Addictive Behaviors and Cultures of Health in the Workplace

Too often, addictive behaviors are often understood purely as individual pathology: a problem afflicting a person, albeit a concern with familial, social and employment consequences. When we widen the lens, however, we can see the broader cultural contexts that encourage or inhibit individuals from engaging in these behaviors. The role of the workplace in affecting alcohol and other drug use is an important site for the development of this understanding. This short piece will introduce you to some of the cultural factors that promote or protect against addictive behaviors in the workplace.To say that your company culture supports addictive behaviors is, emphatically, not to say that you or any other decision maker actively condones unhealthy relationships to alcohol, drugs or other compulsive behaviors. The language of enabling used to be common in the literature on addiction.1 The enabler is the person who emotionally, materially or tacitly supports the individual in continuing her or his addictive behaviors. This idea retains tremendous popular usage in mutual-support societies and in communities of treatment organized in concert with those societies. But there is a lot of judgment and personalization at work in the language of “enablers.” It assigns moral culpability to the people responding to the challenge as well as to the individuals struggling with the challenging behaviors. Instead of a personal failing, we can profitably think of cultures as enabling or inhibiting, risk-elevating or minimizing, promoting addictive behaviors or promoting substance wellness.

So now is an opportunity to ask ourselves: is our workplace a social context that valorizes healthy, sustainable choices regarding alcohol and other drug use? Do leaders in our organization take preventative or permissive actions? How does our workplace help or hinder someone who is contemplating changing their relationship to substances? How about someone who has already undertaken a personal project of improved substance wellness? Chances are, we haven’t addressed these questions – at least in these terms. Instead alcohol and drug use, as it relates to the workplace, is probably understood as a disciplinary or safety concern. Those are hugely important dimensions. Substance wellness, however, requires an additional step.

Creating company culture isn’t as obvious as creating company policy. Take for instance policies concerning employee drug use. There are widespread, and in some cases, mandated sanctions for employee-reported drug use. Compliance with the 1988 Drug Free Workplace Act, and with the many state legislative efforts in this spirit, may require explicit procedures concerning drug use – including responses to employee reports of off-site drug related arrests. Sometimes these standards are coupled with employee testing and zero tolerance regimes.  When carefully studied, however, these policies are of uncertain benefit. Even in as restrictive a labor environment as the US Navy, economic analyses suggest that resources allocated to zero tolerance efforts would be better allocated to rehabilitation.2 In the private sector their merits are even more questionable, a fact corroborated by the declining number of employers conducting mandatory pre-employment screenings for drug use.3 But whether compliance with the Drug Free Workplace Act or employee drug-testing, neither of these gets to the heart of substance wellness promoting culture.

How many organizations have an explicit zero tolerance (or one strike, or two strike) policy coupled with a company tradition of alcohol-fueled holiday events? When major milestones are reached, what does the celebration look like? The goal isn’t to ban alcohol from all activities. Instead it’s to understand the ways that substance wellness can be promoted (or unintentionally devalued). In the Washington Post, Joyce Russell described some of the features of companies that have alcohol-centered cultures. Russell asks, “Can you hold a social event without having alcohol or would no one come? If no one would come, what does that say about the culture of the company?”4 Writing as an organizational psychologist and a management consultant, Russell re-emphasizes the importance of clear and consistently enforced policies alongside ready access to resources for individuals struggling with alcohol or drug use. But a fuller response to the promise of substance wellness involves conscious creation as well as regulation.

The last several years have seen the widespread promotion of “Cultures of Health.” It’s not a new phrase, but it has seen marked traction since the advocacy work of the Robert Wood Johnson Foundation. Beginning in 2013, the RWJF launched an ambitious effort to re-envision population health, organized around this language. Several high profile corporations have signed on to realize this concept in their own workforces (see for instance the corporations behind the International Corporate Health Leadership Council http://www.ichlc.org/). This suggests a programmatic platform designed for population health is also being implemented within diverse workplaces. It is an attractive concept, and there are many ongoing efforts to translate the broader call to action into a workplace-specific solution. At its core, a “culture of health” is defined by RWJF as “one in which good health and well-being flourish across geographic, demographic, and social sectors; fostering healthy equitable communities guides public and private decision making; and everyone has the opportunity to make choices that lead to healthy lifestyles.5" The centrality of mental health to this vision is inescapable. And so, too, the role of substance use, substance misuse, and substance wellness.

A culture of substance wellness, like the broader culture of health, demands that substance wellness flourish across geographic and economic locales. Healthy relationships to alcohol and other drugs can’t be the exclusive preserve of the most senior members of the team. A democratization of this health commitment needs to reach every corner of the workforce – not simply in terms of access to treatment or supportive services, but in conscious validation of choices to engage in substance wellness. For key decision makers, too, an awareness of substance wellness must animate the cultivation of atmosphere and culture. Choices that support substance wellness – from what is available to drink at a party to how to cope with work, family and life stress – need to be widely disseminated across the workforce.

What would it even mean to promote substance wellness in the workplace? It entails a lot more sensitivity, planning and fun than many people might think. First you need to take a look at what default strategies for engagement are. Don’t limit yourself to company planned events – talk to your managers and leaders about what their staff and employees do. What does a company event look like now? What could it look like if substance wellness was one of the animating concerns? Do you offer opportunities for your employees to reflect on their relationship to alcohol or other drugs? Chances are, you already actively promote tobacco cessation programs. What do you do for other areas of substance wellness?

1 For an old definition, consider this entry to a short glossary of addictive behavior terminology published in the Journal
of the American Medical Association: “Enabling Behavior: Any action by another person or an institution that intentionally
or unintentionally has the effect of facilitating the continuation of abuse or dependence.” Rinaldi RC, Steindler EM, Wilford
BB, Goodwin D. Clarification and Standardization of Substance Abuse Terminology. JAMA. 1988;259(4):555-557.
doi:10.1001/jama.1988.03720040047025.
2 Mehay, S., & Webb, N. J. (2007). Workplace drug prevention programs: does zero tolerance work? Applied Economics, 39(21), 2743–2751. http://doi.org/10.1080/00036840600749532
3 Zeidner, R. (2010, November 1). Putting Drug Screening to the Test. Retrieved September 15, 2016, from https://www.shrm.org/hr-today/news/hr-magazine/pages/1110zeidner.aspx
4 Russell, J. (March 9, 2014.). Does your workplace have a drinking culture (and problem)? Retrieved September 18, 2016, from https://www.washingtonpost.com/business/capitalbusiness/does-your-workplace-have-a-drinking-culture-and-problem/2014/03/07/094b8a3c-a55f-11e3-8466-d34c451760b9_story.html
5 http://www.evidenceforaction.org/what-culture-health