alcohol and other drug problems among addiction professionals

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◆◆The difficulty of treating severe pain adds an element of complexity to discussionsof opioid pain medication use, misuse, abuse, and dependence. Whatother pain-management options are available? What constitutes dependencein cases of severe chronic pain? Under what circumstances might these issuesbe different for employees in recovery, and for employees in recovery from opioidaddiction?Definition of the term “relapse” grows more difficult when the substance beingused has been prescribed for a legitimate medical condition, and especiallywhen that substance is being used as prescribed.Participants agreed that much more work is needed to address all these complexities;to define the necessary terms; and to establish guidelines for distinguishinglegitimate use from misuse, abuse, and dependence. Guidelines are needed to helprecovering people manage their medication in responsible ways. Organizations alsoneed clear policies for the safeguarding of staff members’ mood-altering medicationsin areas where clients might otherwise gain access.As they did in response to the previous two questions, participants also emphasizedthe need to focus on behavior in the workplace, and on the measurementof that behavior against existing policies and ethical codes. Potential solutions tothese and other issues are discussed in greater detail in Chapter Three.nShould Recovering Staff Be Treated Differently?Participants’ next task was to map out any differences in the ways in whichorganizations and their leaders tend to respond to recovering and non-recoveringstaff. They were asked to discuss the differences in: (1) the requirement for abstinence;and (2) the consequences of the use and/or abuse of alcohol and otherdrugs between:◆◆Addiction professionals who publicly affirm that they are in recovery andAddiction professionals who publicly affirm that they have no problems withalcohol or other drugs, and those who evade the issue.Participants cited a number of difficulties and complexities they faced in discussingthese issues:◆◆Differences in the definitions of terms such as “recovery” and “relapse” may againpose obstacles in these discussions.It is essential to determine which problems might legitimately be related tolapses in recovery status. Does this apply only to resumption of AOD use, oralso to disruptive behavior patterns related to a lack of self-care and attentionto personal recovery? (It is not uncommon for people working in the addictionn 24 n
◆◆field to interpret their work with clients as “12th-step work,” and to use that interpretationas a rationalization for neglecting self-care.)Policies in this area are often inconsistent from organization to organization,and often inconsistently followed within a single organization. Standards mayalso vary in different types of treatment settings (e.g., medication-free treatment,methadone programs, therapeutic communities, DUI programs).The question of whether or not employees are treated differently based ontheir recovery status is often followed immediately by the question of whetheror not, or in what ways, they should be treated differently. Does their higherlevel of vulnerability to these substances justify stronger vigilance on the partof supervisory staff?There was a fair amount of consensus that recovering staff are treated differentlyfrom non-recovering staff, although policies might dictate otherwise. Participantsaffirmed that recovering staff are often under higher levels of scrutiny and supervision.They may be passed over for promotions because of assumptions based ontheir recovery status. Changes in mood or problems in performance or behaviormay raise suspicion or be interpreted as relapse patterns, while the same changesor problems might be overlooked in non-recovering staff.Participants also said that problems and possible relapse signs tend to be overlookedmore often in high-value and long-term employees, regardless of recoverystatus. This can result in discriminatory treatment, with all the resulting damage toemployee trust, team cohesion, and effective teamwork.In considering and establishing standards in this area, it is essential to:◆◆◆◆Set clear and consistent standards and establish these as preconditions foremploymentFocus on whether or not the use of alcohol or other drugs causes impairmentin job performanceTake into account the impact on community perceptions of treatment and ofthe treatment organizationEnsure that the standards provide protocols for intervening effectively in theevent of relapse, rather than simply terminating employees who relapseThis exploration of the problem left participants eager to tackle the next phaseof discussion: ways of addressing these challenges. That is the subject of Chapter 3.n 25 n
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