The Risks and Rewards of Substance-Misuse Benefits

Human resource professionals say substance misuse by employees worsened due to the added stress of the COVID-19 pandemic, though employees were better able to hide addictions when working in hybrid and remote settings.

Lisa Bertola, a Boston-based senior health consultant at Segal, an HR and employee benefits consultancy, said employee substance use, misuse and abuse has risen sharply over the past two years.

"Recovery is a theme employers should embrace—everyone stumbles in life and health," Bertola said. "We are at an important historical juncture that requires leadership to demonstrate courage and act fairly."

About 60 percent of Americans diagnosed with substance use disorder are working, she noted.

But while there are certainly many rewards to be gained by offering employee benefits that address substance misuse, there are also some potential risks.

Offering a Helping Hand

Employers need their employees to be engaged and productive. They can't afford to lose top performers to substance misuse. This is true whether it is the employee or an employee's family member who is experiencing an addiction.

"It's expensive to recruit and train new employees," said Sarah Gunderson, a clinical consultant at Segal. "If a company doesn't offer benefits for substance use disorder, it's likely going to lose that employee investment as the person eventually becomes unable to fulfill the role. Likewise, employees will struggle through a fog of presenteeism if they're preoccupied with a family member who can't find treatment for a behavioral health need."

Staying Compliant

There are, though, some potential risks involved when offering counseling services.

Employers are not required to cover treatment for substance misuse, but if they do, the Mental Health Parity and Addiction Equity Act (MHPAEA) and its implementing regulations require equal coverage limits for mental health/substance use disorders compared to medical/surgical benefits.

"Companies face the risk of noncompliance with parity rules if they do not have a compliance expert review the total suite of behavioral health benefits within the health plan" and in the services provided under an employee assistance program (EAP), Bertola said. Compliance is especially important now that the U.S. Department of Labor has stepped up investigations and enforcement actions around the MHPAEA's parity requirements.

In addition, Bertola noted, digital tools intended to help employees with addiction recovery may raise care-quality and HIPAA privacy concerns. But, she added, the rewards of providing access to help, whether through in-person or virtual counseling, or via artificial intelligence-driven apps, "likely outweigh the risks from a population health standpoint."

Bradford Sherry, vice president, employee benefits senior account executive, at World Insurance in Charlotte, N.C., pointed out that when employees don't get the help they need, "that raises the potential for increased absenteeism, addiction-related medical needs that drive up benefits costs and potential safety risks in the workplace," such as employees who may be operating heavy machinery or vehicles while under the influence.

Using Best Practices

As employers decide on benefits to help address substance-misuse issues, there are some important best practices to follow.

Offer an array of options

EAPs are a common option, but they may not go far enough to adequately address employee needs, whether for themselves or for their family members. Generally, the number of covered visits is limited, for instance. Employees may also be concerned about privacy issues when using company-sponsored EAP services.

The more options available to employees, the greater the likelihood that they will find a solution that best meets their needs. "Digital support through smartphones, telehealth and contingency-management programs are incredibly helpful, as are peer support and recovery ambassador programs," Bertola said.

Provide easy access

For those employers that offer access to telemedicine services, Sherry recommends making sure these services also offer easy access to mental health professionals. In some cases, for instance, it may make sense to offer access to a separate, dedicated behavioral health virtual service that would allow employees to connect to a wider array of professionals and set up appointments quickly.

"Make sure that you're keeping up-to-date on what's available in EAPs, telehealth, and also separate stand-alone mental and behavioral health services," Sherry advised.

For Peter Loeb, CEO of Lionrock Behavioral Health, an online substance-misuse counseling service based in Petaluma, Calif., the issue is personal. In 2010, he lost his sister to substance misuse. His daughter, Ashley Loeb Blassingame, co-founder of Lionrock, has been clean and sober for 17 years.

Telehealth options, Loeb noted, can be a good way to overcome the barriers of stigma and shame that many people with substance-misuse issues experience. In addition, he pointed out, "when an employee is in a telehealth treatment program, they don't have to leave work."

Encourage leaders to lead the charge

To address the stigma around mental health benefits generally and substance-misuse counseling in particular, "company leadership must promote the benefits available," Gunderson said. "It's ideal if company role models and management disclose their own personal use of counseling and other benefits, because behavioral theory shows us that people are more likely to follow the endorsements of their leaders."

Some executives, including those in very high-profile positions, are doing just that. Loeb points to Chris Anthony, a vice president with Salesforce in Los Angeles, as an example. Sober for 16 years, Anthony is open about his journey to sobriety.

Other top businesspeople—including Oprah Winfrey—have been equally honest. This openness can have a marked positive influence on others.

"The more people who are respected are able to say, 'Yes, I'm in recovery; I struggled through this problem,' the more people who are also struggling are going to be willing to get help earlier," Loeb said.

Protect privacy and confidentiality

It's critical to ensure employees "understand that their use of benefits is confidential and employers won't find out which employees are using which benefits," Gunderson advised.

Carrie Singer, executive director of Quince Orchard Psychotherapy, a group mental health practice employing more than 40 therapists near Washington, D.C., points to privacy, treatment quality and levels of care as the most important factors for employers to consider when choosing substance-misuse benefits options.

Employers should ask, "Are we paying a per-member, per-month price just for an app, or is there 24/7 crisis response and licensed counseling and psychiatry support available?" Singer said. Other factors to look for include referral to Alcoholics Anonymous or other peer support, and inpatient detoxification care, which "are different ends of the care spectrum" but both important, Singer said.

Loeb pointed out that it isn't "those people" who experience substance-misuse issues, but people all around us.

The greatest potential risk, he said, is doing nothing at all.

Lin Grensing-Pophal, SHRM-SCP, is a Wisconsin-based business journalist with HR consulting experience.