuse Screening Test). Items included in the DAST refer to “drug use” in general terms, and include both illicit and prescription drugs, but specifically exclude alcohol use.
Use these tools for screening
A free, confidential online alcohol screening is available at www.alcoholscreening.org.
Alcohol Screening: A Quick First Step to Reduce Problem Drinking tells how some employers have set up screenings.
People with substance use disorders typically fall into one of two categories:
- Hazardous or problem users and
- Substance dependent users.
Problem users may benefit from brief interventions. These brief counseling sessions can be conducted in five or fewer encounters lasting less than 20 minutes. Often, the best people to provide this treatment are staff of the company's Employee Assistance Program or doctors. Many research studies have demonstrated that problem users respond well to brief treatment, reducing their use and changing risky behaviors such as driving under the influence. For people who are dependent on substances, brief interventions can be very helpful in motivating them to get started with treatment and stick with it. Company awareness campaigns help problem users to understand that recovery can be within their reach. Each September, for example, the federal government makes available to businesses posters, brochures, fact sheets and videos so that companies can participate in National Addiction and Alcohol Recovery Month.
How Employers Can Promote Screening
Employers can take the following steps to ensure screening of employees who are at risk for substance abuse:
- Provide comprehensive health benefits that cover substance use screening, treatment, and aftercare.
- Comprehensive coverage ensures that employees have access to the individualized care they need at every stage.
- One study found that providing comprehensive substance use benefits costs just $.06 more per member per year than imposing a $10,000 limit on those benefits
- Evaluate current health plans to determine whether they require their providers to screen for drug and alcohol problems. If an existing plan doesn’t, the employer may be paying more for healthcare than necessary.
- Establish standards and outcome measures for health plans to meet when they require routine screening for substance use problems in physicians’ offices, emergency rooms, clinics and behavioral health centers. For instance, a company might negotiate with its plan to include within the terms of a new contract improvements in the identification rate of alcohol problems.
Find out more about brief interventions.
- Alcohol Use Disorders Inventory Test (Use this version to interview someone else)
- Alcohol Use Disorders Inventory Test (Use this version to screen yourself)
- To locate treatment programs in your community