September 11, 2017
Opioids in the Workplace

Employee assistance programs offer a bridge to addiction recovery

HBJ Photo | Steve Laschever
HBJ Photo | Steve Laschever
Anthem Blue Cross and Blue Shield behavioral-health manager Ana Secondo (foreground) with her team of employee assistance program (EAP) case managers at the health insurer's Wallingford call-in center. Anthem has seen a rising number of EAP calls involving opioid misuse, signaling, Secondo says, growing public awareness — and less stigma — about their hazards.
HBJ Photo | Steve Laschever
Dan Fallon, a program manager at Wheeler Clinic, says EAPs offer employees an accessible, confidential portal through which to seek and get help.
HBJ Photo | Steve Laschever
Dorinda Daniels is an EAP case manager at health insurer Anthem.
Dan Boissonneault, President of the Connecticut Employee Assistance Professionals Association
Jodi Jacobs, oversees the virtual call center at Anthem Blue Cross and Blue Shield

EAPs are popular among employers, but underutilized by workers

Seventy percent of all U.S. companies and 90 percent of Fortune 500 companies purchase employee assistance programs (EAPs), according to the National Safety Council.

Findings from 21 studies assessing the efficacy of corporate health and productivity programs found that EAPs have positive returns on investment. All programs reported favorable returns ranging from $1.49 to $13 per dollar spent on the program. It is noteworthy that the mental health program showed one of the highest ROIs, according to the National Safety Council.

The problem with EAPs, however, is that few employees use them either because they don't understand the value or may fear negative ramifications if they seek help.

For most of his 46 years, Dino has worked lifting heavy loads at Connecticut construction sites, as a crane operator.

In his free time, he also lifted heavy loads in the gym, chiseling his stocky frame. But when Dino, whose last name is being omitted to shield his privacy, injured a shoulder in training, he was prescribed Percoset — a painkiller brand that combines acetaminophen and oxycodone, an opioid. Opioids are a class of natural and synthetic compounds found in narcotics, like heroin and morphine, that act on the body's central nervous system to relieve pain or sedate users.

The shoulder healed, but Dino found himself eventually tethered to a smorgasbord of synthetics: the Percoset made it hard to sleep, so he turned to pills for that. Then, he embraced Valium, prescribed for anxiety disorders, just to function, Dino said.

Before long, he said he was spiraling down, to the point he began missing work. A senior official in the construction union where Dino was a member intervened, threatening him with no work assignments if he didn't take advantage of the union's employee assistance program and get professional help.

"Wow, I didn't realize it had gotten that bad,'' Dino said he recalled at the time.

"The addict is the last to know,'' said Kyle Zimmer, health and safety director at the operating-engineers union, IUOE Local 478, in Hamden, of which Dino is a member.

Employee assistance programs, or EAPs, exist as part of employee-benefits packages at most major employers' — and to a lesser extent in smaller employers' — offices, workplaces and shop floors in the country. With formal roots that date to the mid-1950s, EAPs hark to the days, experts say, when one worker would notice another intoxicated on the shop floor, and intervene to get them treatment so they could return productively to work.

Today, however, opioids have replaced alcohol as a major substance of choice among people looking for synthetic relief from life's day-to-day demands or an addiction.

And the growing opioid crisis is expected to increase the need and role of EAPs as "bridges'' between struggling employees and employers, EAP experts say.

On Oct. 1, federal law takes effect requiring employers and federal agencies to screen for four more opioids — hydrocodone, hydromorphone, oxycodone and oxymorphone — that have increasingly been showing up in workers' drug tests.

Dan Boissonneault, a certified EAP professional who is president of the Connecticut Employee Assistance Professionals Association, says widened testing for those narcotics will likely prompt users to turn to corporate and labor-union EAPs for help. The law mandates that workers in "safety-sensitive'' industries such as construction, commercial drivers/chauffeurs, airplane mechanics, etc., must be randomly tested for additional opioids, along with the standing list of drugs that includes morphine and codeine.

"I think we're going to see more activity in safety-sensitive areas,'' said Boissonneault, who works for East Hartford jet-engine maker Pratt & Whitney and by contract acts as senior EAP coordinator for the International Association of Machinists and Aerospace Workers District 26. He also sits on the board of the Employee Assistance Professionals Association.

EAPs are also still around, ostensibly to not only help opioid, alcohol and marijuana users, but also help others struggling with the myriad pressures 21st-century workers encounter — problems with finances, significant others, the law, etc.

But experts who hail EAPs and the purposes for which they were created claim many employers today have emasculated their programs, making them more tools of punishment than reclamation vehicles.

"EAPs have become commoditized and a political creature,'' said Joel Bennett, of Fort Worth, Texas, who consults with private employers, nonprofits and municipalities on organizational health and employee well-being.

Bennett contends, and others concur, that too much emphasis from EAPs nowadays is short-term, revolving-door treatment, particularly with opioid misusers, rather than on prevention.

"EAPs work if they promote healthy use of [painkiller] substances,'' Bennett said. "EAPs need to educate employers as to what those look like.''

He and others also insist that too many employers nowadays blindly rely on their EAPs to handle troubled employees after they are addicted, rather than investing up front more to educate their workers about prevention. The solution, some say, could be as simple as teaching workers better ways to manage their money, which might curb the incidences of domestic abuse, depression and other mental-health issues that prompt victims to self-medicate.

EAP frontlines

Several central Connecticut institutions serve on the EAP frontlines. Plainville's Wheeler Clinic has provided employee-assistance services to Connecticut businesses, municipalities and nonprofits for more than 40 years. EAP services are among the more than 100 Wheeler offers, including medication-assisted treatment for opioid misuse, said Dan Fallon, a certified EAP professional who is a program manager at Wheeler. Wheeler offers EAP services to more than 65,000 individuals across approximately 70 for-profits and nonprofits based in Connecticut.

Fallon said EAPs offer individuals with addictions an accessible, confidential portal through which to seek and get help. They also refer people to other beneficial services to arrest opioid use and can monitor employees' treatment and aftercare, he said.

One trend Wheeler has witnessed, he said, is more companies partnering with health and wellness providers, pharmacy-benefit management organizations and EAP practitioners, to analyze data and better coordinate patient care.

Also, employers are re-evaluating their current workplace drug and alcohol policies, and educating workers and hiring prospects to identify substance-abuse issues and help affected employees as early as possible.

In Wallingford, health insurer Anthem Blue Cross and Blue Shield houses its national EAP call-in center, serving employees of private companies, municipal agencies and nonprofits that subscribe to its EAP-support network.

Calls to its confidential hotline launch a team of licensed EAP professionals to answer caller concerns ranging from drug/alcohol misuse to troubles at home or work, said Jodi Jacobs, who oversees the virtual call center.

"We do a good job assessing them, figuring out how they get to the right person,'' Jacobs said.

Anthem behavioral-health manager Ana Secondo supervises 17 Anthem EAP case managers who each juggle some 60 cases monthly. Anthem has seen a rising number of EAP calls involving opioid misuse, signaling, Secondo said, a growing public awareness — and less shame and stigma — as to their hazards.

"It's a good thing that we're seeing more opioid cases, due to the heavy media attention,'' Secondo said.

Anthem refers EAP callers to medical providers and will also follow up with members within 24 to 48 hours, officials say.

Through its EAP call center, Anthem plays an indirect role in curbing opioid misuse, Jacobs and Secondo say. One way is via its "Pharmacy Home" program offered to its commercial and Medicaid customers.

Under the program, individuals are assigned to one pharmacy and/or one care provider who handles patient-members' opioid prescriptions. This way, Anthem EAP experts say, physicians can monitor their patients' access to opioids while also ensuring they are receiving appropriate drug counseling and other mental-health support.

Since the April 2016 launch of Pharmacy Home, Anthem says it has enrolled nearly 450 members and sent warning letters to over 3,100 members who met the defined criteria.

Overcoming the stigma

EAPs have come a long way, Fallon said, since their formal start in the 1950s with former Eastman Kodak Co. and other big employers, evolving as an outgrowth of the movement to identify and rehabilitate workers with alcoholism. Early EAPs, he said, were seen as tools to ID individuals with alcohol addiction and quickly intervene using worker peers and addiction counselors to help them.

Later, as care professionals identified other workplace "stressors'' that can negatively impact workers' performance, experts say EAPs evolved to assist those, too.

By the 1980s, when the nation's cocaine addiction kicked in, EAPs were in full swing. Almost every large U.S. employer, and many smaller ones, offered EAPs as a workplace benefit.

Today, painkillers made from opioids have largely supplanted alcohol and cocaine as users' drug of choice.

But one fact about EAPs remains: The stigma on tapping EAPs for help, especially when "alcoholic'' and "addict'' labels are applied, experts say.

"People feel embarrassed about using EAP services,'' Fallon said.

To erase EAPs' stigma, experts say employers can foster more tolerance and understanding in their offices and shop floors, by educating workers about the stressors and other factors that promote addiction. Not all individuals with an addiction got their by choice; genetics, mental-health issues and other risk factors render some people more susceptible, experts say.

Bennett, the Fort Worth, Texas, EAP consultant, contends that EAPs' effectiveness could be strengthened if more employer-members held them accountable for yielding positive, evidence-based outcomes for their users. There is room, too, he said, for employers and their staffs to deepen their understanding of the multiple layers of treatments that exist, particularly for heroin and other opioids.

View whole series here.

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