Background Information

Substance abuse prevention programs are concerned with reducing the risk of individual use and abuse of alcohol and other drugs. The Institute of Medicine's definition of prevention, applied to the workplace, provides the following three types:

• Universal Preventive Interventions - focuses on the entire work force and families;
• Selective Preventive Interventions - provides interventions for members of the work force or their families who are in a high risk category for substance abuse;

• Indicated Preventive Interventions - high-risk workers or their family members having signs or symptoms of substance abuse problems.

By integrating substance abuse prevention within health and wellness programs in the workplace, employers can reach the broadest possible audience of employees and their families while reducing the negative impact of the stigma often associated with substance abuse.

Why Employers Should Include Substance Abuse Prevention In Health Promotion

• Most heavy drinkers (77%) and illicit drug users (70%) are working adults;
• Alcohol and drug use/abuse among employees is strongly associated with accidents, absenteeism, turnover, and work performance problems;
• The workplace is where large numbers of parents can be reached with messages about keeping children alcohol and drug-free positively impacting on work force productivity and reduced employee stress;
• Substance abuse prevention messages can be successfully integrated into standard health promotion and wellness programs such as stress management without effecting the goals of the health promotion program;
• Workplace based substance abuse prevention programs can reduce such costs as workers' compensation claims, litigation, injury, and health insurance, among others.

Integrated Health Promotion/ Wellness and Substance Abuse Prevention Programs

Workplace based health promotion programs promote and support employee and their family health and wellness through awareness, education, and skill building activities and environmental/behavioral change. These programs have been shown to have a positive return on investment (ROI). Employers have an increased interest in encouraging and supporting healthy lifestyle choices, as they become more aware of the interrelationship of employee health and productivity. Employer costs for these programs can rapidly be offset with fewer work-related injuries, improved attendance, less turnover, and increased morale. As employees and their families work towards optimum health in these programs, their sense of loyalty to and the satisfaction with the workplace increases.

Health promotion programs can prevent substance abuse by: (1) moving people toward more healthful lifestyles and/or, (2) providing them with motivation, skills and knowledge directly applicable to substance abuse prevention. These approaches focus on primary and secondary prevention (not detection and treatment). Several researchers have documented impact on health attitudes/practices and measures of substance abuse.

Health promotion programs can include a number of strategies and activities. Some of the most popular activities include: health risk assessments/appraisals, brown bag seminars or training classes on specific topics, newsletters, health fairs, incentive programs, work/life programs, exercise facilities. Environmental and policy-level strategies include substance free workplace gatherings, drug-free workplace policies, smoke-free environment, and upper level management participation. Health promotion topics presented in the workplace include stress management, nutrition/weight management, time management, smoking cessation, cardiac wellness, women's health, and substance use and abuse. Research has shown that integrating substance abuse prevention messages into basic health promotion topics is more effective than presenting substance abuse as a stand-alone topic. Often, programs offer incentives to increase participation. These incentives may include reduced health care premiums, bonuses, time off, health club members, trips, etc.

Different occupations and diverse audiences can require modifications in topics and strategies. What works well in one workplace may not be suitable for all workplaces. Programs need to be culturally and linguistically appropriate and the gender and age of the audience should be taken into consideration. Programs may be offered either within or outside the facility.

Program Accessibility and Confidentiality

Programs should be selected and designed to meet employee and employer needs. To reach the broadest possible audience at the times most convenient to the employer, their employees and families, a variety of strategies should be considered. Workplaces vary in the types of approaches which can be accommodated. For example, long-term classroom-based training may be too time consuming for some workplaces. Alternative strategies include: interactive computer/web-based training, videos and print materials, distance learning techniques, and technological applications. These techniques may be especially suited for physically challenged employees, shift workers, and employees particularly concerned about the stigma attached to particular health topics. They also broaden the ability of the program to reach employees' families. Programs must be offered in a manner in which employees and their families feel their confidentiality is protected, for example when implementing health risk appraisals.

Removing the Stigma of Mental Illness and Substance Abuse

Many employees do not want to be associated with anything related to substance abuse or mental health topics. At health fairs, frequently the booth on substance abuse prevention is not visited at all unless there is a substantial incentive (prize, giveaways, etc.). Employees and family members who find themselves in a substance abuse related crisis might have been able to avoid it if only they had been more comfortable to early on obtain information or assistance.

Health promotion and wellness programs are effective vehicles to disseminate knowledge and reduce the risk and/or impact of substance abuse and related problems such as HIV/AIDS, sexually transmitted diseases, depression and other mental illnesses, and violence and victimization that affect employees and their families. Providing employees and family members with applicable information is a way to attend to problems now and prevent future problems.

Employees may not be comfortable attending a program entitled "Substance Abuse and You" or "Dealing With Depression," fearing they have "self-identified" just by their presence. However, when much of that same information is billed as "How to Talk to Your Kids About Drugs," "Recognizing and Reducing the Signs of Stress," or "Facing Traumatic Events," there is considerably higher participation.

How Are Health and Wellness Programs Provided?

Health and wellness programs can be delivered in a number of ways. Employers can choose to offer the program through their own organization (frequently, through their Human Resources Department) or through their union(s). As an alternative, many employers contract for these services through their health care provider, Employee Assistance Program provider, or independent human resource or health promotion program provider. Many small businesses form consortiums that purchase these services at reduced costs. The comprehensiveness and intensity of the program can vary depending on whether the program is internal to the organization or external and the needs and resources of the workplace. Employers or unions contracting for these services should work closely with the service provider to ensure that programs match the needs of their employees/members and their families.

Evaluation

A number of different evaluation tools are available - from the most simple to the most sophisticated; short-term to long-term. The extensiveness of the evaluation depends on the questions you are trying to answer. The basic areas of evaluation include:

• Participation information (who attended, how many, etc.)
• Employee opinion of the program's usefulness
• Management opinion of the program
• Effectiveness of the program on targeted outcome (e.g., weight loss, smoking cessation, stress relief, reduced substance misuse, etc.)
• Cost (e.g., cost avoidance, cost effectiveness, return on investment, etc.)
• Policy/environmental implications

Program evaluation is important to understand the impact of the program on the workplace, the employee, and their family and to strategically plan for future implementation of such programs.

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