The power of protective layers: Employers advancing whole-person health

By Dr. Nora Volkow

This blog was originally posted here .

There is a growing movement among employers to holistically recognize employees’ mental, financial, and physical health through a "whole-person" approach.?

This blog re-posts a feature from the Milken Institute , in which Sabrina Spitaletta, senior director, Public Health discussed with Dr. Nora Volkow the ways organizations can lead with policies and activities that promote optimal mental health and prevent substance use and misuse.

1. Employers are defining "whole-person health” in various ways. From your perspective as the director of the The National Institute on Drug Abuse (NIDA) , how do you envision a whole-person health approach in the workplace? The concept of whole-person health is based on the evidence that a person’s health and well-being derive from a number of interrelated factors—biological, environmental, behavioral, and social. These factors also influence the development of health conditions, including mental health and substance use disorders. Factors that have a negative aspect may increase the risk of substance use. For example, workers experiencing a stressful environment at work are at higher risk for drug use and for developing a substance use disorder. On the other hand, positive aspects of a person’s environment, such as a supportive community, stable employment, and access to health care, can protect against substance use disorders. From an employer point of view, positive environmental and social factors might translate to establishing fair and equitable workplace policies on health insurance, paid sick leave, family leave, flexible work schedules, and other benefits and assistance.
2. What are the risks if employers do not adopt or move towards a whole-person health approach? According to a 2021 survey from the Substance Abuse and Mental Health Services Administration (SAMHSA) , about one in five of all full-time employed adults in the US reported having a substance use disorder. A person with such a disorder may experience crushing setbacks in their health and in their life. Substance use can also affect performance at work. For example, cannabis use is associated with cognitive deficits, motivation problems, and perceptual distortions, as well as increased risk for workplace injuries and accidents. Employers have numerous interests in preventing on-the-job impairment related to cannabis use and other substance use, which could affect their own or others’ safety. Employers also have an interest in keeping their employees free of other consequences of substance use disorders, which include increased health-care costs, absenteeism, and decreased job performance. Beyond the workplace, substance use disorders and related health problems are an urgent public health issue. More than 110,000 people died from drug overdoses in 2022, the most in any year, according to predicted provisional data from the US Centers for Disease Control and Prevention .
3. What steps are employers uniquely positioned to take to normalize and achieve a whole-person health approach? There are effective programs for preventing and treating substance use and substance use disorders, but their use remains limited. Only 22 percent of people with opioid use disorder, for example, receive medications to treat it. Employers can learn how best to integrate comprehensive coverage of treatment for substance use disorders and mental illness into their insurance and reimbursement process. Employee wellness programs can also be an ideal environment for delivering evidence-based prevention interventions. These activities help people in the early stages of a substance use disorder before it becomes a more severe health condition. A CDC report in 2018 found that employer-sponsored medical expenses related to employees with substance use disorders cost $35.3 billion that year. Preventing and treating addiction can help offset these costs. Other steps can save lives of employees and the public, like providing the opioid overdose reversal medication Naloxone on worksites and training employees how to use it.?
4. How can employers develop a culture of whole-person health in the workplace? Stigma against people with substance use disorders can keep them from seeking treatment. We know that a substance use disorder is a chronic, treatable condition. When an employee communicates that they are facing a substance use disorder, approaching it as a medical condition can reduce the stigma that can keep people from seeking badly needed medical help. Workplaces are in a very good position to address this problem. Employees should feel safe speaking with managers, coworkers, and workplace-sponsored health program staff about their substance use or mental illness, knowing that they will be treated with equity, with respect, and with confidentiality. One good place for employers to start in developing a culture of openness and acceptance is by learning and sharing Words Matter , NIDA’s guide to using language that does not perpetuate stigma.
5. How do employers build a sustainable whole-person health approach that anticipates the ebb and flow of the external environment, whether those are shifts in the economic, social, and/or political landscape? Employers can look to current scientific evidence as a bedrock for establishing sustainable whole-person health policies and activities. The National Institutes of Health funds scientific evidence on drug use, its health effects, treatment, and recovery. This research can inform policies and practices of communities, other federal agencies, state and local health leaders, education, human services, and the legal system. The business world can also use these general principles in approaches to employee health and wellness. There is a wealth of good, established data when it comes to promoting optimal mental health and preventing substance use and misuse.

View Nora's blog on NIDA's website.