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Is Performance Evaluation Training and Consulting a New Gateway to EAP Consulting

Think about performance reviews and performance evaluations of employees. If your experience has been anything like mine, you know that supervisors not only dislike conducting performance evaluations for a host of reasons, but many supervisors renege on their responsibilities and don't do them at all. When I worked for Arlington County government, I discovered many supervisors hadn't done performance evaluations with employees in years. Where was HR? Ignoring these supervisors of course. The risk associated with lack of performance evaluation is enormous, and there is one overwhelming reason why. It's this: The supervisor has only his or her relationship as a tool to managed the employee performance, conduct, and other behavior. A bad relationship can turn into violence and other problems--like theft and conflicts--but the worst of all is violence in the workplace. Stay tuned. We are going to be display a new program and course on conducting effective performance evaluations. I believe there exists an enormous opportunity to propel the EAP field forward, and that is by claiming the high ground on this unmet need to train supervisors. Get ready for the Performance Evaluation Training Program. I will post a link so you can view it soon.

Careful! Don't Serve Up Problems with EAP Concierge Services

Concierge services - non-traditional helping hand services provided by EAPs and other work-life businesses to help employees resolve everyday work-life problems are gaining hold in the EAP field--well, here and there. A recent post on LinkedIn from a EAP in the United Kingdom got me thinking about this topic again.

The fragile rationale for the inclusion of concierge services in EAPs is that if you can't walk your dog and are worried about the carpet at home, this distraction isn't good for your employer's productivity. Hence a leap forward to providing a helping hand to employees that gets the logistics and worry off the employee's mind to free that brain up for more productivity.

I have one reaction to this: What is the "spirit and intent" of the EAP Core Technology?

Skeptics argue that such "concierge" services are the creations of the work-life industry and move away from what EAP services are all about. Others paint a rationale completely consistent with the core technology. 

The reality of course is that competitive pressures to keep EAPs in business (otherwise known as the market economy) are turning some EAPs into do-it-all for you, one-stop resources for employees. Is this practicaal and protectionist or it shooting EAPs in the foot?

Is this an evolutionary step in the EA profession? Or, is it a step away from behavioral risk management, hands-on help for troubled employes, and better penetration into unmanaged risks in the organization associated with human behavior that only REAL EAPs can identify and dislodge? Does it contribute to a loss of focus for the profession, thereby making it ever more vulnerable to being hijacked by managed care?

In many ways, EAPs have always provided some concierge services. I remember a kindergarten teacher phoning to say she was completely frustrated with AMTRAK for billing her $850 twice for taking a bunch of students on a field trip to New York. After four months and getting nowhere fast, she called the EAP. Yes, we took the case. After all, she does not have the time at work to be on the phone all day. About an hour of bird-dogging AMTRAK and the problem was solved. Concierge service? Perhaps, but is this proof that EAPs should dive in head first into this shallow water? If you argue yes, would you post a sign outside the EAP door that advertises "consumer affairs problems solved here?" What about your brochure?

Will these services build your utilization rate? Yes, but at what ultimate cost? I hear the siren's wail on this one? I think it is a shipwreck for the EAP field to venture this direction. I would argue you could make it easier to get farmed out. 

I think there is something called the “spirit and intent” of the EAP Core Technology. It requires an honest assessment of whether activities of your program match it because the profession is fewer in number this year than last--with many EAP closures only since 2012. I don't think concierge activity is what I would call a salvation related activity.

Reducing Absenteeism: Yeah, EAPs Do That Dummy!

There is a old threat to productivity rearing its ugly head in a new way - absenteeism. Before you say, "no kidding, Dan!", get this: The Washiongton Business Group Health ten years ago released a report, "Staying at Work" Report. It said, "properly targeted and executed disability and absence management programs can, in fact, produce real gains." They cite approaches that fail to mention EAPs in any way.  I just do not understand this!

The ongoing interest in absenteeism problems stems from a survey conducted showing 78% of human resource managers believe the main cause of absenteeism is a belief that those who skip out of work believe they are entitled to time off. This is extremely interesting.

The second most cited reason was a lack of supervisor involvement as a catalyst to discourage worker absenteeism. This has EAP solutions written all over it.
There is no way to discover the occurrence rate of personal problems to the degree that they affect absenteeism through a survey of human resource managers like the one conducted by this Blue Ribbon group. Superimpose this fact on top of the empirically-based research paid for by EAPA members dues and conducted by Linda LaScola Research sometime around 1992-3?, which found that human resource managers don't know how to use EAPs efficiently, and you got yourself a real case for EAPs coming to the rescue.
The obvious problem: EAPs are not being used as management tools in American companies as they were in the 70's. Instead, they are seen as counseling programs predominantly for self-referral. Nothing in this research, and nothing in any article reporting it, ever mentioned anything about EAPs! However, in the 1970's the WBGH was a high-powered elite group that played a significant role in promoting the establishment of EAPs in Fortune 500 companies. (I suspect most of the folks at WBGH from 70's are retired. This might explain their institutional memory loss. That, combined with about 33 HR journals telling everyone that an EAP is something run by a managed care company with an 800#.)

What to do:  Help spearhead an absenteeism management program that puts the EAP front and center. Consider new training, and ask the organization to give you access to their absenteeism report. Watch your EAP utilization spurt up. Let me know if they blow you off. I would love to know why. "EAPs don't do that" might be the key reason -- like they know what EAPs do better than you do! I have seen this a million times. You open your mouth at meeting, and someone says, "EAPs don't do that". Where does this stuff come from?

Do you have a newsletter for employees? If you do not, let prove something to you. You're utilization rate will go up 20% annualized with a monthly EAP newsletter (2 pages--never four!) or if it does not, I will publicly apologize in this blog at the end of a free three month trial.

So, let me send you a free trial. Don't worry, I will not chase you down waving a bill at you. Go here for it.

EAP Utilization Tip: Utilization Review & Hospital Social Workers

How many hospitals are in your town? Medical social workers or utilization review nurses might be the busiest occupation on the planet with the most stress. The cut-backs in hospitals and the personnel shortages they face, have made social workers busier than ever--that's if they have not been fired yet. Some hospitals have let all of their hospital social workers go. They have replaced the bulk with utilization review nurses who line up support and medical help post-discharge.

They could use some help. And they would love to refer employees from the company or companies you serve who've ended up in the hospital for one reason or another. You could lighten their load and get the utilization credit for your program. Remember family members could use EAP services too, so make sure your statistics include "employees impacted" by EAP services.

In many instances, medical social workers perform the same kind of  "brokerage" services for patients and their family members that EAPs do. (Brokerage is arranging services for the client without the client's involvement and then passing them off to that service or agency for continuing care or services.) Medical social workers interface with hospice services, meals on wheels, visiting nurse agencies, home health care, medical equipment companies, admission departments of nursing homes and assisted living facilities, social security disability and retirement offices of local government, many other services. If you have done this work as a medical social worker or hospital utilization nurse, you know that burnout is high. You're on the phone constantly.  Help these hospital professionals by letting them know you exist. When a patient is admitted to the hospital, the EAP (that's you) can be contacted to help arrange support or other services. They instantly become a new EAP client referred to your program. Note that you will need to reinforce your availability for assisting the hospital with patients who are also employees of the companies you serve. I would arrange six monthly letters to the person in the hospital who is head of insurance utilization. Send them monthly regardless. After that, your utilization will increase. Let me know what happens. This is a win-win for everyone, including your EAP client, especially.

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EAP Utilization Tip: Partner with Local Gyms & Exercise Merchants

Gold’s Gym and other franchises are privately owned. This means you probably have opportunities in your town to negotiate with such gyms to get free passes for your EAP clients. You'll boost worksite wellness, too. This is a very cool draw to improve your EAP utilization, and it works. I've done it.


The Gold’s Gym in our area (Arlington Virginia) agreed to give us one month passes for clients who we felt needed to take better advantage of opportunities to improve their health. Good preventative health means pursuing an exercise program, and what better way to get started than with a one-month free pass to a local gym. Word of mouth that the EAP offers clients free passes to a local gym can increase your EAP utilization. It doesn't take much. Just make this a quiet way in which your EAP helps employees. Don't promote it. Simply let it happen and watch the vote of confidence your EAP will soon get.

Imagine being able to hand a free monthly pass to an employee suffering with depression. You know reactive depression and milder depressive disorders benefit from exercise, so visit the local gym. Meet with the decision maker and claim the high ground on this improving the EAP utilization strategy.

EAP Marketing Tips: 1 of 10: Talk about Risk Reduction More Deeply

I am going to discuss marketing related issues for EAP providers. Many have complained about low balling, managed care, and "commodization". Commodization is not a problem by the way. It is a symptom of the problem. That problem is lack of definition and codification about what EAPs really are, what they should be, and how they ought to be defined by a nationally recognized organization that both promotes and protects the parameters of the EAP program definition so corporate customers and potential purchasers pull away and are less likely to be attracted to inferior, well marketed knock-offs. (Okay that was a little rough, but this is a blog.)

Back on point. The issue in in free markets is usually also about having a better product and the ability to communicate that. I think a piece of the problem lies here. The problem it seems to me is that EA professionals don't really know their own product very well. Let's discuss this over the next couple weeks and see if my notes transcribed to this blog from the jotted scratches on gum wrappers I possess can assist you with additional insights that will make you better prepared to discuss your program and better able to standou in a crowd because you are able to define a better product.

Issue #1 of 10 for Marketing Discussions with Potential Purchasers of EAP Services:
With the increasing risk to employers of being sued by employees, how does the EAP play a role in reducing this risk beyond simply seeing employees referred for personal problems?


Because CT-EAPs (the CT stands for true core technology-driven programs. Since anyone can call themselves an EAP and get away with it handily, I often like to write "CT-EAP".) deal with troubled employees, many of whom have problems with management, they are frequently the first to learn of an employee’s interest or intention to sue the company. For example, my supervisor did such and such, I am angry, I wonder if I can sue. Such statements, if handled properly, make the EAP an early, front line defense against employment claims and related lawsuits. EA professionals help employees seek solutions to personal problems and will steer employees to more constructive alternatives to meet their needs. In many instances this is accomplished by referring them to human resources, providing conflict resolution assistance, or seeking other alternative dispute resolution channels. Although not researched, EAPs certainly save money by helping ward off lawsuits long before they ever are filed. These are precious dollars recovered from loss. It is more crucial than ever for today’s EA professionals to understand federal laws that govern the employment relationship. EA professionals should know these major laws and have a basic understanding of their tenets. Armed with this knowledge, they can better consult with supervisors in the course of managing troubled employees. Every EAP should respond to an additional question, “How do you respond when an employee comes to your office and states that he or she is interested in suing the company?” Communicating to customers that your EAP is a program of attraction like a magnet for troubled employees and those like to agress against the company financially, where they can get their needs met in "healthier ways" is a huge and attractive marketing point ignored by the most experienced EA professionals and related marketers. A business hearing this may respond very quickly with "where do I sign up!"

OSHA Safety and Health Checklist (and No EAP)

You would have to be from another planet to not know that EAPs are cost-beneficial and that when fully implemented have a positive impact on helping reduce accident rates and injury related costs. The research has already been done 30 years ago. And EAPs reduce other behavioral losses in the workplace as well. Somehow however the recommendation to have an EAP is still not listed on OSHA's Safety and Health Management Systems Checklist. This list is no small thing. This is the front line handout OSHA distributes nationwide. It covers many recommended steps that companies should take to reduce accidents and injuries. I think "Establish a Employee Assistance Program" should be on this list. I know probably agree. Think about the lives saved, reduced accidents, and reduced injuries associated with helping troubled employees, particularly alcoholic employees, not to mention reduced property damage and lost time results having an EAP in place. How much pull to you have with OSHA? Do you know anyone there? Are you reading this post from  your desk at OSHA because you work there? (Hi!) The above PDF was last printed in March 2008! The clock is ticking. QUICK! Before this gets re-written without an EAP mention, let's get OSHA to include EAPs as an important part of a Workplace Safety and Health Management System. Right now, I see this as an overlooked and critical component that needs to be on this list. Do you agree? Phone right now while you are thinking about it. This is the office of communications phone number:  202-693-1999. If enough people phone, they will consider adding EAPs. It's the little things folks that promote this profession. Look for more of these gems--things EA professionals can do to promote their craft. Email me and I will post suggestions on this blog. Health and wellness in the workplace is dramatically enhanced when EAPs are in place.

Yes, Your Own Blog Can Pay Off! Pay Attention to Marina London

Hi everyone, yes, it is true. Blogging pays. If you are at the EAPA Conference taking place in Tampa right now, and you are participating in the seminar on blogging, pay attention.

Blogging is awesome and it can really, really help the EAP field---and your EAP.

But let me give you a tip. Select a niche!!! Don't blog about anything and everything. Of course, I am blogging about EAP related issues, but I could just as easily blog about EAPs and Workplace Violence.

Let's discuss this for a moment. Can you guess how many times the phrase "workplace violence" is Googled each month? I will tell you.....looking it up now as I type.......the answer is 49,500 times per month.

Impressive? Yes. But let's say you blogged on Workplace Violence every 7 days. No big deal -- just 100 words on how EAPs can play a positive role in reducing the risk of workplace violence. What would happen?

Here what would happen. Because your blog begins to accumlate highly relevant content, you would slowly but almost assuredly find yourself on page one of Google.

Do you realize the implications of this?

It means traffic---and that means anyone interested in the topic would slowly  begin to view you as the expert on this topic and witha  link to your website on your blog, discover you and your EAP. Search engines will rank you high because you are consistently talking about this topic. The rest is your message. But with 49,500 searches and you being on page one of Google, do you think you would get a few interested customers? Duh.

Getting Spit On? Call the EAP!

Finally, I found an amazing and dramatic illustration of the topic I like to harp on most -- having EAPs identify and then make use of opportunities that suddenly and dramatically emerge in the workplace where the EAP solution can be applied. When EAPs do this, they grow their value and reputation, and if they are lucky enough, come in contact with major stake holders who have enormous clout. These stake holders -- property casualty insurers are one -- can elevate EAPs dramatically.

Can you guess how days the average bus driver in New York City took off last year after they were spit on by bus riding customers? The average time off was 64 days!!!!! One took off 191 days. No, these are not drivers to be disciplined for gross abuse of leave policies. They are getting paid by workers' compensation!

Amazing you say? Indeed. It's costing tens of thousands of dollars right out of the city coffers. And many of these drivers are claiming they need psychological help as a result of the pedestrian abuse they experience. Here is a link to the story.

What's the issue, and is there an EAP solution for the drivers, the public (indirectly), and the financial crisis associated with this workers' compensation nightmare? I think there is, or at least I hope you walk away from this blog with the idea that you can find untold numbers of opportunities to make yourself more useful and valued in the EAP setting. (And by the way, fear not, you won't have managed care competing with you for these classic applications of the core technology. It is off their "grid" entirely.)

Off the top of my head, the EAP should be included in a round table discussion with top management and review the data associated with these incidents. Specifically, what should be determined are patterns associated with everything from time of day these incidents occur, profiles of the spitting customers, antecedent and provocative events, worker profiles, and other variables that may point to behavioral interventions appropriate for the EAP.

For example - EAPs have skills or can closely coordinate with resources that have the skills to provide stress interventions for these cases, education on managing emotions, behavioral interface with customers, how to diffuse violence (which of course is what we are talking about when it comes to spitting). And, what about customer service? Dealing with angry and abuse customers? (see fact sheet).

How many bus drivers are depressed, alcoholic, or experience other behavioral problems exacerbated by these types of stressful incidents? What about anger management training or examining customer service issues that help employees avoid responding or provoking inappropriate behavior from people? There many more issues to examine here. Are more men than women assaulted. What's the difference? What about processing anger in groups and learning skills.

The violence of spitting on a bus driver surely is a crime. And law enforcement must play a powerful role. However, there are psycho-medical and dynamic behavioral issues at play with the larger problem, and of course, the enormous expense of workers' compensation costs demand a comprehensive attack on the problem.

The EAP is part of the solution. At least, this is much is true before I am willing to say there is not: Completely omitting any consideration of an EAP role in dealing with this problem is financially irresponsible.

Now, if the EAP is being considered at all, and no one has suggested, we need to ask why?

This problem lies at the feet of the profession. And here lies the answer to a new dawn for employee assistance programs. Am I wrong?

Resolving Coworker Conflicts - Done

Resolving coworker conflicts is something many employee assistance professionals are well skilled at doing. However, many EAPs don't advertise or promote this service. You should think about doing so to improve your worth and perceived value. Providing education on resolving coworker conflicts can increase your visibility for this service and EAP utilization, but the really good news is that such help to the organization brings with it big returns that may help you stick around. You will notice that many of the products and services at WorkExcel.com are designed to help EAPs be more valuable. For example, doing Stress Management Secrets for Supervisors was not an accident. It was produced to get EAPs closer to the decision makers.

To offer a promotional and educational tool, available in five formats, I recently created new product on Resolving Coworker Conflicts. You can see it here. Feel free to give me a call if you have any questions. This program will elevate the visibility of your EAP and reduce risk to your host organization(s.)

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EAPs Can Do Managed Care and Increase Their Value

1. If you work for an internal EAP with a company that is self-insured, consider approaching your human resources and benefits management team to discuss the possibility of getting the mental health component of your EAP "carved out" so you can provide limited managed care services. If you are a very well trusted tenured pro, they just might consider it. Listen up. I am not recommending to you anything that I have not done myself, including this task.

2. If you can achieve this goal, it will increase utilization rates dramatically. Here is the selling angle: 1) The EAP can pre-screen and refer employees to appropriate mental health professionals based upon their clinical evaluations and guidance. This will save money by getting employees to the right provider the first time.

As an incentive, permit 80% coverage for mental health benefits versus 50% for those that don't go through the EAP. Self-insured companies can do this sort of thing. This will also allow the EAP to identify behavioral/medical problems that may underlie existing disorders contributing to the symptoms brought to the EAP session by the client.

3. Even a phone interview with an employee to discuss a referral -- in the event the employee does not perceive the need for a face-to-face interview, or refuses -- can go along way toward identifying primary health problems that can be more effectively treated by the referral source the EAP might suggest.

4. If you succeed in getting a carve-out, the primary services you will provide include: 1) approving therapists; 2) notifying the insurance company who they should approve payment for; 3) re-certifying regularly; 4) selecting providers when a specialist on the managed care panel doesn't exist; and, 5) deciding to pay higher fees than the managed care company is willing to do themselves. This is a good deal for employees and can increase confidentiality. Yes, it will save money for the company, too. That's right, many managed care companies will not require "outpatient treatment reports" and they will accept the EAP's approval of out-of-panel therapists. You decide. You have to be diligent, but remember, "its your money not managed care's money."

5. All of this can limit the amount of clinical information, other than a CPT code, that will go to the massive computer memory at the managed care company. This improves actual and perceived confidentiality. Survey other internal programs nationwide to identify strategies capable of adding this dimension to your EAP services.

If you are interested in seeing the new “Preventing Violence in the Workplace” program (five formats available), reply back here and I will make sure you are on my early release list to view it, and get the limited time discount. This is a reward for being nice enough to sign up for this blog. More to come in the future! The discount won't be as low as the Flash Video Subscription Service (you know about this product, right?) subscripton service, but it will be signficant. The program is in sound in Flash Video for your web site, DVD, PowerPoint, and a self-playing Flash CD.

Is Your Quarterly EAP Newsletter Placing Your Program in Danger of Being Cut?

What a weird question? Well, it's one of the many elephants in the EAP living room, so let's discuss it.

Can an EAP newsletter that you distribute too infrequently make your program less visible and more likely to be cut? After communicating with hundreds of EAPs and watching what happens internally with EAPs that I have managed, I have slowly gravitated to an answer on this question. It’s “yes”.

It’s convenient not dealing with the distribution of a newsletter more often, but still appearing as though you are “doing something” to promote your EAP. Is this your mindset?

This vintage approach to communicating wellness information in a technological era has become almost an apologetic frequency as your newsletter sheepishly slips into employee in-boxes every three months.

I would like to make the argument that this is too infrequent and makes a statement about the importance of this material and your program, in particular.

Do you disagree? Consider why you do this. Is it because there is a history of EAPs always doing it this way because that is all that was initially available from vendor sources? So, by default, did it become the standard for EAPs, and you copied others? I think this is precisely what happened.

Since I joined ALMACA (EAPA’s early name) in 1978 – 32 years ago I have witnessed the evolution of this service. And, I have watched it grow more important.

With all the stress that employees face, and with the degree of importance that you place on your EAP as a life-saving and cost-saving mechanism, isn’t it a bit ironic that you only distribute a quarterly newsletter to employees when you could do it bimonthly or monthly for less, and with less hassle?

You may have a quick comeback — employees have too much to read! Don’t fool yourself. This is your codependency talking. You're giving in to a HR manager’s phone call telling you to slow it down about other material you may have sent. Or it's simply your imagination, because you haven't received such a phone call at all. You're just making this statement to avoid the work and it sounds damn good. I have caught many EAPs in this argument. It's not reality. This, too-much-to-read line is bogus.

If you are hearing this line, it is all about muscling you around and telling the EAP how to do its job. Why is that the most important thing employees read regarding their well-being and perhaps the one thing that they really look forward to most receiving, is the one thing that should be cut back?

What you’re hearing from HR, if indeed at all, is one HR manager’s opinion, or at best a manager’s opinion relayed via HR.

You need to understand something: HR managers don’t argue with top managers. They are their primary customers. Instead HR managers ask how high to jump. Corporations are on a big outsource-the-HR-departmet kick these days, and HR managers -- like EAPs are a threatened species.

I assure you that you are not getting the results of a survey that is supported by employee opinions.

Here’s the problem. Employee newsletters have historically been four pages. The problem begins and ends there.

Quarterly newsletters are always print or sub-links to the vendors own web site destroying your seamless look. They are expensive, with 500-600 word articles, and they are a vintage solution manufactured for EAPs in the early 1980’s when anything more frequent would be over-kill. Employees had more leisure time then to read these "books".

But the problem today is that they sacrifice your EAP or program visibility. You become less competitive with other things in the organization. You don’t want that. It will jeopardize your program.

You are sacrificing visibility and communicating the message that quarterly life-saving health and wellness information is quite enough. Trust me, you do not want to send this message.

An EAP newsletter is a resource, and visibility mechanism, and item of extreme interest to employees. And it is a way to compete against other things in the environment that are targeting the employee’s attention. You must not give in to the “stop distributing this material because our employees don’t have time to read it” mantra.

Instead, stop sending 4-page newsletters. Send two-page newsletters bimonthly or monthly.

Employees do not generally finish or complete four-page newsletters in my experience and in my view. This is another reason that you are locked into a 4-page solution distributed quarterly. It’s nuts to send it more often! And its expensive. So, change the model to the 2010 solution. Get out of the 1980's.

In this era, go for less content, shorter more action-oriented tight copy, and more frequency with the ability to edit the content yourself on the fly. This way your EAP will stay visible, be perceived as being more valuable and relevant, and be more effectively mainstreamed. Anything less and you’re in danger of being seen as expendable during next budget cycle.

Distribute EAP-wellness-productivity newsletters via PDF. Post them on your web site and send a link to employees when they are added to the site.

Distribute print to employees without computers, or send copies to appropriate locations. Your utilization will increase, your visibility will be enhanced, you will spend less, and employees will read more, more frequently. Your EAP will be talked about more often, and this is what you want.

A two-page monthly newsletter is 50% more content than a quarterly four-page newsletter! (Read that again.) And, the two-pager is more likely to be completely read. Are you with me?

You’ll will also reduce waste, motivate more self-referrals, and reduce more risk to the organization with a two—pager, monthly newsletter. Oh, and it will cost less than print. Everything I am writing here is pure logic and it holds up in real life.

Still need paper, make copies from your clean PDF supplied by the vendor. Can’t get permission from the vendor? Dump the newsletter vendor!

FrontLine Employee and WorkLife Excel are your modern day solutions to effective employee and EAP newsletters.

You can get brochures here:

FRONTLINE EMPLOYEE EAP WORKPLACE NEWSLETTER
WORK-LIFE-EXCEL WORKPLACE NEWSLETTER

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

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.

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

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.