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Autumn 2009 | Vol 13 No 1

Q & A

What you should know about helping addiction clients return to work

By Avril Roberts

What are the challenges for people recovering from addiction and returning to work?
“Clients put pressure on themselves to get back to work quickly,” says Brooke Eagle, co-ordinator of Ontario Works and Adult Programs at Rideauwood Addiction and Family Services in Ottawa, Ontario. “They want to prove themselves as skilled and valuable employees, but their bodies aren’t yet working 100 per cent and their ability to remember, learn new tasks and handle stress is reduced. This can be a recipe for stress, low self-esteem and relapse.”

The workplace itself can trigger relapse. For example, alcohol consumption plays a big role in socializing in the food and beverage industry, casual construction work and corporate environments, says Eagle. Work days may have been structured around substance use. “If people were using alcohol or other drugs at lunch time or slipping out in the afternoon to use, their bodies may physically crave substances at those times.”

Workplace attitudes can also be a challenge. “If co-workers know why the employee was away, he or she upon returning to work may feel the general stigmatization of addiction,” says Alison Nielsen-Jones, substance abuse professionals (SAP) program administrator for Family Services Employee Assistance Programs in Toronto. “There may also be suspicion or lack of trust, particularly if the employee’s work performance was affected prior to addiction treatment.” Colleagues who don’t know why the person was away may resent having had to shoulder additional tasks during the absence.

Exclusion from social events like baseball games, where everyone goes out for beer afterwards, can be an unpleasant surprise. “People don’t know what to say or how to act, so they end up excluding recovering employees from the very activities that help make the workplace worthwhile, rather than engaging them and giving them opportunities to participate without jeopardizing their recovery,” notes Dr. Rick Csiernik, professor of social work at the University of Western Ontario in London.

Another issue is that aftercare follow-up and support may be inadequate, says Reza Roodi, director of recruitment at Embers Staffing Solutions, an employment agency in Vancouver, British Columbia, that helps people recovering from addiction find jobs. Employees may be unaware of supports available in the workplace or unwilling to access them because of stigma or confidentiality concerns.

People living on the margins who need long-term support may find that support is no longer available once they return to full-time employment. For example, as Eagle explains, Ontario Works funding of a participant in the Addiction Services Initiative ends once the client is no longer receiving social assistance.

What job search issues does a person in recovery face that a person without addiction doesn’t?
Post-acute withdrawal syndrome is a major barrier for job seekers, says Liam Carey, a counsellor with Oasis Addiction Recovery Society in Toronto. Depending on the drug and the length of time using, these physical and emotional symptoms can last up to two years and may include an inability to think clearly, memory problems, limited focus, emotional instability, overreaction or numbness, sleep disturbances, physical co-ordination problems and extra-sensitivity to stress. People may not have enough energy to do a full day’s work. “In early recovery, many people can just about handle four hours,” notes Carey.

Explaining gaps in a resume can be tricky. Eagle notes that clients who participate in Ontario’s Addiction Services Initiative for people on social assistance typically have a host of issues: long-term, chronic street-level addiction, precarious housing or homelessness, generational welfare, limited education and training, criminal backgrounds, sporadic work history, multiple addictions, including sex addiction and co-occurring mental health problems. It’s not easy to disclose this type of background to potential employers.

Once on the job, requesting time off during the work day can be a problem. People may need flexible scheduling to attend 12-step meetings, counselling, therapy, court diversion or other recovery activities, says Carey.

How do you know when an addiction client is ready to return to work?
For Nielsen-Jones, who conducts substance abuse assessments of employees who have tested positive for substance abuse, “The clear gauge for return to work is that the person has completed the treatment portion of their referral to addiction services and is now on to relapse prevention.” However, she cautions that from a liability perspective, addiction counsellors should never state in writing that a person is ready to go back to work. “All risk management needs to remain on the shoulders of the employer,” she says. She suggests that a better course of action would be to issue a letter to the client noting: “You have successfully completed such-and-such a treatment program. You are successfully complying with the relapse prevention program. At this point, there’s no clinical reason that I see that you need to remain off work.”

Roodi requires his job-seeking clients to be clean and sober for a minimum of three months and have some stability, for example, stable accommodation, a telephone for contact and treatment for mental health issues.

Eagle individually assesses each client, asking, Is this workplace, workload or work environment a good match for you? Is this a good time for you to be returning to work? She says the Ontario Works clients who reintegrate successfully into community and work environments typically stay in the Addiction Services Initiative program for up to three years.

Work readiness may include the kinds of pre-employment preparation available to Oasis clients: basic life skills training in areas such as task completion, problem-solving, conflict resolution, time management and interpersonal communication, personality/career assessment and computer training.

Can return-to-work policies promote medication use and even create addiction?
In qualitative research on return to work after injury, Dr. Ellen MacEachen, a scientist at the Institute for Work and Health in Toronto, has found that aggressive return-to-work policies are resulting in injured workers returning to work earlier than they should and taking increasingly higher doses of addictive pain medications, such as opiods, to keep functioning at work.

Nielsen agrees that injured workers may be pressured to return to work, but says that increasing pain medication doesn’t necessarily lead to addiction. “It’s not the dosage that creates an addiction. There have to be other factors contributing to the risk of having an addiction.”

How can clinicians help clients return to work and stay at work?
Clinicians should develop a firm, structured relapse prevention plan detailing concrete actions clients should take and have clients sign off on it. For example: Attend AA or NA meetings three or four times a week, or attend a specific aftercare program two nights a week for 16 weeks. The plan should also include immediate steps clients can take if they think they are in danger of relapse, for example, calling a supportive friend. “The more connections they have, the quicker people go back into recovery,” says Carey.

Clinicians should also prepare clients for return to work by having extensive discussions about the workplace – colleagues, friends, supervisors, social aspects, triggers for relapse, job expectations, job stressors. Role playing is a good way to develop strategies for dealing with workplace issues, such as asking for accommodation or managing conflict on the job.

Tapping into client’s dreams – asking, What do you want to do? What were your dreams when you were a kid? – can boost clients’ self-motivation and uncover hidden talents and potential, says Roodi, who is a firm believer in the merits of vocational training: “Not just any vocation that will keep people at a minimum wage, but vocation that will eventually turn into work where people can make a substantial living.”

What workplace supports exist to assist employees recovering from addiction?
Employee Assistance Programs (EAP) can offer personal supportive counselling to employees returning to work after addiction treatment. EAP counsellors are generalists who may not have expertise in addiction, but they can address workplace and personal issues that influence recovery, monitor progress on the relapse prevention plan and help clients meet recovery goals. EAP counsellors can also provide referrals to community-based organizations and services.

Workplace accommodation, the other key form of workplace support, can offer a variety of choices to assist in the gradual reintroduction to work. Peer assistance can be another valuable support. Some large organizations, typically in the industrial and manufacturing sectors, hold self-help meetings on-site. Many professions, such as medicine, law, policing and aviation have peer recovery groups. In unionized workplaces, there may be counsellors to provide ongoing support. Temporary workers, casual and seasonal labourers may be able to find peer recovery support locally.