Substance Use and Stigma: Considerations for Employers

Addiction is a hidden workplace epidemic, but employers can make a difference.

March 29, 2021

By Matthew Stefanko, director of the National Stigma Initiative at Shatterproof, and Rachael Cooper, senior program manager of the Impairment Practice at the National Safety Council.

Only a few years ago, in 2018, the decline of fatal drug overdoses for the first time in years presented a bright spot in the opioid epidemic. Unfortunately, that progress has since been wiped out as fatal overdoses are once again on the rise, claiming a record 85,000 lives from September 2019 through August 2020. While this reversal is disheartening – and COVID-19 only complicates it further – we cannot give up hope. New strategies and partners can help us work toward ending this epidemic, starting in workplaces across the country.  

More than 70% of individuals with substance use disorders (SUDs) are in the workforce, making this a crucial workplace safety issue. Employers also have a compelling financial incentive, with one study estimating that the opioid epidemic alone cost $123.7 billion in lost productivity from 2015–2019.

That is why the National Safety Council and Shatterproof are partnering to ensure employers are prepared to support workers with SUDs and end addiction stigma. Stigma remains a foreign concept to many organizations, even as it affects the health and safety of their employees. Fortunately, NSC and Shatterproof offer a variety of resources, but there is no time to lose.

The Impact of COVID-19

COVID-19 has worsened the addiction crisis and will continue to do so as people experience social isolation and financial uncertainty and as over-burdened healthcare delivery systems impact treatment and recovery services. The pandemic has exacerbated many SUD risk factors, including psychological ones, such as mental health conditions including anxiety or depression and trauma, as well as social risk factors, including unstable housing, low socioeconomic status and unstable employment. The long-lasting impacts may not manifest as problematic substance use until weeks, months or even years later. When they do, employers must be prepared to support their workers. 

Even more worrisome, this crisis disproportionately impacts individuals of color. Black and Hispanic individuals were nearly twice as likely to report increasing their substance use to cope with pandemic-related stress or emotions than White individuals. Black individuals are also more likely to die from an overdose than any other race, according to Q1 2020 data from the National Vital Statistics System. Employers can play a crucial role in reversing these trends, but they must understand the roadblocks created by stigma. 

Understanding Stigma

Stigma is an attitude, behavior, or condition that is socially damaging or discrediting, and can manifest in many ways. Shatterproof has identified four types of stigma as priorities: 

  • Public
  • Structural
  • Self
  • Stigma against medications for opioid use disorder

Shatterproof has also identified nine commonly cited drivers of the opioid epidemic: 

  • Overprescribing
  • Increased access to heroin and fentanyl
  • Insufficient treatment capacity
  • Gaps in evidence-based treatments
  • Criminalization of SUD
  • Insurance coverage disparities 
  • Social isolation
  • Lack of help-seeking 
  • Societal barriers to recovery 

Seven of the nine drivers of addiction are either partially or entirely driven by stigma, and many of these barriers are evident in the workplace, highlighting the role employers can play. 

Employer Actions

Three out of four employers report having been affected by employee use of opioids. There are 5.9 million employers in the U.S. with approximately 127 million full-time workers. Since employers set organizational policy, influence language norms, and purchase healthcare benefits, and employees spend more than one third of their day at work, they are in a unique position to influence the knowledge, attitudes, and behavior of their workers to reduce stigma. 

First, employers must understand that they benefit from having employees in recovery. Workers in recovery have lower healthcare costs, are less likely to take unscheduled leave and are much less likely to have had more than one employer in the last year. That adds up to an average savings of $8,543 per worker.

People in recovery often have a high degree of self-awareness, resilience, compassion, dedication and understanding. These skills and behaviors should be valued for the positive impacts they bring to the workplace team, company and culture. Building a recovery-friendly workplace is critical to support employees, and cannot be done without addressing and reducing the role of stigma.

To help, employers and individuals can access numerous free resources on stigma, become a Shatterproof Ambassador and take the anti-stigma pledge. Organizations looking to make a deeper commitment to stigma reduction can also access Just Five© digital education, an online, self-paced, mobile-enabled program focusing on increasing awareness, reducing stigma, and sharing information about addiction prevention and treatment. Organizations and safety professionals can learn more about the costs of substance use to their workplace using the Substance Use Cost Calculator and get customized resources through the NSC Opioids at Work Employer Toolkit

Now, more than ever, workers need the support of their employers. Visit shatterproof.org/EndStigma to be part of the solution.

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