Personal Assistance Service (PAS) | 2200 West Main Street | Erwin Square Tower | 4th Floor, Suite 400A | Durham, NC 27705 | 919-416-1PAS (919-416-1727)

Supervisor Newsletter Archives

Addictions: Recovery, Sobriety and Relapse

Q. Perhaps others won’t admit it, but I am hesitant to confront an employee who might be under the influence unless it is pretty obvious. A lot of employees drink, but if someone looks sober and is functional, that’s what matters to me. Where am I going wrong?

A. Duke is a drug-free workplace; therefore, it is crucial to follow the guidelines of our drug-free workplace policy. Employees in mid-stage alcoholism, for example, do not necessarily appear drunk, even if their blood alcohol level is relatively high. They are, of course, still at risk for accidents and injuring others. These employees eventually discover maintenance drinking; where they consume alcohol in small amounts to maintain a blood alcohol level that prevents the agitating effects of withdrawal that are noticeable to others. When you do confront your employee, anticipate some resistance and defensiveness if you have overlooked this problem for some period. You can talk with a PAS counselor and request help preparing for a successful, constructive discussion.

Q. One of my employees went away to a treatment facility for meth abuse treatment. He self-referred to that facility and seems to be doing great. I am nervous because he socializes with employees after hours and drinks alcohol with them. Can meth users drink alcohol safely?

A. Your employee may be abstinent from meth use, and his occupational and social functioning may be dramatically improved, but alcohol use following treatment for meth addiction would be contrary to the position of nearly all medical doctors who are experts on addiction and its treatment. According to the American Society of Addiction Medicine, addiction treatment requires "engagement in recovery activities." Recovery means abstinence from psychoactive drug use, which includes alcohol, in order to avoid relapse to the drug of choice. Your job, of course, is monitoring performance and not focusing on the employee's personal decisions outside work, no matter how ill-advised they may seem. Relapse and its effect on performance may be evident in a week, a year, or more. If or when that time comes, refer the employee to Personal Assistance Service.

Q. We dismissed an employee due to performance issues related to an alcohol addiction following a relapse after treatment. We hear the employee has been sober for over a year now. It's incredible because the situation was an ongoing 25-year saga of problems and relapses. What could explain this?

A. It is impossible to know all the factors that contributed to this pattern when the employee worked for you and the surprising success at recovery after termination. However, some common observations about recovery are worth understanding. Chronic alcoholism is always accompanied by an unpredictable path of progression, which often includes:

  1. Problems at work and home
  2. Physical illness
  3. Legal difficulties
  4. And enabling patterns within the family and in society

All of these direct the course of the illness and the timing for when (if ever) the addict will accept treatment. Remember, alcoholism is a drug addiction accompanied by cognitive distortions in thinking, especially denial. It is possible that your employee's fear of job loss may never have materialized until after it was experienced, wherein the need for treatment and recovery was accepted in order to financially survive.

Q. I have an employee whose appearance has changed significantly, not unlike those before-and-after photos you see online of people who use meth. I don't know if she uses meth, but are there ways I can begin talking with her about my concerns and encourage her to use Personal Assistance Service?

A. It is appropriate to inquire about the status of an employee who appears ill. As you express concern about the employee's wellbeing, you can give her information about the organization's resources, including the Personal Assistance Service. Not all meth addicts have classic facial scarring from picking at their skin, at least not initially. However, other signs of use may include paranoia, hallucinations, repetitive motor activity, memory loss, aggressive or violent behavior, mood disturbances, severe dental problems, etc. Addictive diseases are chronic and progressive, so things are going to get worse if meth is an issue. Given your concern, you should consider a referral to Employee Occupational Health and Wellness for a fitness for duty examination. A fitness for duty examination determines the employee's suitability for being at work in order to guard against an individual who may be unsafe to himself/herself or others. Talk with a Personal Assistance Service staff member and consult on this situation to identify what other issues exist and what treatment options would be recommended for this employee to receive the help she needs.

Q. Must everything we do as supervisors fall under the heading of "being a role model?" Personally, I think it is good to loosen up every once in a while so that employees see we are real people who can have a good time.

A. It may not seem fair, but your employees are continuously judging you by your behaviors. By virtue of your position, every behavior you exhibit to employees is viewed in the context of you as a role model. This is an inescapable dynamic of workplace authority and supervision. But there is more to it. All behaviors of supervisors make an impression on employees because their behaviors are symbolic. They tell your employees what you value, what you support, and what you stand for. This is a powerful tool in leadership. Not understanding this dynamic can cause you to lose their respect, along with harming your ability to influence and shape a team. Unfortunately, this easily happens when supervisors feel uncomfortable with this power or believe that being "one of the guys (or gals)" is more important.

Q. Why are symptoms of alcoholism and drug addiction so different among employees? The most dramatic variance I have seen in my career is the issue of tardiness and absenteeism, e.g.-some had a lot of tardiness and/or absences, others had none.

A. In the early stages of the illness, the behavioral signs and symptoms of alcoholism or drug addiction usually appear where they are least likely to create undesired consequences for the alcoholic or drug user. Some of those undesired consequences include tardiness and absenteeism from work, legal problems such as DUI or accidents due to intoxication, and poor work performance such as frequent mistakes and errors. The early stage of the illness is a time when the addict can exert more control. As the illness grows worse, this control lessens and more unpredictable behavioral patterns result.

Q. When does a workaholic’s behavior become a concern for a supervisor? Personally, I admire the productivity and dedication of this person, but I know it’s an obvious problem for someone, possibly their family; if not us.

A. Your employee may or may not be a workaholic, but like with other personal problems, it’s best to avoid making diagnostic conclusions. Many people, even spouses, confuse love of work or working too much with workaholism.  Workaholism is characterized by a deeply ingrained and maladaptive need to work, making it a priority, believing no one else can do the job, experiencing insecurity, feelings of failure, and feeling anxiety if one can’t work. Ambitious employees who have fewer restrictions and responsibilities at home may naturally work more. Younger employees who enjoy relationships with peers may also put in more hours, because being at work offers the opportunity to have meaningful social connections.  Neither the ambitious employee with fewer home responsibilities nor the younger employee would necessarily be characterized as workaholics. It is perfectly understandable that you would admire the production and dedication of your employee.  However if that employee exhibits the following behaviors, you may have cause to be concerned: 

  • accusing others of not working hard enough
  • claiming to be indispensable
  • disrespecting others who don’t work as much
  • eefusing to reduce work hours at the organization’s request,
  • being late to company events that are not “strictly” work-related, with the excuse that they could not “pull away” from work.

If an employee is exhibiting these behaviors, you may want to talk with a PAS counselor to assess how best to address the issue with the individual. 

Q. Is there a difference between an employee with an alcohol problem and an employee who drinks frequently but does not believe he or she has an alcohol problem?

A. Both could deny having a problem, but there are distinct differences between the two. Denial is a defense mechanism. By definition, denial entails some form of awareness—no matter how slight—that something is amiss. A recovering alcoholic, in recounting their experiences with denial, will tell you that they had some awareness that their drinking was a problem. It is a myth that alcoholics have absolutely zero awareness that there is a connection between drinking and difficulties they experience. Additionally, denial is almost never the only defensive mechanism used. It exists in tandem with other defense mechanisms like externalization (blaming other people or circumstances for drinking-related problems).  It becomes relatively easy to identify the illness of alcoholism through questions about drinking practices and experiences, combined with this internal struggle with denial.  Personal Assistance Service counselors and other treatment professionals are trained to identity the problem of alcoholism by using the assessment tools mentioned above.  Alcohol abuse or alcoholism can be a factor that contributes to an employee experiencing performance and fitness-for-duty issues, as well as other stressful issues that the employee is unable to manage. However, in your role as supervisor or manager, you are primarily concerned about your employee’s behavior that indicates they have performance problems or fitness-for-duty issues. Personal Assistance Service (919 416-1828) and Employee Occupational Health and Wellness (919 684-3136) are resources available to you if you have questions about an employee’s violation of Duke’s substance abuse policy or concerns that their use negatively impacts work performance.

Q. My employee periodically refers to himself as an alcoholic but has been sober for 22 years. Why does he use this term?

A. Many alcoholics in an active recovery (especially 12-step programs) who are abstinent from alcohol and mood-altering substances refer to themselves as alcoholics or recovering alcoholics depending on whom they are with and the context of the social or occupational setting. The recognition that one is an alcoholic is not unlike employees who refer to themselves as diabetic even if the disease is well-managed. Many alcoholics believe their very next drink could be the one that leads to their death, because they have come so close to it in the past, tried so many times to get sober, or both. Their sobriety is therefore first and foremost. This attitude of awareness and gratitude is one of self-preservation. Practicing and feeling comfortable with describing oneself as an alcoholic is usually viewed as an important part of their awareness of who they are and the fragile nature of sobriety, and it is a reminder that they could lose it all tomorrow.

Q. What is Internet addiction and how can I spot whether Internet addiction is affecting productivity? How would you hold an employee accountable if you can't "diagnose" the worker? It seems like a catch-22 to me.

A. "Internet addiction" is commonly discussed in the media and online, but it is not an official medical diagnosis yet because words like "addiction" (and "disorder") are reserved for accepted medical conditions. Internet addiction also describes many compulsive uses of technology. The preferred term is "compulsive Internet use." Other forms of compulsive use of technology include social media use such as checking Facebook, gambling, gaming, pornography, shopping, and financial trading. Any of these may negatively impact workplace and personal productivity. Beyond electronic discovery of usage, assignments not delivered on time may be a potential key indicator of compulsive Internet use. Lying about use of time on the job or lying about using the Internet for important business purposes is also common when someone is a compulsive Internet user. To document productivity issues, assign measurable goals to your employee, such as a certain number of "widgets" or tasks that must be completed on time each week.

Q. My employees want to conduct an intervention with their coworker who is a meth addict. I support their good intentions, but they want to do it at work when the employee arrives. I feel a little nervous about this happening at work.

A. Workplace activities that you endorse, especially with regard to personnel matters, should be related to your organization's mission and functions. There are many potential problems, legal and otherwise, associated with having an intervention at work conducted by employees. Despite the perceived urgency and the well-meaning intent of coworkers, you should recommend they meet with Personal Assistance Service and consider a better plan or approach after consulting with a PAS counselor. Do not put yourself in the position of having approved or endorsed this activity. Interventions have received enormous attention in the media by way of books, fee-based services, and even TV shows. However, managers should not approve them as acceptable workplace activities. As a reminder, if the employee purported to be a meth addict has problem work behavior, you can use the "Corrective Action" process to begin helping the employee improve work behavior. Personal Assistance Service is another resource to help the employee deal with issues such as addiction that may be impacting work performance.

Q. We have an employee who comes to work late, and it causes problems for everyone. The employee is likeable, but everyone knows about his heavy drinking. Yet, I don't understand why none of his peers confront his behavior.

A. If your employee did not have an alcohol problem, he might be confronted more readily by peers. Assuming employees believe the lateness is explained by alcoholism, they may feel unable to be assertive and confront the behavior. Here's why: Alcoholism still suffers from enormous myths and misconceptions. Over the years, alcoholism has been wrongly identified as a personality disorder or the result of moral or psychological weakness. These views remain, and almost everyone is familiar with them, if not consciously, then at least subconsciously. Alcoholism is a disease, and these prior descriptions of why people have alcohol problems do not fit the facts as we know them today. Still, these pervasive misconceptions turn alcoholism into an accusation. This is what makes people back off. Because the lateness is believed to be associated with alcoholism, employees enable by remaining silent while hoping for change someday. As a supervisor, you can prepare to talk with the employee first about the problem of tardiness. In addition to discussing this problem work behavior and sharing your expectation for improvement, you would want to refer the employee to Personal Assistance Service. The Personal Assistance Service counselor will explore with the employee those factors that cause the tardy behavior. If alcohol use is identified as an issue, the Personal Assistance Service counselor will be able to help the employee with the most effective treatment resources.

Q. Some employees do very well after referral to alcohol addiction treatment programs, but some do not. They relapse, struggle, and eventually lose their jobs. How can supervisors intervene earlier or increase the likelihood of success for these employees?

A. Within the recovering community of alcoholics and among treatment professionals, there are many stories of alcoholics who seemed unable to achieve abstinence. But treatment professionals will tell you that examples of late-stage recoveries exist. Supervisors, like family members, should learn about enabling and avoid doing it. Enabling plays a key role in the progression of addictive disease and, in turn, resistance to treatment. Like alcoholism, enabling can manifest a chronic and progressive pattern. In the early years of the disease, a supervisor may enable the employee by overlooking performance shortcomings. Twenty years later, the same supervisor may be involved in a chronic pattern of enabling behavior by driving his or her employee to work because of a confiscated driver's license. Loaning money and covering for behavioral problems are also common enabling behaviors. To learn more about enabling behavior and how to avoid it, contact Personal Assistance Service to talk with one of the professional counselors.

Q. I believe there are employees in our work organization using illicit substances and others who know and enable this behavior. How can people continue to enable this behavior when they know how bad they'd feel if something terrible happened as a result.

A. Most people understand enabling as protecting, covering up, and making excuses for a coworker, friend or family member with an addiction problem. But stopping is not as easy as it sounds. To stop enabling an individual who has an addiction problem requires the enabler to make choices that may create significant stress, guilt, and feelings of loss. To change one's behavior, is often not easy and can have life-changing consequences for the enabler. The enabler usually manages this choice with procrastination, denial, minimization ("It's bad but not that bad," or "She's a functional alcoholic," etc.), and projection ("It's not my job to deal with it."). The result is cover-up and protection of the drug user. Individuals who find themselves in an enabling role can get tremendous support and help to change their enabling behavior from "self-help" groups such as Al-Anon and Nar-Anon. If one of your employees has confided in you that they seem to have difficulty getting out of the enabling role, you can refer them to Personal Assistance Service. The Personal Assistance Service staff will help them with counseling and resource information and referrals so that they might change their enabling behavior.

Q. My employee went to Personal Assistance Service (PAS) for help with her problem alcohol use, but she was unable to stick with the treatment program. Unfortunately, this resulted in the employee losing her job because of performance problems. Why do some employees recover while others do not? I can't help but think that I was not supportive enough to help her succeed?

A. As with the treatment of any chronic condition, the burden of following instructions and managing a program of recovery from alcoholism rests with the alcoholic (patient). Duke recognizes substance abuse as a treatable condition and therefore staff from Employee Occupational Health and Wellness (EOHW) and Personal Assistance Service (PAS) is committed to providing assistance to help employees resolve alcohol or drug-abuse problems. A frustrating part of alcoholism is relapse. Your feeling upset and wondering if you could have prevented it is a natural response. However, the relapse is not your fault. A universal tenet in all effective treatment models is that patients are responsible for their own recovery. There can be many reasons for a relapse, including inadequate treatment, inefficient or inadequate follow-up, concurrent mental health or physical problems, provocative and non-supportive living environments, failure to follow instructions, poor education about the illness, and relationships with codependent persons who undermine recovery. A failure to change one's lifestyle is often another cause of relapse. The best way for you to help your employees is by better understanding the disease with help from Personal Assistance Service, referring employees to PAS when performance issues appear, and holding them accountable for their own conduct or performance.

Q. One of our employees recently died from a drug overdose. Everyone was shocked and saddened. I heard something years ago about a possible drug problem, but never since, and the employee's performance was excellent. I am feeling guilty. Did I miss symptoms?

A. Your employee could have relapsed without any warning signs that you could have spotted. Drug addiction can be treated and abstinence achieved. It is essential that the individual remain in some type of program that helps them maintain abstinence. Abstinent employees refer to themselves as "recovering" or in recovery. Years of abstinence can pass, and performance may be outstanding, but the disease does not vanish. Addiction is a chronic illness. Experts in the addiction-treatment field generally regard drug addiction as a progressive disease with no cure. Every area of an addict's life is affected and must be treated: physical, emotional, and spiritual. A recovering addict without an active and effective approach to maintaining recovery has a higher risk of relapse over those who have such an approach. Consequences of any relapse are unpredictable, but death from a narcotic overdose for relapsed addicts is possible. When addicts in recovery overdose and die, there may be great difficulty in comprehending why. Treatment experts and members of the largest group of recovering people, Narcotics Anonymous, have observed that relapses usually occur in the absence of an adequate recovery program combined with a sudden or acute stressful life event or circumstance.

Q. My employee said he is drinking after many years of being sober. Work performance is outstanding. Is there anything I should be doing about this situation?

A. Since there are not work performance or attendance issues, there is no issue within the scope of your supervisory responsibilities that requires your intervention. Relapses typically lead to job performance, attendance, and/or conduct issues, but there is no way to predict if or when these might occur. However, because your employee shared with you a brief history and his current situation with regard to alcohol use, you may wish to remind him that PAS exists as a source of help should he decide he needs it in the future.