Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

The Employee Assistance Program Model15. Addictions in the Workplace 347When available, it is ideal to place the employee’s “case” within the EAP. Theoverall approach of the EAP is to identify and treat the drug-abusing employeeand to help the employee maintain his or her career and productivity, ratherthan to fire him or her. EAPs provide both primary and secondary prevention.They make job-based evaluations and referrals, and some also provide substanceabuse treatment, thus increasing job retention and lowering complications.EAPs are valuable for workers in that they provide a nonthreatening place toobtain alcohol and drug abuse information and counseling, as well as early diagnosisand treatment. In some companies, up to 40% of the employees use EAPs;approximately 17% of these are for substance abuse. Approximately 30,000EAP programs exist in the United States. They have been in decline recently asmanaged care has grown. Employers are generally in favor of the EAP system,since they feel that, in the long run, it is more cost-effective to treat employeesthan to fire them and retrain new ones. Seeing recovering alcoholics and drugabusers return to work happier and more productive is also helpful for companymorale. Insurance companies are generally in favor of EAPs, since successfulsubstance abuse treatment has been shown to reduce overall medical costs.Company EAPs vary in demeanor, from stern to forgiving, and also from amoral to a medical model (which most EAPs encourage).By definition, EAPs are in a difficult position. They are the advocate ofthe employee, yet at the same time must protect the interests of the employer.And although patient confidentially must be preserved in all types ofmental health treatment, in order for the EAP to be effective, there must besome degree of communication with the employee’s supervisor, union, or personneloffice. It is important that the guidelines for communication of thistype be clear at the very beginning of treatment. In most programs, theemployer communicates with the EAP regarding job performance, and theEAP provides the employer with periodic progress reports, without divulgingconfidential information. The “success rate” of the EAP has been cited to be70% (Blum, Martin, & Roman, 1992), although outcome measures requirefurther refinement.More often than not, participation is voluntary, though for some employeesreferral is an alternative to a job action. It is best for the EAP to beproactive about its roles (Lapham et al., 2003). Education about the EAP isessential, and a clearly written policy indicating that drug use will not be toleratedis helpful as well. EAPs can also train both employees and supervisors.Supervisors should be trained to (1) understand their role in implementation ofthe policy, (2) observe and document job performance problems, (3) confrontemployees who are unsatisfactory in job performance, (4) understand the effectsof substances in the workplace, and (5) know how to refer employees with suspectedproblems to the EAP or other mental health professional. Employees