Substance Wellness: Rethinking Substance Use Treatment and the Role of Employers

Workit Health understands itself, its program and its membership as contributing to a recent and important cultural shift in behavioral health. There is an ongoing evolution from a value-laden and moralizing understanding of addictive behaviors towards a more nuanced view that is both empowering and scientific. We are hardly alone in this. Maia Szalavitz opens her rightly lauded Unbroken Brain with an author’s note about language: her ardent desire to replace stigmatizing and dehumanizing language with terms like “person with addiction,” emphasizing the humanity and the complexity of her subjects. She similarly advocates for “substance misuse” in place of “drug abuse,” given the negativity associated with “abuse.” For closely related reasons, Workit Health treats addictive behaviors, rather than addicts or alcoholics. Many members of the Workit family may not identify with the imagined severity of the condition popularly meant by words like “addict” or “alcoholic.” Instead, these members want to manage their relationship to substances outside of the larger frame of an identity: “drinking less” for instance, not“recovering from alcoholism.” But this choice in language is also part of a deep commitment. When Workit Health targets “addictive behaviors” it stresses that these are things a human does, not what a specific humanis. This is a key distinction.  A behavior is just one part of a complex constellation of attitudes, attributes and actions contributing to a person. Altering what we do is a fundamentally more manageable task than changing who we are. Replacing a response to stimuli (a behavior) is, in part, a matter of learning a new response and practicing it. Here we are again allied with the core argument of Szalavitz in Unbroken Brain, what she refers to as the “role of learning” in addiction. A core contention of the Workit Health program is that we can learn new ways of responding to the world around us. Thus while remaining agnostic on the “disease concept” of addiction, Workit Health is able to emphasize that behaviors emerge in context. Sometimes we can re-author those contexts just as much as we revise our behaviors within them. But sometimes we need help to generate the new possibilities that accompany new contexts. This is particularly clear in our workplaces.

In a conventional workplace benefits arrangement, addictive behaviors are an individual pathology to be treated in secret. Far beyond discretion, this situation lends itself to the added challenge of viewing substance use or misuse as a moral burden. The need for intervention – the behaviors an employee would like to alter – becomes a potent source of shame, itself a barrier to change. Accessing a hidden resource (by design or default, many assistance programs feel hidden), an employee must covertly undertake a major challenge, alone. It doesn’t have to be this way.

“Substance wellness” is not a personal project. It belongs in the mainstream of organizational concern. Individual confidentiality can be carefully maintained while a company-wide supportive environment is cultivated. Helping employees and colleagues understand their current relationship to substance use, and empowering them to author a new relationship as needed, is a matter in the collective interest. A holistic understanding of wellness needs to extend to brain health, a domain where substance use and misuse is one core area of consideration.

When a shared commitment to substance wellness is instilled as a cultural value, small shifts in the behavior of a population can add up to a significant workforce improvement. A healthier company is ultimately a more effective one. Crucially, these aggregate gains in productivity are felt pointedly in the lives of employees with the highest acuity of substance use. When an individual needs to comprehensively alter a behavior – by pursuing abstinence, for instance – it is vital that she or he return to a workplace environment that allows for non-drinking or non-use. Not-drinking needs to be an appropriate and valued avenue for full company cultural participation (and believe us, they aren’t by default!). The broad atmosphere of support generated by this kind of cue helps employees with the most severe substance challenges thrive.

Altering addictive behaviors isn’t easy, but it isn’t impossible either. Employers have a big role to play. The right stewardship can create a climate where change is imaginable, accessible, and achievable. Unburdened by moral judgment, smart employee substance wellness programs give employees the tools they need and a place to use them.