Could a simple alcohol wellness intervention help reverse the employee mental health crisis?

By: Dr. Adi Jaffe and Dr. Debra Lafler

Everyone is talking about employee wellbeing. It is now one of the main strategic business objectives for employers going into 2022. With two years of the COVID-19 pandemic and many business, cultural, political, and overall way-of-life changes, employees are struggling to adjust.

Employees and their families are reporting more stress, greater depression and anxiety, and increased feelings of burnout. Employers are responding with changes to culture, work-life balance improvements, education and resources for self-care, and are offering more mental health benefits.?

However, what hasn’t been widely reported yet nor addressed in a systematic way is the alarming increase in alcohol consumption during the pandemic and how that may be impacting employee wellbeing.?

Employee wellness is expanding

Historically, employee wellness has focused on things like physical activity, nutrition, weight loss, and stress management. It has offered screenings for blood pressure, cholesterol and glucose. Wellness portals, apps, and incentive programs have been popular. In the last two years, resilience training has also become more widely available. However, wellness offerings have always been more of a ‘nice to have’ rather than a necessity for companies. Now, with a full-scale mental health crisis on our hands, two things have changed. Employee wellness is no longer a ‘nice to have,’ it is a priority, and mental health support is a serious and necessary focus. With that, employers have been emphasizing their employee assistance program (EAP) and mental health benefits to help, but they are looking for what else they can do.?

A hidden epidemic affecting employee wellbeing?

Addressing alcohol has, for the most part, never been addressed in the employee wellness field. Employers may promote their employee assistance program (EAP) and mention the availability of alcohol and substance abuse help in its description, but that’s usually as far as it goes. However, alcohol and wellness are known to be intimately intertwined, and employers should include it more prominently in their programming, especially now.

Why now? Drinking is at an all-time high and it’s affecting everyone.

During the pandemic, social trends of having “quaratinis,” Zoom happy hours, and even putting alcohol in your mug and hiding it by taping on a tea bag tag while working, became a reality. Studies have shown that 60% of Americans surveyed increased their drinking at the outset of the COVID outbreak. While early data shows substantial fluctuations, on average, drinking frequency has increased between 18%-254% and people are drinking 40%- 200% more alcohol per month. Additionally, there has been at least a 20% increase in alcohol sales from 2019 to 2020 ; and a 41% increase in heavy drinking for women in 2020 . For the first time ever, studies are showing that women now are drinking equal amounts to men. This is important because alcohol affects women’s bodies more severely. They experience more hangovers and blackouts and show signs of significant health issues like liver problems, heart disease, and cancer more quickly than men. Furthermore, regular heavy and binge drinking, regardless of gender, are associated with substantial mental health struggles, and the current trends suggest we are heading towards a maelstrom of serious psychological implications.

And alcohol use may just be our “canary in the coalmine.”

Alcohol as a solution and potential problem?

Alcohol is used in our society as a multi-functional tool. We see it as a social symbol of connection, joy, and relaxation. We serve it at happy hours, dinners, gatherings, celebrations, sports games, and even work functions. More importantly to the issue at hand, our society uses alcohol as a solution to stress and mental health issues. We use it to cope with feelings of depression, anxiety, anger, grief, loneliness, boredom; and to help us fall asleep.?

Unfortunately though, if alcohol becomes the primary source of coping instead of healthier tools and strategies, it can become a problem. Heavy alcohol use can lead to serious mental, and physical, health issues. It can also impact the quality of our lives and the way we show up at work and at home.

Now in the aftermath of the last couple of years, we find ourselves in a place where alcohol is playing this exact dual role, being both the solution and the problem, for many Americans, including those who are full and part-time employees. In lieu of other mental health support, many are relying on alcohol as their primary coping strategy, and this is found to be the case both after work, and increasingly during work. With remote work being more prevalent, we are seeing more earlier-in-the-day drinking (like instead of waiting until 5 p.m., people are starting to drink at 3 p.m.), and therefore too, on-the-job drinking (like with the taping on the tea bag tag example).??

Unfortunately, if we simply wait for things to resolve on their own, they are likely to continue worsening.?

Help shouldn’t just be for “alcoholics”?

Historically in our society, and in the workplace, we don’t offer resources or services to help people with alcohol use until they start acting in obvious problematic ways. We may even label them as “alcoholic.” Employers usually wait until someone is not performing their duties, displaying poor behavior, repeatedly calling in sick, and/or they keep showing up to work either very hungover or still heavily intoxicated and “smelling like a bar.” The employer then usually enforces some sort of discipline procedures, possibly puts the employee on leave, and suggests professional treatment. This isn’t helping. This is blame, shame, and punishment.?

Yes, the employer likely has an employee assistance program (EAP) to help locate substance abuse treatment, and/or medical and mental health benefits to help the employee pay for such treatment. However, the bad news is, first, it is much harder to treat alcohol use at later stages; and second, traditional substance abuse treatment approaches are not always as successful as we think they are. They often fail, lead to extended absenteeism or job loss, and create conflict and pain instead of gratitude and help.

By waiting to offer resources and services to individuals until later stages of problematic alcohol use, we are missing the opportunity to help employees earlier, and have that help actually be effective. Intervening in alcohol use early, with simpler and less intrusive solutions, is not only ideal, but imperative.?

Offering resources early would also likely be seen as a well-being perk for employees, which could boost morale and engagement.

It’s time to stop thinking of alcohol-based interventions as something just for “alcoholics,” and instead think of them as a way employers can support all employees with their wellbeing, just like any other wellness program. Employees want help. They just don’t know where to turn.?

Traditional addiction treatment isn’t the way?

The vast majority of individuals who struggle with alcohol and drug use do not seek help. To provide a statistic, of the 70 million Americans who report struggling with alcohol or substance use, only approximately 2.5 million reach out for professional treatment. Unfortunately though, even among those 2.5 million that do try to get help, recovery success rates are low and relapse is the norm. This isn’t a personal failure on their part, this is a systematic failure. The way we do treatment isn’t working.

Perhaps more importantly, it isn’t only about those that get help, it’s about those that don’t. Over 90% of people who consider themselves in need of help for alcohol or substance use do not seek it out because of 4 primary barriers :

• Cost
• Logistics
• Shame
• Abstinence

Cost and logistics: professional treatment is expensive, even if you have health insurance. Also, it takes a lot of time. You have to take time off of work, sometimes without pay. You have to schedule time away from significant others for hours a week, multiple days or even a month or more at a time. If you are a caregiver to children or elders, you have to hire help while you are away. Unless you are wealthy, most people can’t afford this sort of help.?

Shame: getting professional treatment is seen as a sign of addiction, and addiction (especially to alcohol or drugs) is seen as a personal and moral failure. We see it as bad behavior, worthy of punishment and exile. Further, we typically only recommend treatment for those who are “alcoholics” or “addicts” or labeled as having an “alcohol use disorder,” or “substance use disorder.” We view it as a mental illness and/or a disease. Even worse, these conditions are seen as lifelong. We say things like “once an alcoholic/addict, always an alcoholic/addict.” These shameful perspectives are not only wrong, they are harmful and deter people from getting help.

Abstinence: essentially all professional treatment and support groups require abstinence. In many community support groups, participants are taught to introduce themselves using the label of “alcoholic” or “addict.” If someone is successful, it means they’re “sober” or “clean,” as if drinking or using substances make a person “dirty.” We use sobriety as the main measure of recovery success and ignore most, if not all, other wellness indicators. For some, this traditional method of recovery works but, for a majority of people, it does not. For those in earlier stages of alcohol use, who often don’t want abstinence, this system is simply not relevant. They want to learn moderation skills, they want to better understand the reasons behind their lack of control, and they want to move forward in a measured way. Even many of those in later stages of alcohol use often resist quitting entirely, making the requirement for entry a major deterrent for getting help. This sort of requirement isn’t present in general mental health care (imagine a psychologist telling someone who struggles with depression that they have to commit to not being depressed before entering treatment) or in traditional medical work.

There has to be a better way.

What employers can do?

Employers can start by talking about alcohol use openly because it is an issue that a majority of us are dealing with, whether that be ourselves or our loved ones. We can include educating about alcohol use in our campaigns, challenges, and seminars. We can put flyers on office bulletin boards (for those working onsite), and put articles and links to resources in employee newsletters or on the company intranet.?

There are a number of national health observances that employers can promote, like Alcohol Awareness Month in April, and Recovery Month in September. There are also publicly promoted challenges during the year like Dry January and Sober October, that employers could promote for employees to engage in.?

To help employees that are in late-stage alcohol use, and in serious need of professional treatment, employers can continue to promote their employee assistance program (EAP) services and remind employees about their mental health benefits through the health plan.?

To help employees, no matter where they are on the alcohol use spectrum though, employers can also look into newer innovative solutions. In the last few years, a number of online platforms have emerged that offer programs, support groups, and one-on-one coaching. These platforms often come at a cost, with a monthly or annual membership fee.?

Since cost may be a barrier to employees engaging in these types of programs, employers can assist by either purchasing access to the platforms for all employees for a discounted rate (just like wellness portals), or offering full or partial reimbursement for individuals that join (just like gym memberships).?

If employers are going to offer access to a platform though, it is best that they do their due diligence and review the content and services, keeping in mind the 4 primary barriers we discussed earlier: cost, logistics, shame and abstinence. Also, since these programs involve entering personal health information into the portals, it is vital that employers review the privacy policies, and ensure their employees' information would be kept private and confidential.?

An exemplary virtual program leading the way

IGNTD was one of the first online programs to be offered, starting in 2017. It was built as a way to combine methods from a variety of research-based approaches and overcome the 4 barriers.?

It’s a fraction of the cost of traditional treatment. It’s online and accessible to anyone, anywhere, any time. There is no labeling (no shame), and abstinence is not required - the individual gets to choose their path.

IGNTD combines methods from:

• Behavioral neuroscience
• Cognitive-behavioral therapy (CBT)
• Acceptance and commitment therapy?
• Harm reduction?
• Positive psychology?
• Mindfulness
• Trauma-informed recovery
• Epigenetics?
• Habit learning?
• And more as new research and methods emerge?

IGNTD provides an online system that includes an easy-to-use tech platform with personally customized content and tools, live support groups, chats, and one-on-one coaching. Most impressive though is the platform technology, a first-of-its-kind in the alcohol and substance industry.

The IGTD platform experience is made to feel like a personally guided journey that allows each person to access help from their phone, tablet, or computer and at any time during the day that is convenient to them. The system learns who the person is (through assessments, interactions and use data) and provides them with the help that is uniquely suited to them. Each person’s help journey is fully their own, and as unique as their fingerprint.

It starts users out by providing a simple, science-based assessment in order to ascertain their initial level of struggle, personal history, and special requirements. Then based on the results, the platform selects the specific content, videos, workshops, and groups that are best for the individual at that time, pulling from a large database of available content.??

The communication they receive adjusts based on their specific interactions. As the user interacts with the system, their recommendations improve over time. For example: Do they like more inspirational or educational videos? Do specific approaches seem to provide better outcomes for them? Do they feel better when interacting with a specific group at a specific time of the day? Over time, their data becomes more and more specific to them.

Also, the system is both adaptive and responsive. Adaptive in that it adapts and adjusts based on users' preferences. For example - some people respond well to cognitive-behavioral therapy (CBT) techniques, and others to mindfulness; some like hypnosis, and others like sharing in groups. And it’s responsive in that it responds to the level of intensity needed based on the user’s preferences and progress. For example - some need more intense help at times, and less intense help when they feel they are doing well.

In the very near future, the platform will also interact with in-person care. If a user of IGNTD’s system needs more help, they can be referred to a local provider who will be able to access all of their records, provide short-term stabilization and acute care (e.g., detox, a week of intensive treatment, etc), and allow them to more quickly return to their lives. In this way, each person’s entire help journey can be made more efficient, less expensive, and less disruptive to their lives.

In sum

Employees are struggling. In fact, we all are, even Executive Officers at many companies are finding themselves stretched and stressed. No one is immune, and no one is to blame. We are not failing; we are human. Alcohol is a part of our culture. It is everywhere. It is also being heavily relied on at this time as a mental health coping strategy. We must provide help.?

Employers are focusing on employee wellness and including mental health as a priority in their plans. Alcohol is usually not included in that plan, unfortunately. However, alcohol is a major contributor to physical and mental health issues. If employers want to help employees with their alcohol use and prevent long-term complications, they need to get innovative with their solutions. Referring employees to the employee assistance program (EAP) or letting them know they have mental health benefits is not enough. We need to treat alcohol use like we do with any other health and lifestyle behavior (e.g., physical activity, nutrition, stress management, etc.).?

Employers can start by talking about alcohol openly, and offering education throughout the year. They can also choose to be on the “cutting-edge” and offer employees an online system, designed personally for them.

In the end, employees need to feel supported and provided for. Employers can do so in a number of ways. Helping with alcohol use is one of them.

Sources:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7763183/

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2770975