alcohol and other drug problems among addiction professionals

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Project Spotlight: Federal Guidelines and Impairment PoliciesParticipant Arnold Evans reported to the group on his review of relevant guidelinesand policies, most notably the Americans With Disabilities Act (ADA), theHealth Insurance Portability and Accountability Act (HIPAA), and the Drug-FreeWorkplace Act. He also discussed some implications of these policies.The ADA has several implications for employers’ decisions regarding therights of employees in recovery. That Act was designed to protect the rightsof people with disabilities and mandate reasonable accommodations necessaryfor people to obtain and maintain gainful employment. “Reasonableaccommodations” are measures that make sense and are affordable within theconstraints of the organization. (See Page 31 for further discussion of reasonableaccommodations.) Recent court decisions have limited ADA protection forpeople with SUDs to those who are in recovery and not still using illegal drugsor misusing prescription drugs.It will be essential to establish criteria for determining “reasonable suspicion”of relapse. If an employee’s behavior patterns vary from his or her ownnorms in negative ways, the employee will need referral to an outside resourceto determine the nature and extent of the problem. Whether or not the relapseaffects on-the-job behavior and effectiveness, and whether or not an employercan prove this impact, are also essential considerations.For those cases in which employees do relapse and seek treatment, it isimportant to have consistent standards for the length of time that must passbefore they are able to resume counseling duties. Some other professions haveprescribed time-periods for employees returning to work after treatment. Forexample, nurses are required to be alcohol and other drug free for five yearsbefore returning and must be monitored after their return. In addition, it isnecessary to determine both the length and the quality of recovery necessarybefore a staff member can be an effective counselor.If employees bring illegal drugs (or illegally used prescription drugs) intothe workplace, or report to work impaired, their actions violate the Drug-FreeWorkplace Act, whether or not they are in recovery. Responses to recoveringand non-recovering staff should be the same in these cases.When addiction is addressed appropriately, as the medical condition thatthe best-respected bodies (e.g., the American Medical Association, the AmericanPsychiatric Association, the American Society of Addiction Medicine) havedeemed it to be, the privacy of people with this disease is protected by theHealth Insurance Portability and Accountability Act (HIPAA). It is the employer’sresponsibility to maintain compliance with HIPAA standards.n 34 n
nEmployer ExpectationsParticipants made it clear that employers are responsible for setting appropriateand realistic expectations in this area and articulating these expectations clearlyin policies and in job interviews. Expectations cannot be presented for the first timeafter the employee has accepted the job, or after the expectations have been violated.The employee’s responsibility is to take all these expectations under seriousconsideration in deciding whether or not to accept the job and to live up to all standardsset forth for the job that he or she has accepted.The organization’s policy and procedure manuals must include an outline ofeach position, including all requirements, qualifications, and expectations. Thesemust be packaged in text that meets all the tests required, including those imposedby regulatory, statutory, and internal policies. Each job description shouldclearly describe the functions associated with the position, the responsibilities ofthe position, and the general codes of conduct that apply during working hoursand non-working hours. One key is a focus on fitness for duty and the mental, emotional,and AOD-related requirements that are necessary to ensure that an addictionprofessional is fit for duty.To some extent, science-based practices can provide a framework for the developmentof effective clinical skills, and so serve as a form of support for healthyprofessional practice. Wherever possible and appropriate, employers should set theclear expectation that treatment processes will follow science-based best practice,use proven approaches, and be effectively supervised. However, employers shouldalso allow sufficient freedom for the use of the individual clinician’s judgment andthe development of an individual therapy style.Some participants identified a tendency among some organizations to set unrealisticrules and expectations, up to and including harsh and punitive standards,and then to bend these rules. If the policy is unworkable or poorly written, theorganization may tend to “operate by exception,” thus turning exception into defacto policy. Instead, employment expectations must be realistic and fair. They mustmatch the level of the job (e.g., management vs. staff ), the professional experienceand education of the employee, the duties required, and the employee’s capacityto inflict harm during the course of work. In addition, expectations must be appliedconsistently and uniformly.Participants noted the need for caution that these expectations not arise out ofstigma, stereotypes, or unrealistic notions of what an addiction professional should be.They acknowledged the level of stigma within the larger societal culture and the powerof that culture in influencing employers’ subjective judgment. They also affirmed thefield’s responsibility to counter stigma within the larger culture, for the sake of organizationalhealth and the general well being of clients and people in recovery.n 35 n
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Page 17 and 18: Vonshurii S. Wrighten, MDiv, MAC, C
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