Lost Opportunities: Gaps in Employer Support for Substance Use Disorders - Part 2

This post is part of series that looks at an employee’s experience with a substance use disorder – in this case, alcohol – to show how employers can provide better support. In a blog post last week, we introduced Randell, a logistics manager at a manufacturing company, who has difficulty coping with the pandemic and its impact on life and work. At first, he found that using alcohol helped him get through the long days of video calls while confined to his home with his wife and kids, but over time his alcohol use increased until he was drinking throughout the day. When his performance slipped and his behavior changed, straining work relationships, his manager spoke with him and shared information about the EAP. He called right away, but it took two months before he could finally see someone, and by then alcohol use was the focus of his need for support.

During the initial telephone assessment with the EAP, Randell hadn’t been forthcoming about his alcohol use. He attributed his stress, relationship issues, and difficulty at work to the pandemic, and so the intake counselor did not refer him to someone specializing in substance use disorders (SUD). Once in counseling, the therapist was able to identify that alcohol was playing a large role in his life, but Randell was resistant to this assessment and, while a different therapist might have been able to break through, when the session ended Randell had little intention of returning. That night he drank a lot after work, had a serious confrontation with his wife, and slept through two important meetings the next day. He drank more heavily over the weekend and called in sick to work on Monday. His second appointment with the therapist came and went.

Jenny, his supervisor, observed his deteriorating job performance. She and Randell talked about issues periodically, but he was difficult and she was tired and had other priorities needing her attention. Before she could put him on a performance improvement plan, however, Randell’s wife also reached her limit. After a heated argument Randell made the choice to go to a treatment facility. He called Jenny to say that he needed treatment and would be away from work for some time. Given the tensions that had built up between them, she was not entirely empathetic, though she tried to be helpful. She explained that after three days of sick time, he would be placed on unpaid leave and sent paperwork for disability.

Randell was in a panic thinking about what his absence at work would mean. What should he tell people? How would this affect his career and how would he pay his bills? And where should he go for help? Randell’s wife turned to the internet, desperate to find a resource. A facility in Florida called “Care by the Sea” had an impressive website and endorsements from industry organizations. It was far from their home in Baltimore, but the website said that they would cover the travel cost and “work with the member’s insurance,” so, with no other guidance, they chose it.

Randell traveled to the facility and checked in. An inquiry to his health plan triggered a flag that an out-of-network provider was being used, but the benefits were approved per the plan’s provisions for out-of-network care, and Randell was in no position at that point to reconsider his choice. Randell was in the facility for 25 days, attending group and individual sessions. At discharge, he was given some information about staying sober, but no referrals to outpatient resources or family supports. When Randell returned home and confronted unresolved issues and strain with his wife and children, he quickly felt unsure of his recovery. Anxiety about returning to work added to the pressure -- and to his craving for alcohol to help him cope. Within a week he was drinking heavily again and in need of immediate support. While Randell was at Care by the Sea, their insurance carrier had reached out a few times with information about in-network facilities. This time, he and his wife contacted the medical plan, spoke to a behavioral health advocate, and identified an in-network treatment program close to home.

This short-term stay produced different results. While alcohol use had become Randell’s central issue, the staff identified a co-existing condition of depression, and treating it along with the alcohol use disorder proved to be extremely effective. A comprehensive treatment plan, family meetings, discharge planning, connection to outpatient providers and support groups were all part of Randell’s experience. When he discharged he had the tools in hand to effectively work at recovery. Before long, Randell was anticipating his return to work. Next week, we’ll learn whether he finds the support there that he needs to continue in his journey.

An important takeaway for employers from Randell’s story is that a shortage of licensed therapists and psychiatrists in-network can mean consequential delays in in getting appointments – in Randell’s case, another two months of drinking and problematic behavior with his family and work. This also leads to higher utilization of out-of-network care – typically with much higher out-of-pocket costs for the member. Further, addiction treatment is a profitable industry and some facilities engage in questionable practices, including non-evidence based approaches to care. Although Randell’s wife had the best intentions in getting her husband into care quickly, the family made a costly decision. Ideally, Randell’s supervisor or an HR staff member would have advised him to check his benefits, call the health plan for help, and to choose a facility with the proper licensing and certification. As it turned out, not only did Randell relapse within one week of returning home, the financial repercussions will likely be considerable and long lasting.

Sandra Kuhn
by Sandra Kuhn

Partner, Total Health Management, Mercer

Courtney Blondino
by Courtney Blondino

Senior Associate, Total Health Management, Mercer

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