Substance Wellbeing: The Value of Prevention

Let’s take a look at a significant opportunity concerning substance wellbeing in the workplace: prevention. If we can reach people earlier in the progression of their struggles with alcohol and other drugs, we can improve outcomes, avoid downstream consequences, and help individuals re-direct their energies towards thriving at their place of employment. Just talking about prevention, however, summons a very real concern: existing methods aren’t working. Why? They’re antiquated and aimed at adolescents, to start. We’re talking D.A.R.E here. As the USA Today told us in 1993, and the Government Accounting Office in 2003 (as reported in the Journal of the American Medical Association): “DARE doesn’t work.”1 And they are right.2

The bulk of preventive programming targeting substance use and substance wellbeing has been developed for adolescents. There are a variety reasons behind this situation. Earlier onset of risky substance use is strongly correlated with future severity. In light of this, early intervention makes sense. Additionally, since adolescents are legally dependent individuals, the burden of promoting future health is felt even more strongly by providers and caregivers. Large-scale initiatives are also politically popular – they communicate to the broader public that policy makers are doing something about real, and felt, crises in many peoples’ communities. Prevention, for youths, has thus largely been understood as an educational challenge. If individuals are equipped with a richer understanding of the perils and pitfalls of risky substance use, they will rationally elect to avoid those behaviors.

The manifest failings of this approach are both evident and widely acknowledged. Telling people about potential future difficulties (and about the dire consequences that attend some of those challenges) does little to modify behavior. Ask any wellness specialist or HR Director anywhere: do dark tales of future woe delivered to your population guide behavior? Where preventive programming is limited to educational endeavors, we can expect minimal impact. Fortunately, prevention doesn’t have to mean warnings of future catastrophes. This is partly a problem of the stark binaries that inform actual practices in the field. Elsewhere we have talked about the limits of abstinent/using frameworks. Similarly, prevention shouldn’t be understood as something that takes place far in advance of “the problem.” Instead prevention should include the suite of measures that prevent a recognized concern from developing the full set of potential consequences.

In the workplace, prevention isn’t just about stopping risky use of alcohol and drugs before they begin. It is about educating employees to recognize when their behaviors are becoming risky and empowering them to take responsibility for the situation. That means prevention isn’t a matter of telling people what could go wrong. It has to be more nuanced, and more detailed. Prevention includes translating warning signs into concrete actions: helping individuals recognize building challenges and offering tools to revise behavior. The old, and moralistic way, was to “wait until it got bad enough that assistance was unavoidable.” Of course, this often has catastrophic results, and can be years in the making. The compassionate revision of this approach was to “bring the bottom up,” that is to say, to help people see where they were headed and reverse course earlier. A value-neutral, quality-of-life enhancing program goes several steps further: meet people where they are, ask them what they want, strategize how to achieve those goals.

A robust substance use prevention program is highly visible, readily accessible and intimately responsive. Everybody knows about it, it is easy to get to, and it feels (and is) tailored to personal needs. It doesn’t look like pro forma zero tolerance policy announcements (even where zero tolerance is a necessary standard), it isn’t dry and disconnected health lectures, and it certainly isn’t waiting until the crisis is so acute and so unavoidable that it demands action.

In political and policy discussions, preventive health makes for a great sound bite. It promises to save money, it is clearly underutilized, and it looks like a solution. Back in the heated political climate of the 2008 presidential election, Joshua Cohen, Peter Neumann, and Milton Weinstein argued in the pages of The New England Journal of Medicine that these claims were often overstated.3 In their widely cited piece, however, they exempted several areas where the benefits are unmistakable: tobacco cessation, dietary interventions, exercise programs and alcohol overuse. Substance use prevention works. But it isn’t easy to do. When addressing alcohol and drug use, effective workplace policies aren’t enough – sophisticated programming to place employees in the driver’s seat, in their own health decisions, needs to become the gold standard approach.

1JAMA. 2003;289(5):539 doi:10.1001/jama.289.5.539-a.
 2Lillenfeld, Scott O. and Hal Arkowitz. (2014). “Why “Just Say No” Doesn’t Work.” Scientific American Mind 25, 70 – 71. doi:10.1038/scientificamericanmind0114-70
 3Cohen, J. T., Neumann, P. J., & Weinstein, M. C. (2008). Does Preventive Care Save Money? Health Economics and the Presidential Candidates. New England Journal of Medicine, 358(7), 661–663.