Substance abuse has a profoundly negative effect on the workplace in terms of decreased productivity and increased accidents, absenteeism, turnover and medical costs. Drug-using employees are 2.2 times more likely to request early dismissal or time off, 2.5 times more likely to have absences of eight days or more, three times more likely to be late for work and five times more likely to file a workers' compensation claim.
In addition, alcohol and drug abusers are two to four times more likely to have an accident as people who do not use drugs and alcohol. To the extreme, substance abusers can be linked to approximately 40 percent of American industrial fatalities. To combat this, many employers have put programs in place to encourage a "drug-free" workplace.
They are aided by resources such as the Drug-Free Workplace Advisor of the US Department of Labor, which assists users to build tailored drug-free workplace policies and provides guidance on how to develop comprehensive drug-free workplace programs. Many other resources exist as well.
For example, the Institute for a Drug-Free Workplace (a national non-profit corporation) is dedicated to preserving the rights of employers and employees in drug- and alcohol-abuse-prevention programs, and to positively influence national policy in this area. The institute offers resources for employers and employees on substance-abuse detection, prevention, policy implementation and employee education.
All of this is much needed, but the prevalence of substance abuse in the workplace and in our society is only half the problem. The other half, which sadly gets far less attention, is the inability of individuals to access the treatment they need. The irony in this is that most health insurance policies written in the United States actually contain provisions for substance abuse treatment.
The Wellstone-Domenici Parity Act passed by Congress in 2008 requires this and was created to put an end to the health insurance benefits inequity that historically existed between mental health/substance-use disorders and medical/surgical benefits. Despite this legislation, the problem continues.
Insurers throughout the country still impose unreasonable deductibles and co-payments or enact care guidelines that keep patients from receiving treatment at the level of intensity or for an amount of time that is universally accepted as necessary.
By ignoring the guidelines of both the Substance Abuse and Mental Health Services Administration and the American Society of Addiction Medicine, insurance companies have sidestepped Congress' clear intention. When they do, everyone suffers.Fortunately, there are things being done to help alleviate this tragedy.
Here are four:
1. Legislative Activity - While some states hope for voluntary insurance reform and change in policy from health insurers, others have taken direct action through the legislative route. Pennsylvania's Drug and Alcohol Insurance Law (Pennsylvania Act 106 of 1989) requires most group health insurance plans to include coverage for addiction treatment.
The only prerequisite is certification and referral by a licensed physician. The act also requires most group health policies to include mandated minimum benefits for treatment of alcohol and drug addiction. These include seven days of detoxification per year, 30 days of non-hospital residential rehab per year and 60 days per year of outpatient treatment.
Earlier this year in California, the state assembly passed a measure broadening mental health services covered by private insurance plans and making it easier for people throughout the state to get access to the care they need. Now, AB 154 - authored by Assemblyman Jim Beall (D-San Jose) - is under review by the state senate.
The bill requires insurers to cover the diagnosis and treatment of most mental illnesses and substance use disorders. The passage of this bill will provide new coverage for 4.5 million people with non-severe mental illness as well as an estimated 6.3 million people annually in need of substance abuse treatment.
Pennsylvania and California are providing us good, sensible models for others to follow. This issue is not confined to one state, one region or one segment of the nation; it affects us all.
2. Essential Health Benefits - The Patient Protection and Affordable Care Act (healthcare reform) guarantees that health insurance plans offered in the individual and small group markets offer a comprehensive package of services known as "essential health benefits." These benefits will include preventive, diagnostic and therapeutic services in at least 10 categories of care, which are defined as "essential" and "equal to the scope of benefits provided under a typical employer plan."
Late last year the Department of Health and Human Services (HHS) deferred the establishment of the specific essential health benefits to the states - declaring that each state (rather than the federal government) would define which medical benefits insurance companies will have to offer consumers starting in 2014. This approach was developed with significant input from the public as well as reports from the Department of Labor, the Institute of Medicine and research conducted by HHS.
The inclusion in the essential health benefits package of meaningful requirements for substance abuse treatment will help do away with the gamesmanship that sadly continues to engulf this issue. Employers can do their part by letting their elected officials know just how important this issue is to the health of their workplace, their employees and their community.
3. Employee Engagement - Employees need to become more aware of their rights if they believe that they have been improperly - and in some cases illegally - denied care. This includes both a greater understanding of their rights directly with their insurance carrier (including in some states the right to independent review) as well as access to other programs that may be available to help. For example, one company offers a free legal referral service for patients and families at a crossroads.
Under the program an individual simply calls a toll-free number for a free consultation. This consultation includes a legal review by a qualified attorney and advice about legal rights. If an individual has been improperly denied treatment, the caller is referred to an attorney with specialized expertise in insurance claims for further consultation. The referral and initial consultation are free of charge. Individuals who elect to retain a specialized attorney to represent them in a specific cause of action will be responsible for any fees associated with this representation.
4. Employers Flexing Their Muscles - Employers can do their part by questioning their insurance carrier regarding their policies and practices for substance abuse coverage. A report issued earlier this year by the California Office of the Patient Advocate revealed that California health plans are doing a shockingly poor job of providing quality care to individuals in need of alcohol and drug dependency treatment.
In comparing the quality scores of California's eight largest HMOs against national performance, the report revealed that only 13 percent of those adolescents or adults who were diagnosed with alcohol or other drug dependencies had the necessary treatment within 30 days of being diagnosed. This is compared to 92 percent who receive adequate care for asthma, 87 percent who receive cervical cancer screenings and 88 percent of diabetics who get properly tested for cholesterol. This is the equivalent of getting 13 out of 100 on a test. Why should such performance be tolerated?
Employer-sponsored insurance is the leading source of health insurance in America, covering about 150 million non-elderly people nationwide. Covered workers contribute on average 18 percent of the premium for single coverage and 28 percent of the premium for family coverage, with employers contributing the balance. That gives employers a lot of muscle in the commercial marketplace. With this much money at stake and with the stakes so high, employers have the clout to put their insurance carriers on notice that denying much-needed substance abuse coverage to their workers is simply not acceptable any longer.
Alcohol and drug abuse are among the costliest health problems employers face. By requiring that health insurance providers make treatment available - treatment already included in most policies - costs to the states decrease and successful outcomes increase. And when this happens, employers will finally see some relief from the physical, financial and psychological distresses that accompany substance abuse in the workplace.
About the Author
Phillip Greer is executive director of the not-for-profit California Treatment Advocacy Foundation, dedicated to improving access to effective and affordable treatment of substance use disorders.