Past articles have focused on the processes of substance misuse and its effects on individuals and families.  Now we turn our attention to the impact of substance misuse on businesses and employers.

I recently had a conversation with the human resources director of a local employer who indicated how hard it is to hire people.  She indicated that 50% of their applicants could not pass a drug screen. When given the opportunity for a second screen, half of those still didn’t pass.  Many business leaders wonder what to do with people who fail drug screens.  They are unsure of their role in assisting employees and potential employees who are struggling with substance use.  Some employers have opted to stop drug testing completely.

Mike Thibideau from Indiana Workforce Recovery says that eighty percent of Indiana businesses have a need for additional employees.  According to the Federal Reserve Economic Research, the August 2019 unemployment rate in White County was 2.5%.  There is a desperate need for additional workers.

Seventy-five percent of Indiana employers report that substance abuse impacts the workplace in absenteeism, shortage of workers, negative publicity for the company, decreased productivity, increased insurance costs, accidents, and theft. Ninety-five percent of overdose deaths occur in working-aged adults.  White County overdose deaths are no exception to these statistics.

Indiana Workforce Recovery surveys show that over 200,000 employed Hoosiers have substance use disorder, and forty-two percent of Hoosiers seeking treatment for substance use are employed. Another forty-one percent of those in treatment are looking for work.  Nationally, there are 28.5 million Americans in long-term recovery and only ten percent of them are employed.

When thinking about recovery, Thibideau reports there is no greater source of change than a good job. When people receive employer supported and monitored treatment, they tend to be more successful in staying in treatment longer and maintaining long-term recovery than those referred by family and friends.  Employers find that supporting their employees in treatment and recovery shows a thirty-six percent decrease in absenteeism and a thirteen percent decrease in employee turn-over rate.  The financial incentive for businesses to support their employees involved in substance misuse is real.  

Stigma continues to be an obstacle for working people entering treatment. In 2016, 31,000 Hoosiers wanted to engage in SUD treatment, but they chose not to get treatment for fear of losing employment.  In Indiana, a failed drug screen is just as likely to result in termination as it is to lead to a referral to treatment. 

Jim McClelland, Indiana Executive Director for Drug Prevention, Treatment and Enforcement states, “Everyone understands that substance abuse in the workplace can be a problem.  But there is a big opportunity here.  We know that businesses need a healthy workforce and we also know that people in recovery from substance use disorder need jobs.”
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Next time, we will discuss what employers can do.

Recent research on substance abuse shows that many factors are involved in who becomes addicted to substances and who doesn’t.  More and more studies indicate that childhood trauma influences many long-term health outcomes. 
The Adverse Childhood Experiences (ACEs) assessment is one example of this research (also known as Kaiser Permanente CDC Study).  In the late nineties, 17,000 middle class Americans were given health assessments and a ten-question survey looking at childhood abuse (physical, emotional or sexual), household dysfunction (having a parent incarcerated, with a mental illness, involved in substance abuse, mother treated violently, parents separated or divorced), and physical or emotional neglect.  (The entire questionnaire can be easily found online by searching for “ACE Questionnaire.”)
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The reason adverse childhood experiences are so impactful is that young children quickly learn whether or not the world is safe by how their needs are met.  Babies and young children learn this through the care or neglect of a caregiver. Unmet needs increase the production of cortisol, causing the stress response system in the brain to be on constant high alert, diverting energy away from other parts of the brain.  This toxic stress weakens the parts of the brain that develop healthy emotional self-regulation, social interactions, and abstract thinking.  These stressors early in life affect not only emotional health and educational achievement, but long-term health and wellbeing as well.
 
As a person’s ACE score increases, so does the risk for negative outcomes. In their continuing studies, the CDC found that almost a quarter of those surveyed had three or more ACEs.  There is a dramatic link between having three or more ACEs and engaging in risky behaviors (accidents, injury, being a victim or perpetrator of violence), having psychological issues (mental illness, suicide, depression), serious chronic health conditions (including obesity, diabetes, heart disease, cancer, COPD), and lower educational attainment.  The Substance Abuse and Mental Health Services Administration (SAMHSA) cautions that “Each ACE increases the likelihood of early initiation into illicit drug use by 2- to 4-fold.”   People with six or more ACEs are likely to die twenty years earlier than those without ACEs.  Studies also show that children of parents affected by high ACE scores are likely to experience them as well, affecting future generations.
 
CDC research indicates that the economic toll of individuals having five or more ACEs costs the United States four hundred billion dollars each year in health care, special education, criminal justice and child welfare services. 
 
In addition to drastically increasing the likelihood of substance misuse, adverse childhood experiences have negative long-term effects on individuals and our society at large.  Next time we will discuss what can be done.

In the past two articles I shared two stories of journeys to recovery.  Why do some people recover while others do not?
Several factors influence an individual’s recovery.  One important factor is the severity and length of substance use.  The longer a person is involved in substance misuse, the harder recovery becomes.  Early intervention is important.

Another factor is Recovery Capital.   Robert Granfield and William Cloud developed the concept of “recovery capital,” defining it as the amount of assets and supports an individual has that help begin and sustain recovery from substance abuse.  Recovery capital varies from individual to individual and differs within the same individual over time.   A person with a higher amount of recovery capital has a better probability of being successful in achieving recovery.
There are four areas of recovery capital:  physical, human, social and cultural. 

Physical recovery capital includes things like: having safe, stable, secure housing, employment/financial assets, physical health, clothing, nutritious food, transportation, insurance, and other basic physical needs of an individual.
Human recovery capital looks at the range of skills, strategies and attributes that allow an individual to function effectively in society and the ability to navigate daily life.  These include mental health, values, life skills/coping strategies, knowledge, experience, education, interpersonal skills, problem solving abilities, aspirations, hopes, and having a purpose.
Social recovery capital indicates the supports and obligations/commitments to social groups and personal relationships, including family, friends, work, social networks, memberships to organizations, and church.  A great challenge for those in recovery is developing relationships outside of the substance using community. 
Cultural recovery capital is the collective values, beliefs and attitudes of the community. These include access to treatment and recovery, public awareness of and perceptions about substance abuse, regional and local laws, and community attitudes towards addiction. 

Recovery capital includes the resources and ability to act in one’s best interest to meet basic needs and take advantage of recovery opportunities. 

Sadly, some people have never learned how to live without drugs and function successfully in society. A drug and alcohol counselor working in a local jail indicated that rehabilitation—teaching inmates how to live in a healthy manner without drugs, only works with people who, at one time, had those skills. For others, habilitation is necessary to build recovery capital. 
  
For people living with trauma and economic instability related to substance abuse, the obstacles facing them in beginning recovery can be overwhelming.
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One of the goals of a community that desires to help people recover from substance abuse is to increase the amount of recovery capital available. Even changes in attitude make a difference in the response to those involved in substance abuse. Viewing addiction as a disease rather than a moral failing helps an entire community to build recovery capital.
More on this next time.

Although every story is different, there are general patterns of substance use, treatment, relapse and recovery that emerge in the study of those in recovery.

Jack’s story is fairly typical. He did well in school, played sports, and had lots of friends.  After a sports injury, his doctor prescribed an opioid painkiller. He loved the way he felt when taking them.  When his prescription ran out, he was able to find them from friends. Although the first few pills were given to him for free, soon he had to pay for them.  At first, he only took them on weekends or at parties. Soon he was taking them through the week as well.  He quickly discovered that if he didn’t take them, he began to be anxious and have flu-like symptoms.   Initially, he was able to pay for them with the money he earned at his part-time job.  As his need for the drugs increased, he went through his savings.  He started looking though medicine cabinets of friends and family members to find prescription medications he could sell or trade for opioids He convinced himself that he didn’t have a problem, as there were others who were in worse shape than he was.  He wasn’t using needles or taking heroin.

He began taking things from his parents’ home to pawn or sell for drug money.  When someone suggested he try intravenous injection, he was unsure he wanted to cross that line.  But with encouragement, he allowed himself to be injected and there was no going back.

Jack’s parents had noticed changes in their son, but Jack was able to create stories that covered his drug use.  He was just tired, had a touch of the flu.  He spent more time in his room and with his new friends.  When asked about his former friends, he said they were lame and didn’t want to hang out with them any more.  As his grades at school plummeted, he became angrier and more belligerent about people being on his case and not leaving him alone.

He couldn’t wait to go to college and get away from all the rules and people who didn’t “get him.” Once there he used his new freedom to connect with other drug users and partiers.   He only lasted a semester at the university before he flunked out.  When his parents confronted him, he said the school was stupid and the professors were too harsh and expected too much.  After several confrontations, Jack confessed that his problem was drug-related and his parents got him into a treatment center.  Jack went from being relieved that the problem was out in the open to being angry and resentful of the rules and strict routine of the treatment center.  He managed to complete the program with plans to go back to school, but once released, he ran into a friend from his former days and soon was using again.  Thus began a several year cycle of treatment and relapse.  His family grew more and more frustrated with him and eventually cut off ties.

Jack spent many years couch surfing and then was homeless.  After several overdoses and Narcan administrations, an EMT connected him with a recovery organization and a medically assisted treatment facility. Initially, Jack did not have much hope, but through the counselling and medication, he began to see that recovery was possible.  He had several missteps, but with the support of his counselor and new friends in recovery, it was not a catastrophic fall back into the life of addiction. 

Slowly Jack relearned how to function again in healthy society.  He developed new interests and began to help others on their roads to recovery.  It has not been easy and has taken a long time to rebuild trust, but his relationships with his family are slowly being restored.  Recently Jack met a woman in recovery and they are beginning to plan a future helping others develop a vision for their own recovery.
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Names and details have been changed to protect Jack’s privacy.