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Will Alcoholism Get Lost in the Shuffle to Prevent Suicide Among Military Personnel?

2009-12-11T12:04:00.005-05:00

Over the past couple of months the Army has been ramping up a new effort to address concerns about suicide prevention among personnel. They are going the "building resilience" route to help soldiers. Other military groups are also paying attention to this thrust.

Keep your ear to the ground and pay attention to this effort because it will lead to a movement that will flow to police, civil service, and employees in mainstream workplaces.

This is how new movements begin, and you if you are an HR manager or employee assistance professional, you want to be thinking about the efficacy of this approach to helping employees in this “new economy”, whether or not they are being shot at in battle.

"Employee engagement" is a critical concern for top management. Understand what this phrase means to productivity, and how resiliency training may complement it, and you will make your department or EAP program more valuable.

So, this could be an exciting move. Don’t be on the outside looking in.

Now, just a couple thoughts more and I am done. It’s Friday after all.

A key thrust for this effort appears to be coming from a joint military group in conjunction with University of Pennsylvania psychologists.

Resiliency has been a hot topic for just only a couple years. It first made its way into the mental health literature by the route of managed behavioral health as way to help people cope with life struggles and prevent relapse. (That is where I first really picked upon it full bore.) Magellan Behavioral Health has a strong focus on this topic, by the way.

The concept is a good one to save treatment dollars, but it is not a substitution for what we know empirically and pragmatically that works to sustain ongoing recovery program that includes abstinence.

That said, these new directional shifts in mental health often overlook other aspects of the target problem that are as old as the hills. (Perhaps boredom contributes to these attempts to wheel out something new and sexy.)

Here’s the thought: Will primary alcoholism as a contributing factor be overlooked as the underlying problem and a common denominator in many, many military suicide cases? I am not reading much about this, yet. So, I am nervous. I hope they aren't going to start seeing alcoholism as just a "symptom" of PTSD, Depression, and other stuff.

About 15% of alcoholics commit suicide and about 33 percent of suicides in the 35-something range have a primary diagnosis of alcohol or other substance misuse; over fifty percent of all suicides are related to alcohol or drug dependence. (Miller, NS; Mahler, JC; Gold, MS (1991). "Suicide risk associated with drug and alcohol dependence.". Journal of addictive diseases 10 (3): 49–61.)

After 30 years, it has been my observation that psychologists, as a group, DO NOT whole-heartily march down main street to convince the general public that alcoholism is an acute, chronic disease, with primary biogenic underpinnings. However, they are guiding this military effort! (Hey listen, correct me I am wrong about any of this folks.)

Research says alcoholism suicide risk exists for those with this primary, health care problem, and smoking as a diagnostic indicator is a great signal to spot a potential risk. Can you say "wow"!

If the alcoholism factor is ignored, attempts to reduce violence, suicide, and enhanced resiliency among military personnel (which is a good thing mind you) may have limited long-term impact. Am I off base with this argument?

Missing so far from the discussion are issues associated with alcoholism, smoking as a diagnostic red flag within occupational groups, the known high risk of suicide among these employees who do smoke, (an extremely high percentage of alcoholics smoke, research clearly shows), and similar research particularly with doctors and nurses showing that those who smoke have higher rates of suicide, too.

In fact, nearly 300,000 U.S. Army personnel in the recent past were surveyed and these conclusions were also consistently drawn.

This research has been done in the USA and also in Europe with the same conclusions. The alcoholism, smoking, suicide risk, depression links are all well-established. I believe a lack of resiliency (naturally a part of the human condition) is missing in many folks because of the erosion forced upon its emergence by active addiction.

And, can you believe it, part of the resiliency program even covers spirituality and mastering skills to develop one's spiritual self!

The question: Is a lack of resiliency or the poor manifestation of it, a symptom rather than the problem?

I am hoping that alcohol, drug, and tobacco use do not take a backseat in this effort.

This article discusses research with 300,000 military personnel where smoking and suicide demonstrate a high risk. I believe the alcoholism link is key variable although it was "poo-poo'd" in this study despite all of the personnel committing suicide were heavy drinkers.

http://www.ncbi.nlm.nih.gov/pubmed/10873129?ordinalpos=1&itool=PPMCLayout.PPMCAppController.PPMCArticlePage.PPMCPubmedRA&linkpos=1

To support this discussion, the following links take you to fascinating articles on the high risk of suicide among medical personnel who smoke. This one is from England (where by the way research last month shows 25% of the workforce drinks alcohol at lunch.)

As a side note, did you know that alcohol on the breath in England cannot legally be used as sole indicator of being under the influence at work used to justify a drug test? (That means if you have a high tolerance, you're in like flint!)

http://www.independent.co.uk/life-style/health-and-families/health-news/doctors-and-nurses-most-likely-to-commit-suicide-698612.html

This study documents the same problem among hospital nurses.

Smokers are more likely to be alcoholics. In fact, 80 to 90 percent of alcoholics smoke -- a rate three times that of the general population. Moreover, the prevalence of alcoholism in smokers is 10 times higher than among nonsmokers.

http://ajph.aphapublications.org/cgi/reprint/83/2/249.pdf

And here is a research supported information about how nicotine boosts alcohol’s effects. Wicked, man!

http://alcoholism.about.com/cs/nicotine/a/bldu040322.htm

16% of nurses smoke, the highest of all professions, and the suicide rate is highest for nurses who smoke in England.
http://www.medicalnewstoday.com/articles/19164.php

If you are workplace professional, keep your eye on these developments so you can spot appropriate roles for your contributions to making these efforts successful.

Can Real EAPs Intervene and Help Prevent Financial Disasters by Helping Disgruntled Employees Stay Away from the Social Media Web Sites?

2009-12-09T11:02:00.005-05:00

EAPs frequently deal with disgruntled employees. It's a significant part of the job, but the benefit of this activity to the financial world doesn't get a lot of play in the EAP literature. For many of us, well, it simply sounds too self-serving. This is a big problem for many people in the EAP field — viewpoint.

Disgruntled employees are often seen as helpless malcontents, troubled, and expendable. Typically, stories in the EAP literature focus too much on how to help these employees be happy, healthy, and productive, while they omit the real story behind the story.

That story is how this helpful activity keeps employers' financial butts out of the sling. EAPs don't get the credit because we aren’t talking about it, and it is my argument that we should care a lot more about this side of the equation. Why?

There is a new twist in the 21st century that is leveling the playing field and giving an upper hand to disgruntled employees. It is making the importance of having an effective, proactive, well-in-cultured EAP critical and worth every cent it costs.

That new twist is the social media, especially Web 2.0 sites like YouTube.com. These are free, monstrous, broadcast media outlets that take no prisoners.

An EAP that is visible, known, trusted, and has a real face with it can attract employees who may turn to it with the goal of processing their frustrations, complaints about ethics, anger with supervisors, or tales of abuse and harassment.

Effective EAPs work with two hats in these situations empathizing with the employee, and protecting the company financially by helping the employee get their needs met in effective and appropriate ways.

Absent this level of easily accessible and visibly marketed support for employees, companies place themselves at financial risk. This is especially true if they try to get an EAP on the cheap. For most, this is a direct result of naivety or advice from misguided benefits consulting firms.

Employees who are angry and disgruntled have strong impulses to share their story and vent their frustrations. Starting with an empathic listening ear at the EAP is a better channel than YouTube. It would be better to have an employee's story end up in the New York Times than on YouTube. YouTube is forever. A classic and recent example follows:

As I write this column, Bank of America has 300,000,000 shares of stock trading (Dec. 8th). But a YouTube.com video posted by a disgruntled employee only a week ago has received over 146,000 views and counting. This growth is the result of word-of-mouth advertising about this video. This is called "viral marketing". It is a powerful force. To wit, mainstream media, without any qualification or fact-checking, has picked up on the video and is using it for its own economic purposes. I have provided the links below.

Not surprisingly, Bank of America's stock price has nose-dived in the same week. It has lost millions.

Is Bank of America's stock price drop the direct result of this video? No one can say for sure. But it is safe to say that it is not helping. And it is more likely that people are looking at this video than press releases about BAC's financial future.

Do you see an argument for having an effective, humanly visible, and appropriately funded employee assistance program that can act as a stop-gap to helping an organization by dealing with and sincerely helping troubled or disgruntled employees?

Can you see the value in making an EAP a benefit to employees and a loss-prevention, management tool for business organizations?

The latter is under-appreciated and it is continually ignored. This is a direct result of a "reformulated" model of EAPs that has been promoted in the health benefits and managed care literature, and has been accelerated by being unchallenged in an organized way.

From the former supervisor referral of an employee who may soon lose their job over poor job performance, to simply being a program of attraction where employees head for coaching, wisdom, and direction, EAPs have unrecognized and unsung potential to be more vital to corporate America's financial vitality than we are hearing about or seeing right now.

It is my belief that once the property casualty insurance industry (the real stakeholders) make this connection, that is seeing vibrant EAPs as loss prevention mechanisms, the EAP field will experience explosive growth in a new direction that will result in less violence in the workplace, few disasters like the one below, and of course, more helped employees.

To see the video, go to YouTube.com and Search “Why Bank America Fired Me”.

Why Bank of America Fired Me

Media Promotion of This Video

Do the 2009 EAPA Standards for EAPs Dispose of "800# eaps"?

2009-12-08T21:03:00.004-05:00

The EAPA STANDARDS AND PROFESSIONAL GUIDELINES FOR EMPLOYEE ASSISTANCE PROGRAMS (EAPS)were sent to the EAPA membership today. In case you missed them, here they are:

>>> Standards for Employee Assistance Programs

Hats off to the folks that worked so diligently with these standards to help the profession move down the path toward more definition, which of course helps preserve the integrity of the field.

Everyone in the membership--and every corporate customer or those who advise corporate customers in the procurement of employee assistance programs should read these standards. Ditto insurance companies, labor leaders, and students merging into EAP field.

Of course, like anyone else, I have a keyboard to spout my opinion on, but it is my belief after reading these standards that there is no way on earth that an "800#" sold by a managed care company as "EAP" (with a little structure thrown in for good measure) can be an EAP. (I worked for such program for about eleven months, so I have some experience to draw on.)

Believe me, I don't call what I was doing an EAP. However, from my cubicle on the 14th floor, I did a pretty good job servicing seven or eight Fortune 500 companies at once.

(Confession, well, we tried anyway. However, the piled up outpatient treatment reports needing authorization on our desks from therapists around the country, sometimes caused us to miss phone calls.)

I think part A of the Epoxy Cement that stick the EA profession back together is sitting in front of us with this document. Part B is needed. That would be an official position statement by the Association that applies these standards to various EAP models and declares them acceptable or defunct. Why read between the lines. Let's just get it out there.

When Congress passes laws and regulations that govern workplace and workplace employment practices, they have an office down the street that gets a copy of the legislation the next morning after being signed by the President. That organization is the Equal Employment Opportunity Commission (EEOC). They interpret the regs and its nuances and say what's what. That might be a very cool step for EAPA to take as well.

EAPA should take a stand and consider a mechanism that clearly rejects programs and services calling themselves EAPs that don't meet the standards. These are elephants in the EAP living room and they have been smashing the house up for 20 years. We like to ignore, for the sake of "all getting along", these obvious problems.

If this next evolutionary step is taken, a wonderful thing may follow--a profession that roars back to a unified membership of 7000 members, rather than the 3600 it now struggles to keep. And, like 25 years ago, we may hear one voice sharing a common definition and vision of what an EAP really is and should be. As a side benefit, I think EAPs would become more of a "household term" and even my mother might stop calling them an EPA.

>>> Standards for Employee Assistance Programs

Economics and the Management of "Dual-Diagnosis" Alcohol-Drinking Clients: How Murky!

2009-12-06T09:38:00.019-05:00

A patient is self-medicating if alcohol is used to reduce symptoms of emotional or physical pain regardless of whether the diagnosis of alcoholism exists. Unfortunately, this definition of self-medication often alters from one clinician to the next. And, of course, we know that some mental health professionals do this for the sake of economics, or maintaining their unshakable model of addiction, regardless of validity.

It is tempting to use "self-medicating" as an exclusionary term to decide the patient isn't simply an alcoholic or not an alcoholic at all. This helps justify the current course of therapy that may not meet the needs of the patient, especially if he or she continues drink. The incentive is usually preventing the loss of client or patient to a traditional course of treatment for addictive disease.

Alcoholics without dual-diagnoses drink to ward of withdrawal symptoms, however. So, as the AAMCO car transmission spokesman says on TV, "How can you tell which is what without mistaking one for the other?"

Why not use the National Council on Alcoholism and Drug Dependence and the American Society on Addiction Medicine's definition of alcoholism. No less that 20 or so authorities labored for a consensus and have amended the definition at least twice. 1990 was the last - 20 years ago. (Can't believe it, geez, time flies.) If you are not using it, why not? Goodness, I hope you know it! Click here!)

Digression: Many people were upset over the finality of the definition and deliberation of this well-credentialed group. Someone went as far to create a dummy website about the definition to load harmful viruses on people's computers who visit it. Talk about resistence. (Google has a warning on the Internet link to keep people away from it. You'll see it if you surf the web.)

A self-medicating patient is alcoholic if tolerance to alcohol as emerged during the course of the patient's drinking career and symptoms of withdrawal exist (even ones subtle enough to be certainly overlooked by non-medical professionals.)

Pathologic organ changes may be present or may coexist, and some of these may be undetectable without a meaningful liver functions work-up.

Obviously, based upon this description, you would need help in deciding for sure if the patient was only self-medicating, and not alcoholic, right? Definitely, especially if you were seeing adaptive and earliest stages of addictive disease.

Of course, it gets murkier.

There is the possibility that your patient is in the early stages of alcoholism. A dual-diagnosis might exist. (Dual-diagnosis was an behavioral health insurance-saving discovery rapidly popularized by mental health professionals, and very quickly, within few years of the explosive thrust to treat alcoholism as chronic disease in the early 70's.)

But here is the punchline: Regardless of why a patient drinks, abstinence is required to properly treat depression or any mental illness, especially if medication is involved, and even if it is a dual-diagnosis.

So this means the patient needs to acquire motivation and a sense of urgency to remain abstinent if he or she does not have it already. And what if you can't get that from your patient? Any non-alcoholic client wouldn't give it a second thought to acquire better mental health functioning. And, of course, an alcohol-using client wanting to stop drinking would be qualified for AA. (And you should use motivational counseling to help him or her do it.)

Consider the following:

1) Refer the patient or client to an addiction medicine (certified) physician for the differential diagnosis who will work with the official, and most rigorously formulated understanding of alcoholism that exists.
2) Do not accept without question or qualm the patient's explanation for why he or she drinks. I still can't believe how many professionals actually accept a patient's own well-intellectualized conclusions, even as they explain it with alcohol on their breath.

It is natural to begin a diagnostic impression on what is conveyed by patients, but remember, alcoholics are well-practiced at explaining their drinking using the same misconceptions and misunderstandings as the general public. Some may even rely upon explanations provided to them by other health professionals who have attempted to treat in the past. The preferred definition of the actively drinking patient is always the one that will permit continued drinking or offer hope of doing so again one day.
3) Be prepared to feel anger and resistance at losing your client to traditional alcoholism treatment, because without sobriety, and a stretch of time to overcome protracted withdrawal symptoms and the normal symptoms of recovery (remember those?), you may not be able to determine what you have sitting in front of you in the clinical setting.

In the end, you may have to fight yourself, the law of economics, and your model of alcoholism at the same time.

A drug and alcohol training program with effective and non-confusing language for use in business and industry can be found here.

Something's Stirring with Psychologists

2009-12-01T12:10:00.004-05:00

Sometimes it is a good idea to know what other occupational groups and professions are planning for the future.

Frequently these decisions are based upon well-researched needs and interests of customers. One such group are Psychologists. They have big plans for reaching out to business and industry in the future. Here's what the Ph.D.s have been focusing on and discussing at their conferences and reporting to their members:

Workplace Resilience Training
Workplace Psychological Well-being
Military Stress and PTSD/Suicide Prevention (then on to other professions)
Bullying prevention in workplace
Presenteeism (employees sick at work and their impact on others/productivity)
Erratic commuting stress and How It Undermines Productivity.
Psychological health of untrained disaster responders (as opposed to trained responders)
Improving personal communication on the job and creating healthier workplaces
Employees with parental duties and productivity declining while at work, but beginning at the moment school lets out -- i.e. What is Johnny doing? Where's the babysitter?, Etc.
The study and management of flexible work schedules, employee stress, and related issues.

Hey, wait a minute! I thought EAPs dealt with most of these issues? And, hey again, I read recently that there are more EAPs than ever! So, what gives?

One itsy, bitsy, small difference. Managed care now provide most EAPs. The CT (translation - authentic) programs are dwindling. Indeed, manager care 800#'s don't have any practical involvement with the issues discussed above.

Could it be that the decline in the number of solid, core technology-driven, personally visible, and integrated employee assistance programs is causing or allowing to become visible, unmet needs in the workplace? I think they are. I have been observing this trend ever since reading in an HR journal a few year ago that HR managers should start addressing more personal problems of employees when "EAPs" can't do it. Holy cow! You never heard that about the EAPs of the 70's, 80's, or early 90's.

So where do HR managers and customers (decision makers) turn to get these needs met? Themselves? Mental health? Of course, they are turning to mental health professionals. And psychologists are at the waiting--organized, focused, and with clout they have uniformly built for decades.

"We have an expert on that subject!"

2009-11-12T16:35:00.003-05:00

Throughout the year the major media will visit health related subjects that have broad appeal to the public. They will also report on major calamities and news stories like the recent massacre at Fort Hood.

The media needs mental health experts when these events occur. Who do they call? The answer is whoever comes to mind. That could be you if you know what to do, and first step you should take is to believe that they want you instead of the same old warm body that calls them every time.

There is one national managed care organization that hogs the spotlight on these events. They have a well funded pubic relations arm and they consitently show up in the media, the New York Times, ann Washington Post. There is another large corporate EAP that does the same thing. I am amazed at their prowess, but they deserve the attention if no one else is seeking.

Hey, were talking about capitalizing on tragedy here. The Fort Hood massacre was beyond belief horrible, but the media will pursue experts to help the public cope with these events, and it might as well be you. This is especially important because the some organizations have completely misguided ideas about employees assistance programs and they don't have any resistance to sharing the view to match their economic pursuits, regardless of its grander impact on the profession.

You will notice that specific topics appear in the news periodically, but predictably. For example, you can predict that approximately once a year the topic of alcoholism will emerge. It might be a news event on the cause, a new drug to fight cravings, or some other related topic. Many other topics related social problems will emerge in the mass media.

Pay attention. You will see that this is the case. Your local television station is not the "major media" in our definition. We are referring to AP news wires, and other major media outlets that sell news to the major networks, principally ABC, CBS, and NBC. However, pay attention to enormously important local news, specifically news events that relate to a subject about which you are an expert.

Now, here is what you should do: Listen attentively to the news. When you hear news that relates to your field of expertise, immediately fax to the local television stations your biography (a half page) and call the news room to say that you are an expert on that subject, and that you are faxing a bio. This is a great way to get publicity and to get on TV or the radio. And, it will make you instantly visible to your potential clients and EAP customers. (It's also a rush.)

Television and news stations scramble to find experts on subjects when the news hits. You are doing them a big favor.

If it is national news, you will have a few hours to respond because it will take longer for local stations to run "local expert" interviews. And it could be day later. If it is local news, your window of opportunity is much shorter, about an hour. Obviously you need to prepare ahead of time by getting phone and fax numbers, and contacts lined up. Then, wait for the "big one"--well hopefully not THE big one, but you get the idea.

The scramble for an expert kicks into gear quickly. That's you. Be there.

Workers' Comp: Getting the EAP Involved

2009-11-02T21:02:00.003-05:00

Most organizations of any appreciable size pay workers' compensation premiums, and for the biggest companies, they are self-insured. Companies want to keep their premiums as low and self-insureds try to reduce their costs, as well.

A CT-EAP (CT=Core Technology) can play a major cost-beneficial role in helping achieve these goals, but it takes education of human resource managers and those who control referrals after injury to pull the EAP into the picture.

This is a utilization improvement link EAPs.

Research supports the argument that empathic contact and support for injured employees received from the organization, plays a role in helping employees return to work more quickly. This saves money, and therefore a rationale exists to include the EAP in the continuum of care after injuries occur. Beyond coordinating the nuts and bolts of medical service and follow-up, figure out how to get your EAP into the care huddle and you will increase your EAP's utilization and influence by offering employees support for issues that nearly always associate themselves with injury and recovery.

Workers' comp claims are higher for addicts—five times that of non-addicted workers-is the commonly cited figure. NIAAA includes this in much of its literature, so there isn’t much argument about its validity. But this only a small piece of the EAP rationale. There is much more that EAPs can do vis-a-vis Workers' Comp.

While there has been solid promotion of EAPs using this alcoholic employee angle as a rationale to promote them, EAPs can also help injured workers no matter what the cause—alcohol, drugs, stress, absent mindedness, back luck, or mental distraction of any kind. After the injury occurs, employees often need support they aren't getting, and the EAP can fill the void.

Unfortunately NIAAA, and many other stakeholder organizations have not promoted EAPs in this way. If they had done so over the past 25 years, EAPs would be in a completely different place in their evolution. They would be household terms, and your mother would still not be calling an EAP an EPA.

Hundreds of property casualty insurers would be acquiring EAPs by now I think if this linkage were more well established. The direct role of EAPs in the workers comp cost-containment fight would have been identified and popularized.

Post-injury, some of the needs employee have to arrange are home health aides, companionship services, shopping assistance, transportation, and an empathic listening ear. Many injured workers need financial counseling and problem-solving for family problems and communication issues. EAPs are particularly adept at arranging the coordination of services or offer emotional support, and it is here they have no occupational match by another profession in the workplace. Few HR managers understand how to quickly obtain the resources above, and even fewer are want to get involved with these issues.

Workers' comp managed care firms can partner with EAPs for the intervention opportunities that exist with worker injuries. But they are not like to take the first step.

Work toward having your HR representatives or managed care companies that process workers' comp claims include EAP literature, the things EAPs can do, and other types of very direct communication with injured workers. Encourage the referral of the injured worker to the EAP for an assessment after the medical crisis and acute care period ends.

You will add points to your utilization rate by way of these referrals and improve your value as a service to employees and the organization's bottom line.

Part V of V - What If the Addict Says, "No!"

2009-10-22T10:38:00.004-04:00

(Note, this post has four previous parts.) I will make all parts available in a downloadable document (grammatically proofed) at a later date.)

If the addict says no, intervention participants should be ready to act on the leverage they have previously decided to use. However, it is extremely effective to give a deadline for the addict to accept the offer of help if he or she says "no."

The recommendation is no more than one day. This gives the addict time to think about treatment and feel in control of the decision to accept it.

Many people argue only for an immediate transport to the treatment facility. I disagree from personal experience. Addicts babies. Don't treat them as such. You must guess that the addict is motivated and willing to follow through.

As a director of a 25-bed adolescent drug and alcohol treatment unit in 1982, I once convinced a teenager to enter treatment after attending an Ozzie Osbourne concert. This kid never would have entered treatment. I guessed I could make the deal. He shook on it and entered treatment two days later.

The desperate act of “forcing” the addict to decide upon admission within minutes of the intervention is linked to the intervention consultant’s role and the implication that the intervention can’t be repeated later when the interventionist does not come back.

Using an intervention consultants is almost entirely viewed as a “one shot” opportunity. It is a disservice to families and the patient to view interventions in this manner.

Virtually all interventions will succeed. That's a bold statement isn’t it? But if you understand the nature of addictive disease and its progression, you know that this statement is essentially true.

Helping intervention clients understand this reality is essential because it provides motivation to practice new behaviors that stop enabling and facilitate crises that can lead to admissions. The goal is for co-addicts (persons in relationships with addicts) to act in tireless and aggressive ways against disease until the addict accepts help at a future point, if not right now. That day will come with a new attitude and a watchful approach to stopping enabling. Alanon is extremely useful for this purpose, but the Alanon sponsor must not be a individual who sends the message of "do nothing", simply live detached. Alanon's message is powerful, but some individuals interpret Alanon principles as avoiding intervention--forever. So, be careful of this message.

There are essentially three reasons all interventions will eventually succeed, particularly if they are "family-managed” rather than intervention consultant-driven. (Family-managed means that the intervention becomes a process, not a one time shot event that is declared a failure on the first try if does not work.) Again, no intervention consultant is used with the family empowerment model.

Reason #1: The reality of the progression of incidental, serial crises until death or sobriety. As the disease worsens, crises continue unabated with only an unpredictable amount of time that separates them. Each one becomes an opportunity to initiate an intervention.

Reason #2: Denial and alibis of the addict diminish and this leads to a rapid progression of the illness’s symptoms. Addicts practice defensive mechanisms to avoid confrontation and consequences for their behavior. If an intervention at first does not succeed, drinking or drug use will increase, although there may be a short-term attempt to reduce consumption in a vein attempt to demonstrate control over the illness by practicing abstinence or moderation. As drinking continues or resumes, problems increase and interventionists (family and friends) need only await for the opportunity to try again. The mission: Make acceptance of treatment non-negotiable as before.

Reason #3: Addicts will sicken as their illness grows worse, making sudden medical crisis an eventual certainty if they do not kill themselves first either by accident, medical event, or suicide. This may take weeks or years, but medical symptoms will almost certainly emerge requiring sudden and acute intervention. Again, this is an incidental crisis as I have defined it earlier, and it is therefore another opportunity to make another move to intervene.

It is a medical fact that two-thirds of addicts die of the medical consequences of alcoholism left untreated. One-third die of calamities of one sort or another. Before death, intervention opportunities are numerous, not one shot. Obviously, no intervention consultant can return for a second, third, and fourth try at the intervention. Subsequent interventions do not require much planning. The addict is "directed" to treatment in the aftermath of each crisis.

Magic in Non-Disciplinary Corrective Letters

2009-10-12T13:26:00.004-04:00

I have always been amazed at how supervisors chase employees to improve performance, stomp their feet to get them to work on time, or scold workers to curtail their inappropriate behavior. When none of the usual, emotional wrangling to to correct employee performance works, and a major incident occurs, out come the big guns - disciplinary action. What happened to the art and science of managing employees with an effective non-disciplinary corrective letter?

The missing piece of armament that very few supervisors seem to ever master well is the non-disciplinary corrective letter. A non-disciplinary corrective letter is a management tool and supportive measure to call an employee's attention unsatisfactory job performance and motivate him or her to make corrections to satisfy standards. These tools can salvage employees, reduce risk of behavioral issues and acting out, and help preserve a more effective relationship with the supervisor.

Effective corrective letters utilize potential reward and fear of loss to match the motivational psyche of the employee. (Some employees become motivated by reward. Other by fear of loss. It is the equivalent of being either left handed or right handed. And, of course some employees are both -- call it "motivation-ally ambidextrous."

Here is a "classic" non-disciplinary corrective letter. Print this model, because it can be a good one in your desk draw to share with supervisors in your one-on-one consults with them.
=============================

To: Sally Smith, Machinist
From: John Doe, Supervisor
Subj: Attendance and Performance Problems
Date: 1-1-2006

Last week I reviewed the sick leave records and discovered that you have taken nine days of sick leave in the past year. Each of these days occurred on a Tuesday following a holiday weekend, or on a Friday preceding a three-day holiday weekend. I discussed my concern about this pattern with you last August 12, 2005. Since then, I have grown increasingly concerned. Your last such absence was on Dec. 27, 2005.

As you know, sick leave is a benefit to be used when necessary. The frequency of your sick leave is too high and affects your ability to perform essential functions. On February 15, several overdue widget projects caused a loss of their sale the day you were out. This cost the company $50,000. Your absences also negatively affect clerical staff. I would like to see your performance improve and your absences reduce.

You have excellent skills, and are a valued worker on the assembly line. But, if your use of sick leave remains high I will take additional steps to intervene, which could include administrative or disciplinary action.

Please provide verification of any future illness in which you lose work time. Please see me if you have any questions with regard to this request or the contents in this memo.

Thank you for your attention to this matter. As you know, the EAP is always available to assist you in the event a personal problem is contributing to your attendance problem. You can reach the EAP confidentially at 555-1234. I will review your use of sick leave in one month on Tuesday, February 1, 2006. Please plan to meet with me at 3:00 PM on that day.

cc: next level supervisor

Workplace Violence and Problematic Relationships with Supervisors

2009-10-09T17:30:00.002-04:00

I wanted to talk with you about workplace violence and supervisor relationships.

EAPs routinely help resolve problematic relationships that employees have with their supervisors. If you haven't worked with this type of issue yet, you will.

I believe this intervention activity that HR managers, EAPs, and even OD people sometimes tackle has the most potential to improve productivity, reduce risk of violence, and help insulate the company from lawsuits -- big ones. The role EAPs play in helping resolve employee-supervisor conflict should get more attention in the literature.

I have always believed that effective EAP models reduce the number of potentially violent acts that, as a result, never happen. The question is, do companies appreciate this enormous benefit that can't be easily proven?

Many of these cases begin with employees who have problems with supervisors. These problems don't just create conflict and distraction. They can lead to death by a violent act. The subject of violence and improving relationships with supervisors is so critical to safety that I always include articles about it during the year when writing WorkExcel.com\'s newsletters. I so badly want to produce 7-9 minute Flash movie on "Best Tips for Reducing Supervisory Conflict with Subordinates" I think this would prevent violent acts more than the usual "know the nearest exit to your office if your employee explodes."

Employees love tips for improving their relationships with supervisors. There are huge payoffs for providing them, and top management will love you for doing so. That's because management can't rally employees to improve their relationships with their supervisors. The dynamics of paycheck-driven relationships simply makes it impossible. Your newsletter is a perfect medium for doing it.

Here are a few topics to consider for your next newsletter and those down the road. Chase after your newsletter company to write about these topics. If you are in a pinch, have them send me an e-mail and I will reply with my thoughts. They shouldn't have any problem if the writers possess an EAP background, of course.

Topic ideas

* Improving channels of communication and increasing frequency of
communicationSpeaking with your boss freely about concerns early on, before
problems arise
* Asking for advice about problems that you are experiencing on the job
* Writing down your concerns and sharing them; helping plan your evaluation goals
* Asking for feedback -- going to the boss and not waiting for it
* Considering your boss's perspective -- not just your own; how to do it and why
* Using tact when discussing differences
* Figuring out what your boss really wants from you, without asking
* Understanding that your supervisor is probably not "out to get you"

Don't just make a newsletter entertaining for employees. Make it a loss-prevention tool for the company. These tips will reduce conflict, improve program utilization, and increase top management's awareness for your true value.

Employee Newsletters for EAPs and Workforce Productivity

Helping Employees with a Wage Garnishment "Fishing Net"

2009-08-26T10:51:00.003-04:00

Garnishments are court orders for the employer to cut a check, mail it to the creditor or entitled party, and along with it process a bunch of paper work every pay period, sometimes for a long period of time. Employers must follow court orders to garnish wages or face paying the entire amount to the creditor themselves. They are a nuance for any hard-working payroll department and they cost the company money. EAP utilization can be boosted dramatically if you make arrangements with your organization to have management make supervisor referrals for employees whose wages must be garnished. The performance basis of the referral is the financial burden on the organization resulting from issues within the employee’s personal life adversely affecting the workplace. Like any management or supervisor referral, the garnishment referral is not a punitive act.

Wage garnishment judgments may or may not be deserved sometimes, but they are almost always symptoms of larger problems in the employee’s life in addition to the debt and credit problems the employee is experiencing. That’s because psychosocial problems frequently produce financial problems. Garnishments could be symptoms of drug problems, marital crisis, depression and mental illness, and of course, compulsive shopping or gambling. It isn’t easy to arrive at the point where one’s wages are finally garnished. Many threatening letters, phone calls from creditors, and the like arrive first. A year or two could pass before a court case becomes a garnishment judgement.

Most organizations have considered referring employees with garnishments to the EAP, although historically such referrals were commonplace among core technology EAPs of the past. Breathe new life into your utilization rate. Set a meeting date with human resources and discuss the practice of employees being referred to the EAP as a result of wage garnishments. There are many ways to do it—from a simply mention in a letter, to a more formal management referral. Like any supervisor or management referral, be supportive when making employee wage garnishment referrals to the EAP.

3. Get your organization to refer such employees and you'll get the business and your utilization rate up. Draft a model letter for the employer(s) you serve, justify the rationale, and start getting these referrals.

Improving EAP Orientations

2009-08-03T09:06:00.000-04:00

Every effective EAP conducts new employee orientations. It can be your one clean shot at having new employees understand the services you offer because there is no guarantee that you will ever have them as a captured audience again.
You want it to count.

Here are a few tips to improve the referral-pulling power of your employee orientations and make the right impression so your EAP utilization stays high.

Provide a More Detailed List of Problems, Issues, and Concerns
Many EAPs only provide only a brief list of the types problems and concerns their program will address. Typically these are broad categories of problems such as substance abuse, mental health issues and stress, health care concerns, financial or legal concerns, family/personal relationship issues, work relationship issues, concerns about aging parents. They aren’t specific enough. Such broad categories require the employee to consider whether their unique problem fits. Make them think less by offering rich details about what falls into these categories.

There is an important adage in marketing that goes, “Don’t Make Me Think”. It means that if the customer has to figure out what you are trying to say, you’ve lost them.

What’s missing is a more detailed list of problems that would increase the likelihood of an employee spotting the specific issue that troubles them. create 6-7 specific examples for each of these areas of concern, and you will promote your program more effectively. This is pure marketing, and the term is called “message to market match”.

Here’s an example of such a list:

Life management issues----marital and couples conflicts, sexual and intimacy issues, parenting skills, social and relationship issues, financial issues (credit problems, debt collections, loss of income, budgeting, and conflict over money.); legal problems; fear and anxiety over medical conditions; eldercare issues and caregiver stress; loss of a loved one and bereavement/grief issues. Landlord, tenant issues, homelessness or threatened homelessness; relationship conflicts, domestic/partner abuse, and victimization.

Emotional problems and mental health issues----depression, anxiety, medication management issues for psychiatric conditions, eating disorders and compulsive eating, social issues and relationship problems, adult child-parent relationship issues, and parenting concerns over teenagers.

Alcohol and drug-related problems----alcohol-related problems, drug-use problems and drug addiction, family members affected by the drug or alcohol use of another family member, relapse issues or maintaining or re-establishing an abstinence program and/or program of recovery from addiction and codependency; teenage substance abuse.

Job-related problems----getting to work on time, coworker conflicts, issues in working with your supervisor, performance concerns, career counseling, difficulties making decisions, stress, exhaustion, work pressures, being affected by downsizing, pre-retirement planning and related concerns, difficulties of a new position.

Part IV of V: Leverage

2009-03-20T13:49:00.003-04:00

Leverage is “part B” of any intervention process. (Influence is part A.) Leverage, however, we discover is frequently not necessary in interventions because the front-end of the intervention where use of influence is dominant, along with the synergist impact of the group presentation, works to motivate the addict to accept help.

Participants breathe a sigh of relief, but nevertheless they were prepared and empowered by their decision to use leverage. (Leverage is something given or taken away from the addict that he or she greatly fears.) Therein lies the power of leverage. Participants know what they will do if the addict does not agree to admission or other treatment option. They act to make treatment non-negotiable in their relationship with the addict. This attitude and willingness to act is crucial to success, and intervention participants must commit to the concept of “non-negotiability” of treatment.

Leverage is used when influence does not work. The participant with the most leverage goes first. Frequently, this is the participant with the closest relationship with the addict, and hence, is historically the greatest enabler.

Often leverage constitutes separation, divorce, removal of children from the relationship, willingness to call the police when the addict drives under the influence, separation from financial means, and other severe measures that the addict greatly fears or finds distasteful.

Leverage has another benefit: It gives the family member relief from the enabling, which causes stress, worry, and continued fear. One family member once said she would call an Army general (the alcoholic’s commanding officer) and notify the general of this drunk behavior when it interfered with work rather than enable him any longer. This was all it took for the admission.

Some spouses obviously "go for it" and are willing to live with exposing the addict for all to see. Once all participants are done presenting their leverage, another discussion takes place to "argue" for the admission. The impact of the leverage is discussed with the addict. (Reality check time.)

Most addicts by this time will go along with admission. There may be some bargaining so the addict feels in control of his or her decision, but if the details are minor like a.m. or p.m, decide if it is worth arguing over. I once made a deal with a 15 year old to enter treatment two days later after an Ozzy Osbourne concert he had planned to attend for six months. Don't ask me why, but after shaking hands and agreeing on it, I believed he would come back two days later. He did.

No person should present leverage that they are not prepared to use. Doing so will harm the intervention severely and it will appear. This is called "buying the addict’s next drunk," because dysfunction increases with no perceived consequences to the continued drinking. And denial is reinforced. This happens with family members torn by guilt or those who have alcohol or drug problems themselves. These persons must be screened out of interventions or re-educated so their beliefs change about addiction and addictive disease treatment. When the addict agrees to the treatment option - action takes place without delay to make it happen.

The Presentation (Part III of V)

2009-03-03T21:39:00.005-05:00

Each person in the group presents his or her personal experience with alcoholic or addict explaining two experiences directly related to the use of alcohol/drugs and its effects on their life without blaming the addict (it's the disease and drug affected behavior damaging the person and the relationship.) Natural emotional emotional pain will be experienced and demonstrated. That’s appropriate. I statements must be used. Describing experiences their associated emotional pain in the relationship is key. If any participant is so angry that he or she can’t describe their pain and get vulnerable in front of the alcoholic, more work with that person should be considered, or their participation in the intervention should be questioned. Before describing the negative events above, each person affirms how important and valued their relationship is with the addict or how they want to return to what that value relationship once was.

When describing negative events, the key to success is not focusing on the addict's need for treatment. That comes later. Instead, have family/friends focus their experience and feelings associated with hurt and pain caused by the alcohol-affected behavior or its outcomes.

Participants describe in detail two events and their impact. A key element in interventions in having family members acquire the ability to consider within their stories the difference between what the relationship is like now as a result of the use of alcohol or drugs and what a vividly imagined and described picture of what it can and should be if only person's behavior was not affected by alcohol.

This is powerful. No presenter should discuss another participant's experience or attempt to point out what he or she thinks the alcoholic can’t see or doesn't understand. This triggers the use of defense mechanisms and sets the intervention back. The group’s goal with the serial presentations is to create a phenomenon called synergistic remorse.

Each person's presentation causes the alcoholic to re-experience feelings of remorse or guilt--originally felt at the time an incident originally occurred. These feelings of remorse are often short-lived, but they are a open window into which the group will insert a treatment solution later. The goal is to have the addict begin to feel a sense of urgency and determination to deal with the drinking problem/drug problem in some way he or she thinks might be effective. (Willpower is usually what's being silently considered.)

At the end of the last story, the group moves quickly to request admission to an addiction treatment program knowing that at the end of a series of effective presentations the synergistic remorse effect is in play and peaked. An attempt to bargain by the addict is the usual response, and then an gentle persuasion experience on the part of the group begins.

The group asks and presses the addict to enter a treatment program immediately. Each participant presses for this decision.

The goal is to successfully urge the addict's acceptance of the treatment recommendation and reject effectively ideas offered by the addict that will certainly be minimal and half-measured attempts to abstain. Participants MUST be effective with their language at providing non-agitating and non-provocative responses to the addict's "better idea". The following is a resource (sorry it is not well proofed, but I can't edit these blogs and information very effectively so bare with me folks.)

Try this document I wrote to help my own intervention clients: “Effective Responses to Defensive Statements Made By Addicts in Interventions". I think it does a pretty good job at educating participants with “what to say” and “how to say it” in response to twenty classic objections addicts use interventions. Language is disease model based and I think you will get the point of why it is effective to marshal support and confidence in family members prior to an intervention.

Family Empowerment Model Intervention: Part II of V

2009-01-22T09:46:00.005-05:00

Part II of IV (See first installment of this article a couple days back)

Family Empowerment: Instruction in the Leverage and Use of Influence.

After instruction in the disease orientation to addiction, participants in
intervention training should be instructed in understanding the use of
influence in the interventions.

Influence is the value or inherent worth that can be subjectively assigned to the relationship a family member or friend has with the addict. All attendees in the intervention should have some influence.

Negative influence equates to provocative relationships of any kind,
including drinking buddies, etc. Such persons should not participate.

Obviously the amount of influence will vary among participants with some, say
a close friend, having a lot, and others say, a cousin or neighbor having
less.

One member of the group must accept responsibility for being
the leader of the intervention group. This person's responsibility is to start the
intervention meeting when it occurs and guide the structure since there
will be no "professional intervention consultant” present.

All members of the group must adhere to strict communication boundaries between training
and the day of the actual intervention. Addicts (as a result of the
disease) become hyper-vigilant and will easily detect subtle mood
differences or behaviors of participants that can tip off to the plan for an
intervention.

The structure of any Family Empowerment Model
intervention includes: Introduction, Use of Influence, Pushing for
Admission, Use of Leverage, Pushing for Admission (second try),
Conclusion, the Admission, and Next Step for a Refusal Outcome.

Eighty percent of interventions that I have arranged never had to use leverage,
but it is critical for it to be present in case it is needed. Leverage
provides intervention teams with psychological power and confidence, which
can be felt by the addict intuitively.

This is the value of leverage. Leverage is something given or taken away from the addict that he or she greatly fears. Next, the group should discuss where they intend to meet the
addict for the intervention.

The group should approach the intervention when the addict is most likely to be least affected by toxcity. Morning hours are frequently better than evenings, for instance, but there is no
hard and fast rule to this step.

Discussion will produce the best time and place. The group must buy into making treatment nonnegotiable. This concept refers the absolute belief by the participants that treatment is necessary to save a life and that the status quo with the practicing addict will never
return unless they fail in their determination for change. Any other type of relationship enables the addict to get sicker.

Until the addict is in treatment, the only practical relationship with the addict is the one that facilitates admission to a treatment program as soon as possible. This is particularly true if the intervention is not successful at its conclusion.

Such an understanding will maintain a state of inertia necessary to act at the next opportunity or incidental crisis associated with the drinking or drug use. This is a key point, because such a crisis will come. It is only a matter of time. When this happens, the group will act to encourage admission and will probably be successful.

This is how virtually all interventions successfully occur not led by a professional become successful. A quick attempt to directly facilitate admission will succeed eventually.

Starting an intervention is always a bit difficult, but a plan should be in place for precisely how it is done, and it should practiced. The leader starts by saying something to the effect that "we are all here because there is something very important that we have to tell you. We need you to hear it. This is very personal for each of us and each of us has something we need to say.

There are obviously many variations on this wording. A fair guess, however is that 95% of addicts will cooperate with the intervention at this point. Few guess what is happening and get up and leave. But there is plan in place in the event that happens.

Participants should rehearse their presentation at least twice. Until the day of the intervention, it is important that participants “carry on as usual” and not “alter suspiciously” their relationship with the addict. A crisis caused by drinking or drug using behavior, however, pushes the intervention date forward to NOW.

Prior to the intervention, participants must make preparations for the following: admission after the intervention (or outpatient intake, or evaluation, etc. You can help them decide which is
best.); logistical considerations that could cause the addict to back out -- money, job issues, pets, vacations, bills, child-care, etc. All bases must be covered.

The intervention begins by the leader talking first. Every participant will talk using the following rules: (1) Avoid blaming; (2) Speak only about your own experience; (3) Do not refer to other people in the group; (4) Avoid shaming; (5) Avoid using the terms "you should"
"can't you see what you've done" or other language that moves away from the participants "first-person account of their personal experience associated with the addict's behavior.

The group is also instructed in the "sandwich technique". The sandwiching technique is an interviewing manuever designed to confront a person with negative facts associated with their
problem while blunting the impact with positive statements that validate the person's worth.
In interventions, this means validating how important or how loved the addict
is by each person.

Each person rotates through the confrontation presentation and speaks about their personal experience with the addict. (Next, blog note, I will discuss the outline of this presentation.)

How Complicated Can You Make a Supervisor Referral...Let Me Count the Ways

2009-01-11T10:14:00.004-05:00

I have absolute faith in the future of the EAP profession because a great idea will always carry it's weight and move forward, so don't take the following the wrong way. I thought I would just have some fun with creative writing this morning. =======================================

Hey, why is the EAP field and its processes so confusing after over 30 years of being an established and legitimate occupational pursuit?

Answer: A lack of detailed and enforced standards and sanctions for misapplied EAP core technology priniciples that hurt employees, cause loss of jobs, and dismantle the EAP profession. I am convinced, anyone can call anything they want an EAP and recognized associations, even if you are a member of them, won't give a hootily. Just pay your dues on time.

When I get the inkling to discuss this topic, I only have to Google a specific term and up pops a great example of what I am talking about.

Here's today's wonderful (not) illustration. Here is how one HR benefits firm with an "EAP product" discusses their procedure for making what they call a "SUPERVISOR REFERRAL TO THE EAP":

STEP 1: HR (not the supervisor!) calls _________EAP to discuss the purpose for the referral and requests a blank Supervisory Referral Form if needed.

STEP 2: HR and employee discuss Job Performance Problem and determine deadline by which employee must contact ____________EAP and have an initial EAP assessment. Supervisory Referral Form is then signed by both the employee and HR/Supervisory Representative

STEP 3: Supervisory Referral Form is faxed to ______EAP attn: Clinical Manager

STEP 4: Employee calls ________EAP intake operator and requests a referral to a provider

STEP 5: Employee calls provider and schedules an appointment as per agreement

STEP 6: ________EAP Clinical Manager contacts provider and HR/Supervisor to begin the process of mediation between the provider and HR regarding the employee’s treatment plan and progress.

I don't know if you were counting, but there are a total of 8 humans involved in this referral not counting the employee. If you missed the person who is assigned to email or fax the supervisor form, you're simply not on your toes.

How many supervisor referrals to you think this provider receives as a percentage of total referrals to the EAP during the year?

True confession: I worked for a company for 11 months in 1995 (I won't mention the name here, but you can visit my resume to find out.) and they had an almost identical process. That organization's supervisor referrals were close to ZERO!

A supervisor referral is a simple thing. And, it's powerful. But add in bureaucratic hoops and fire rings to create a circus and your utilization rate will flop. Worse still, behavioral risk with the folks that might go "postal" or have other problems that cause financial loss will increase.

Here is what a supervisor referral is (I am going to be a little cynical and expansive in this paragraph to emphasize my point.)

STEP 1: A supervisor referral simply uses the application of authority or leverage of job security to motivate a troubled employee to accept the exciting opportunity to be accommodated and assisted by the EAP to get help for a possible personal problem in lieu of the possibility or immediately pending disciplinary action for documented job performance or conduct problems.

STEP 2: The EAP is notified, preferably, but it won't and can't interfere with the supervisor referral and the employee's responsibility to act. Documentation is given to the employee and the EAP, and a release is requested to be signed by the employee to verify participation and cooperation with whatever is going on at the EAP.

A release is essential to good EAP work, but what if you can't get it? Remember, EAPs are voluntary. Well, answer: It isn't needed or necessary if the employee doesn't want to verify attendance and cooperation (which can easily be explained by the EAP or the supervisor as not a smart choice.) Verifying attendance and cooperation is to the employee's benefit. No organization is handicapped without a release.

That's the sum and substance of a supervisor referral. One human involved, plus the employee being referred will make it work beautifully with an EA professional at the other end.

The key is making the employee responsible for change and accountable for change. Supervisor follow-up is key. A breakdown in communication and bureaucratic snarling in supervisor referral process translates to an erosion of the employee's perception of accountability for change.

Addiction Intervention Consulting for EAPs

2009-01-07T08:56:00.002-05:00

Should you offer intervention consulting to employees who have family members or close friends with alcoholism or drug addiction problems?

You may mistakenly believe that intervention consulting requires going to where the intervention is being held, and passively being available in case expert guidance is needed at the event. The intervention industry, which is fraught with rip-off artists has promulgated the belief that intervention requires highly skilled professionals who show up on a Sunday morning after a pancake breakfast to surprise the alcoholic with a loving and supportive surprise meeting.

Nothing could be further from the truth. Intervention guidance does not require "specialists". The evidence for such an observation is in plain site. Addicts are admitted to treatment programs every day with only the hip-shot pressure placed upon them by family members or employers who accidentally, on purpose, said the right thing for the right reasons to motivate an addict to accept help. No intervention expert was present. And, I would imagine 95% of admissions to addiction treatment programs happen just like this--influence and leverage of those in relationships with addicts effectively applied.

Most admissions to chemical dependency treatment programs occur without an interventionist guiding the process, which is usually very expensive. The call to "have an expert" present effectively eliminates many people from the opportunity to ever consider an intervention. This not fair. To say to a family that they can't be just as successful without an intervention is one of the greatest disservices ever to be levied on addicts and family members.

How do you help these people? Despite attempts by interventionists to claim a high levels of artistry and to promulage fear if an expert isn't present, the reality is that the basic principles of successful intervention can be easily taught.

And, my argument is that success rates are higher if this "empowerment model" is used. That's because family members can try again if the first intervention fails, and they can become determined engines of change until it happens.

Most interventions (althought not called that) are completed by insistent family members with no interventionist present. In other words, people do say the right thing, perhaps accidentally, that motivates an addict to enter treatment. Usually these are family members who have decided to make treatment “non-negotiable.” The result is admission.

So, how do you add this expertise to your EAP?

The logistics. Such a meeting to educate an employee should include at the most four or five persons who have significant influence or leverage. More than that, and too much cross talk emerges dragging out the training of these individuals. (From experience and having done as many as 11 trainings in one week, the two major tools of intervention are helping family members IDENTIFY and USE tools of "Influence" and "Leverage".

Influence is the value or weight assigned to the relationship one person has with the addict. Leverage is something that can be given or taken away, which the addict greatly fears. Each of these are crucial tools in interventions, and they are used differently, and at different times, as I will explain. My argument in this blog of course is to argue that addiction intervention training skills should (and I would like to argue must) be a part of your scope of service. It is perfectly within bounds of the EAP Core Technology.

The instructional meeting will last about two hours. (This is not treatment or group therapy, although I know many therapists who have illegally/unethically bill for it through 3rd party reimbursement.)

A person with addictive disease has a medical illness. You are providing common sense principles of constructive confrontation to help family/friends motivate the addict to accept help. This is not therapy.

Your first task is to get information about the addict. Get the family to tell you the whole story. Get a feel for the situation. Next, enter a discussion about addictive disease. You must determine each of the participant’s knowledge about the disease and ensure that each of them understands the biogenic nature of the illness. Educate as you go. Any participants with “psychologically oriented,” or “willpower” models about the disease will sabotage the intervention.

Ultimately exclude such persons if they can’t come around. Coach them out of the intervention. Next, you must deal with guilt. Each of the participants will feel guilty about the intervention to some degree. These persons will also sabotage the intervention if they can't get past it. Help them see that they are not going “behind the addict’s back”.

Most of this guilt is based upon an enabling dynamic fueled by the addict’s direct or implied demands for loyalty in order to avoid confrontation over a period of years. Explain this to erode their mistaken beliefs. My next blog note: The Intervention Training Meeting Part I.

I know this is a bit gutsy, and that I am going against about 30 years of convention, but people need to hear the message. By the way, the movie "I'll Quit Tomorrow" will get your company sued fast if you ever try to duplicate what promotes--bringing the family into the workplace and surprising the employee in the office of the company's president to be confronted about their alcoholism. Burn the film if it is in your midst.

Feel free to e-mail questions or rebuttals as I continue this blog. I would like to respond to your comments: publisher@workexcel.com.

EAPs and the Great Uncharted Territory of Cost-Benefit

2008-12-24T07:37:00.005-05:00

(In this post, I am going to add a bit more to my previous post in November on EAPs and management liability. I see that I missed a couple points.)

The great uncharted territory of cost-benefit for EAPs is the positive impact they have on the bottom line in helping prevent lawsuits brought against companies by their employees for employment practice missteps and wrongdoings.

Did you know that the average out-of-court settlement for wrong discharge is over $100,000? The average jury award is over $500,000, and employers lose over 60% of the time. Health care dollar saved by EAPs do not compare with the size of the awards employers face in the lawsuit arena.

Discrimination, wrongful dismissal, constructive discharge, and dozens of other employment practices violations cost American employers billions in awards. Many of these awards are secretly agreed to by undisclosed out-of-court settlements.

So risky is the employment setting that a new insurance emerged in 1991 called EPL (Employment Practices Liability) insurance. Two companies existed then. Now over 80 insurance companies offer EPL. None of these insurers are using EAPs as cost-containment products like managed care is doing for their products. And, hardly any company is considering how an EAP can help reduce this liability in general.

EAPs are frequently first to learn of an employee's intention to sue. Indeed, how often have you had an employee in your EAP office say, "I think I want to sue?" "Hey, do you think I can sue!?" or a similar statement?

As an employee assistance professional, your task is to help the employee get their needs met in more effective ways. The buzz phrase for thwarting lawsuits and handling disgruntled employees is "alternative dispute resolution." (Yes, I know this is really a term used in labor disputes, but let's broaden this term for a second --- really, to be more precise, this term describes official channels established by management to deal with disputes employees bring, which if not managed effectively, could lead to litigation. Very frequently EAPs work things out and save management and litigation dollars. I see our ability to management conflict in organizations as a form of ADL.

Does the human resource department of the organization understand your ability to align constructively with employees and help them get their needs met without turning to lawyers? The biggest weapon you offer is an empathic listening ear and the most valuable benefit you offer employers is empathy for employees and redirection to constructive help. It’s called “putting out the fire.”

This impact of empathy toward employees that EAPs provide and that cannot be provided by other individuals in the organization who are closely aligned with management (human resources, occupational health, etc.) is under-researched and under-appreciated.

The employer who understands this empathy-redirection-protection paradigm will give you more time to educate managers. They will ask the EAP to be involved in providing management consultation. And your influence will expand as an EA professional beyond the limited role many HR managers mistakenly believe you only fill now.

You Gotta Get Out More

2008-12-14T17:06:00.003-05:00

Sure, it can difficult because you are so busy, but few things will help keep your utilization up more than getting out of the office and traveling to the work sites to show your face to employees. In some organizations, factories, plants, or huge industrial work yards or similar settings, it's easier to simply go without a specific purpose. You go to the site, and with permission from a yard supervisor or other management official, walk in. Say "hello and greeting people as you go. NOTE: This strategy is very powerful and reinforcing, and will drive your utilization up faster if you go to the work site the DAY AFTER A TRAINING EVENT. The reason this is true, is because it is immediately reinforcing. You were just there. The memory of who you are is still present in the temporal lobes of these employees (to put it bluntly!) Do not be surprised if calls come to your EAP office afterwards or if employees walk up to you directly to chat about problems.

If you have a huge organization with multiple sites, consider assigning one of your EAP staff to that location for training, communication, and relationship-building.

Other work sites make it less appropriate to just show up and do a walk through. In such instances, you’ll need to consider a specific reason to show up. Perhaps your moving posters, dropping of cards someplace, or simply having a monthly meeting with the site manager on what needs might exist for the organization's work unit.

Why does this external rubbing of elbows work? Employees see you, consider their personal problem (remember 12-18% of the workforce has one right now) and think about calling. Then, some do. Visit again in three months and different employees will phone. The key low-dose frequency of contact with these potential clients.

Employees are also reminded about the company’s investment in them. This is appreciated and the reputation of the EAP as “being available” grows. Hint: 800#'s don't have legs.

1991-- the Pivotal Year for EAPs that Wasn't

2008-11-25T21:26:00.004-05:00

What were you doing in 1991 when the U.S. Congress passed the 1991 Amendment to the U.S. Civil Rights Act? If you were like me, you were oblivious to its implications for the employee assistance field, but it was earth shattering and monstrous.

The only reason the EAP field didn't feel the 9.0 quake rumble under its feet was because all of us, or nearly so, were on the wrong side of the mountain mining what little gold there is in the Managed Care industry. We were trying to understand it, team with it, fight it, and for some surrender to it. Some really famous EAPs sold themselves completely--and vanished.

Where we should have been was digging for the mother lode was on the other side of the mountain. We should have been teaming up with the Property-Casualty insurance industry. That's because the property-casualty insurance industry is not interested in keeping employees from accessing their behavioral health insurance benefits and using EAPs as gate-keeping devices to save health insurance dollars--what little there is to be saved.

These big boys want everything an EAP can throw at a company to reduce behavioral risk exposures. They want--they need the core technology. Why? They pay for the lawsuits that were made possible by the 1991 Civil Rights Act. They are the insurers for damages caused by bad employee/manager/management behavior.

Are you beginning to see the picture?

So what happened in 1991? You will answer this question for yourself in just a minute.

Let me ask: Are you aware that a corporation like Denny's, Toyota, or any business entity can be sued for unlimited punitive damages for sexual harassment and racial discrimination?
Did you know that 10 years ago the average out-of-court settlement for a wrongful discharge claim was $100,000. Even better, did you know that the average jury award for wrongful termination/discharge is $500,000?

So how expensive, or better said, how cheap is an EAP that can help prevent these payouts using its tools and resources so problems never become problems? Call it "dollars recovered from loss."

Ask yourself: How many times have you, as an employee assistance professional sat in your office and had an employee grumble, "I'm going to sue this place." If your experience has been similar to mine, you will probably say, "quite a few times." Of course, if you're a pro, your approach is to help such an employee get their needs met in more effective ways than suing the employer. Unfortunately, these vital successes probably aren't statistics in your annual reports.

The 1991 Civil Rights Act relates to behavioral risk exposures of employees and managers--ones that EAPs deal with all the time. But here is the kicker: Insurance policies were developed in 1992 to protect these companies. But who is protecting the insurers? Enter EAPs.

EAPs, with their education, intervention, assessment, proactive program development, supervisor training, and effective follow up can reduce these exposures. Are you aware of the psychomedical aspects of worker injury and recovery? I would suggest you investigate it. It is rich territory for EAP application. The goal: reducing Workers Comp payouts.

EAPs haven't seen their best days yet. They're ahead. They lie in protecting companies against financial loss associated with human behavior. But these programs can't be watered down. They need to represent the robust approach that the core technology suggests.

Head for the other side of the mountain--and bring a shovel.

Cover Your W-2's and 1099s

2008-11-13T11:35:00.007-05:00

So let's see how much of an EAP purest you are.

Depending on your orientation to employee assistance programs, it makes absolute perfect sense for the EAP cover only workers who are actually paid employees, who are full time or part time, and who receive access to the employer's benefits, especially health insurance plan.

But what about this? Should an EAP be made available to any employee who works for the organization regardless of pay status--volunteer, 1099, contract, or W-2s?

Any worker who touches the company is subject to personal problems and other forms of behavioral risk. This has nothing to do with pay status. EAPs were developed first and foremost as tools to manage trouble employee behavior, primarily substance abuse. The goal was not only to salvage employees and the proverbial secretary who costs $7000 to replace, but to protect the organization against financial loss--loss of all kinds from troubled employee behavior.

It makes sense to manage any paid worker's or unpaid worker's performance with the EAP. The rationale for doing so is based on the historical reasons EAPs emerged. I know many internal EAPs--especially older programs--that do precisely this. However, I know very few external provider EAPs that do. That's because employers don't want to pay for the extra lives and they have "met the need" by offering the EAP as a benefit only to their "insureds". They forget, or have never learned, that the EAP is a productivity tool. It is not a benefit or counseling service. It's there to protect the employer as well. Many would argue this is their first and most important purpose, and that this is perfectly consistent with the well-being of employees.

The view that an EAP is a benefit has brought us to the point where behavioral risk exposures are increasing for employers. Many don't get the number of supervisor referrals they believe they should be seeing. I have read where some HR managers are taking on the counselor role with employees. Look around the mainstream HR journals and you will find articles on the subject of "putting 'humane' back into human resources." In other words, some HR writers are calling for the HR role of pre-counseling, and then referral of employees to resources in the community. (Holy mackeral! This is what EAPs do!) This phenomenon is due to the loss of the EAP message in mainstream HR literature.

There is a need for education to help make a “cross over” to another way of thinking about EAPs, one that would renew and re-establish, what EAPs can do for organizations. We then need to market the EAP as a resource for all employees and workers, not just the "insureds". The EAP field will be better off, and so will its future. Employers may then begin to pay the necessary fees to have viable EAPs that keep their tushes out of the sling and understand why EAPs are such a good thing for them, not just their employees. Increase your EAP utilization with communication materials that actually keep the need for building utilization in mind with each article written.

EAPs: Teach this Strategy

2008-11-09T12:26:00.003-05:00

No EA professional that I know of has ever helped a troubled employee learn this strategy, but it will go light years in helping employees with performance problems flip overnight to become outstanding employees if they aren't impeded by a severe personal problems like alcohol or drug addiction. To purchase this fact sheet go to http://www.workexcel.com/. It's reproducible and editable, and you put your name on it, etc. Search for fact sheet E076 after November 10, 2008. That is when I will have it posted.

Understanding Completed Staff Work

Maximizing your effectiveness in providing superiors with realistic and actionable solutions to problems is one of the quickest ways to enhance your value within an organization. Understanding the principles of Completed Staff Work will help you to develop a comprehensive and systematic approach to researching, documenting, and presenting your recommendations to your superiors.

Completed Staff Work is a doctrine originally developed in the U.S. military that describes the standard of responsibility, thoroughness, detail, professionalism, and accountability required when preparing material for a superior.

According to a document prepared by the Office of the Provost Marshall General of the U.S. Army, Completed Staff Work is “the study of a problem and presentation of a solution by a staff officer in such a form that all that remains to be done on the part of the head of the staff division, or the commander, is to indicate his approval or disapproval of the completed action.” (Harari)

Principles of Completed Staff Work

Independence
Creating Completed Staff Work is as much about process as result. When you are charged with finding solutions for your superior, your job is to work without further input or advice from your superior. Although certain matters may need clarification during this process, all details necessary to researching, documenting, analyzing, and providing a solution are your responsibility.

Thoroughness
Your research and analysis should be exhaustive, considering all possible scenarios,
alternatives, and repercussions in determining the best recommended course of action. This recommendation should include thoughtful and detailed steps for implementation, including contingencies for any foreseeable problems.

Clarity
Once your research and analysis are complete, you should prepare your final recommendations to your superior in a short, concise format. Your presentation should present a clear, unmistakable conclusion that leaves no question unanswered.

Ownership
Completed Staff Work requires the individual presenting the material to take a strong, clear position. Bureaucratic doublespeak and tepid conclusions are unacceptable. Your final recommendation should be one that you would be willing to stake your career upon.

Rising to the standard of Completed Staff Work requires the best that an employee has to offer. The default operating procedure in many bureaucracies is to limit personal risk, shift responsibility, and do the minimum required to “get by.”

Consistently presenting Completed Staff Work to your superiors will set you apart from peers and earn you notice as a serious and diligent professional.

Old Trick Pulls Utilization--Table Top Tents

2008-11-07T11:33:00.002-05:00

Yes, it's simple. But, if you have a workplace with a large cafeteria, table-top tents (cardstock
paper folded in half with your EAP message on either side placed in the middle of
the table) can be effective at marketing the EAP. MS Publisher -- a common Microsoft Office software program can provide you with a quick do-it-yourself template for this marketing strategy.

Use 100# cover or card stock paper or this strategy to prevent drooping messages! It stays standing.

Consider placing five questions about your EAP that target myths and misconceptions about confidentiality, communication with management, what kind of problem EAPs tackle, and other interesting--tough but contraversial questions--on one side of the card and the answers to these questions on the other side of the card. This will stimulate conversation between employees at the table with one asking questions and the other trying to respond with the correct answer.

Everyone will be talking about the EAP by the early afternoon guaranteed.

Use questions that dispel myths and misconceptions about the EAP. Directly under the answers, consider providing additional information in smaller type that expounds on the answer given to the question on the other side of the card.

Consider these issues: Is the EAP is part of the disciplinary process? Is the EAP is therapy? Biographies about staff. Do supervisors find out what employees use the EAP? Can family members use the EAP? What confidentiality laws that govern EAP records, etc. Why EAPs formed. History of EAPs.

Don’t forget to put the phone number of the EAP on the card!

How to Get a Whopper of High EAP Utilization By Promoting Your Professional Staff

2008-11-05T12:00:00.007-05:00

Chances are your EAP staff are a unique bunch of folks, but employees within your organization simply don’t know much about them. Of course, they may have heard a brief bio at an EAP orientation but, this alone is not enough to have a favorable impact on your EAP utilization.

Promote your staff using internal communication like your EAP newsletter or other in-house publications. If an organization that you are serving as an EAP provider has its unique internal newsletter, say at a large bank or other business, go to the public relations department and suggest that they run a series of articles that highlight your EAP staff, their background, and skills. A picture along with the bio is a plus.

Specialities such addiction intervention, mental health treatment, adolescent expertise, family counseling, or eldercare resource knowledge will draw employees who identify with those problems. “Identify” is the key word. Simply telling employees that EAPs deal with personal problems is not as effective as actually talking about the specialties of EA staff directly. You want your potential client to get closer to the EAP, and you do this by creating imagery of expertise that the client will feel attraction to using. This makes it all real. Employees don’t want to see themselves as having “personal problems.” They will however, be attracted to solutions.

They much rather stay in denial about the label, and pursue help for their pain. Don’t profile all your staff at once. This is too overwhelming, and a tactical mistake. Instead, dedicate a whole column to one staff member. Really get in there and supply some detail. Then watch how the phone rings. Two years later, do the same thing, but come at it from a different angle. This time discuss past positions prior to the EAP, hobbies, or unique interests. Make your staff real, and you will get a real return.

EAP Marketing and Utilization: Channels of Communication

2008-08-30T08:13:00.004-04:00

One of the secrets to promoting any product or service is becoming a pro at using multiple channels of communication for that product or service in delivering the marketing or promotional message to the customer. In this sense, I am speaking about potential EAP clients (employees or work units) within the organization that can take advantage of your services. Increasing your EAP utilization or marketing EAP services effectively requires analyzing and studying these channels of communication and keeping your eyes open for new ones as they pop up. You may spot one at any moment as it produces an EAP client. That’s a signal to grab it, stick it in your marketing basket, and add it to your marketing mix. A focused discussion with your staff can produce more through a brainstorming process, but arriving at the point where your antenna go up with "Marketing Channel, Alert! Alert!", is the place you need to eventually arrive.

If you worry about your EAP utilization, the answer to increasing it off the charts lies in examining, tracking, and exploiting these marketing channels. Putting pen to paper to identify them and work them strategically can boost your utilization rate, reduce behavioral risk exposure in the organization, and provide evidence to prospective EAP corporate customers that expertise in your craft is going to return big bucks to them in cost-benefit if they go with your proposal. It may also prevent your EAP from closing its doors or getting farmed out to an 800 number in a cubicle on the 24th floor of an office building on the other side of the country. Understanding marketing channels is not only an art, but an essential strategic undertaking in the survival and growth of your EAP.

You are already very familiar with one or two channels of communication that apply to your employee assistance program. One no-brainer is the EAP brochure distributed in strategic locations within the organization. Another channel is your health and productivity, or work-life newsletter given to employees at a frequency decent enough that you are actually remembered. And still another is making short presentations on mental health or work-life topics. There may be 20 to 30, and even more marketing channels that escape your awareness, yet each may potentially contribute to a higher EAP utilization. You should identify these channels of communication so you can work them to your advantage. If you do not make a focused effort on doing this, you can easily miss half of them.

Channels of communication reinforce each other and each contributes to increasing or maintaining your EAP's utilization. In the next few messages, I will begin discussing a few of these with the goal of helping you establish a 6th sense for spotting these gems and mining them for the benefit of your EAP, corporate customers, and most important troubled employees.