Returning To Work After Rehab: How Employers Can Help

It has been well-established by studies and anecdotal evidence that the best path to long-term recovery for a drug or alcohol addict is a program of inpatient addiction treatment. Individuals who use this mode of treatment remove themselves from their daily lives, and they sequester themselves away so they can focus on their recovery without any distractions from the outside world.

Inpatient rehab works for a variety of reasons. The recovering addict does not have access to drugs or alcohol, or to people or places who can supply them with drugs or alcohol. They are sheltered from the stresses of work, strained relationships and problematic finances. They don’t have to worry about the minutiae of life, like cooking dinner every night, getting the kids’ sports uniforms washed in time for their soccer games, and remembering to pay the bills on time.

Perhaps most importantly, people in inpatient treatment programs have round-the-clock access to support, there is no way for them to bail on therapy sessions that they might find uncomfortable, and they are surrounded by people who know from first-hand experience what they are going through.

The Challenges

But as effective as it is, inpatient rehab is not without its problems. Its biggest benefit is paradoxically also its biggest challenge: the individual literally steps away from his or her life in order to get better. That means being away from home – and something that can present a significant obstacle – being away from work.

What are the drawbacks?

As with anything to do with substance use disorders, the work-related challenges vary from one person to the next. A lot depends on the employer’s Human Resources policies, the individual’s immediate supervisor, whether the addiction has impacted work performance or work relationships, and whether it can be determined that the work itself had anything to do with the substance use problem developing in the first place.

There are a number of reasons why the prospect of taking time off work to go to rehab can be daunting. These include the following:

• Stigma: although most people agree that societal attitudes toward mental illness are better than they were five years ago, we still have a long way to go. According to CAMH, almost 40% of Ontario workers would tell their managers if they were suffering from substance use disorder or mental illness. What this means is that there are, in all likelihood, a great many substance abuse disorders that are being left untreated because the individuals are afraid to tell their managers they need to take time off to get help.
• Red tape: corporate bureaucracy and rigid Human Resources policies are hairy enough to navigate for people who don’t have addiction disorders. But things that are frustrating to most people can seem like insurmountable obstacles for those whose addictions have left them anxious and paranoid.
• The return to work: the addict may worry that if they do go to rehab, they will come back to work to find that things have changed. Maybe there will be new people in place. Maybe there will be the same people, but their attitudes will be different. Maybe the employer will have transferred the individual to a different role that is not a good fit. Readjusting to life after rehab is challenge for all recovering addicts: the challenge is compounded if significant things in the outside world have changed.
• Ability to do the job: a legitimate concern for many addicts is that they may no longer have the ability to do their job when they return from their stint in rehab. For example, an opioid addict who could previously lift boxes in a warehouse may no longer be able to do so because they cannot mask the pain with drugs. Someone in a client-facing role may find that constant interaction with customers triggers anxiety, which in turn triggers cravings. A police officer whose PTSD triggered a substance use problem may not be able to handle investigations of violent crimes.

There are some drawbacks from the employer’s point of view as well:

• How much will it cost to hire and train someone to fill in for the employee while they are away at rehab?
• Will the employee be able to take up where they left off when they return, or will they need to be eased in gradually? Is there a chance that their skills could no longer be current when they get back?
• What if the employee returns to work, and then suffers a relapse?
• How will the employee’s absence and subsequent return impact other employees?

How Can Employers Support Employees With Addictions?

If you are an employer, the answer to this question depends on where you are in your organization’s hierarchy. If you are the owner of a sole proprietorship, you can make your own rules as long as they fall within provincial and federal laws. If you are a middle manager in a corporate giant that answers to shareholders, you have to work within your organizational framework, make whatever changes you are empowered to make, and where possible, propose policy and procedural changes to the powers that be. No matter what kind of company you are in and where you are in the pecking order, there are ways to support employees who are on a path of addiction and/or recovery.

Ensure open lines of communication

The reason a lot of workers don’t seek addiction help is because they’re afraid to ask. They worry about what people will think of them, and in many cases, they may even be concerned that if they admit to substance abuse, they will lose their job.

By creating an environment in which employees can talk to their supervisors if there is a problem, you may be able to stop a potential substance abuse problem before it even happens. That stressed-out employee who’s been working long hours could work with you to create a more balanced life instead of taking cocaine for the energy rush. The front-line employee who is being sexually harassed by a co-worker could report what is happening, knowing that the complaint is being taken seriously, instead of going home and taking benzo medications and wine in a desperate attempt to quell the anxiety.

And in an environment where communication is encouraged instead of squashed, where employees are listened to instead of being told to just do their jobs, someone who does develop a substance use problem is far more likely to step forward and say that they need to take the time to get better.

Make sure employees know where to get help

If your organization offers health benefits to its employees, make sure the employees know just what the employee assistance program covers. Arrange lunch-and-learn talks about mental health in the workplace, and post information about mental health and addiction services, and local 12 step meetings and support group meetings, on the bulletin board in the department kitchen. If there has been an incident that affects a lot of your staff members, such as the death of an employee, make sure the right professionals – such as grief counsellors – are on hand to help those who are struggling.

Have a return-to-work strategy for employees who go to rehab

Adjusting to life in the real world can be tough for someone who has just come out of rehab. The individual will have undergone some changes. They may need some job-related accommodations. They may have to develop a new set of routines as a way to cope. If their relationships with co-workers took a hit during the period of active addiction, bridges may have to be mended.

An employee who is just coming back to work shouldn’t be expected to just show up and start performing. An actual strategy should be put together for the return-to-work (RTW) – the primary goal of the strategy should be to maximize the employee’s probability of success.

A good RTW strategy is jointly developed by the employer, the employee, and the employee’s health care provider, be that a physician, a psychotherapist, or an addiction counsellor. The plan should incorporate the following:

• Job description: not the official boiler-plate text put out by HR, but a list of what tasks the employee is expected to do, a ramp-up schedule for those tasks, and goals or milestones that are quantifiable to the individual.
• Job accommodations: formulated by going through the job description step by step to determine whether the employee can perform the task as it exists, or whether something has to happen in order for them to perform the task. For example, someone with a chronic pain condition might need ergonomic adjustments to their computer workstation.
• Workplace accommodations: if an addiction has left someone with a disability, accommodations may have to be put in place for a wheelchair, walker or service animal.
• Task substitutions: in some cases, where the employee cannot perform a task of the job, they may need to be reassigned to different tasks – the employee should be actively involved in this decision.

Conduct regular reviews of the RTW strategy

In many cases, well-meaning employees go through the due diligence of putting together a RTW strategy, but then they don’t check up on it. They simply implement it and assume that everything will work out. This can backfire, because a lot of the content in the RTW strategy could change over time. Restrictions (tasks that the individual has been advised by a medical professional not to do) and limitations (tasks that the individual has limited capacity to do because of physical, mental or cognitive impairments) can be either permanent or temporary. They may be progressive, meaning that accommodations have to be increased with time, or they could diminish, in which case accommodations could be tapered off.

The job description could change as well, as the employee adjusts to being out in the real world and gains in both strength and confident. At the same time, circumstances at home could change. It is very common for addicts to go through relationship upheavals in the aftermath of addiction, and as much as we like to tell people to keep work and personal life separate, it’s not always that easy to compartmentalize.

Build an empathic work environment

Ultimately, a lot comes down to work culture. Employers and supervisors can probably make the biggest difference by setting the right tone in the workplace. Host team building activities that will allow employees to interact with each other in a positive way. If an employee is away at rehab, talk to their coworkers in advance of the RTW date. Prepare them for the employee’s return, and if the circumstances warrant it, have a guidance professional in to talk to them. But – and this part is crucial – all of this has to be done with full respect for the employee’s privacy. If confidentiality is breached, you could lose the trust of all of your employees, and you could be violation of labour laws. Remember that it is up to the employee to disclose information to their coworkers. Remind your staff that their returning colleague should be treated with respect and empathy no matter what they choose to divulge.

Photo credit: f3nd1. This picture has a Creative Commons attribution license.