Friday, December 11, 2009

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.

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!)

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.

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

16% of nurses smoke, the highest of all professions, and the suicide rate is highest for nurses who smoke in England.

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.

Wednesday, December 9, 2009

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

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 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 video posted by a disgruntled employee only a week ago has received over 146,000 views and counting (Woops! Update - now over 220,000 on 1-10-10. See what I'm saying?).

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.

Whether it is supervisor referral of an employee who may soon lose their job over poor job performance or an EAP being a program of attraction where employees head for coaching, wisdom, and direction, EAPs have unsung potential to be more vital to corporate America's financial security than we are hear about or see.

If EAPs don't toot their own horn to more viable customers, they risk being kicked out of the symphony.

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 and Search “Why Bank America Fired Me”.

Why Bank of America Fired Me

Media Promotion of This Video

Tuesday, December 8, 2009

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

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

Sunday, December 6, 2009

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.

Tuesday, December 1, 2009

Something's Stirring with Psychologists

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.