Substance Use, Symptom, and Employment Outcomes of Persons With a Workplace Mandate for Chemical Dependency Treatment

Abstract

Objective-This study examined the role of workplace mandates to chemical dependency treatment in treatment adherence, alcohol and drug abstinence, severity of employment problems, and severity of psychiatric problems.Methods-The sample included 448 employed members of a private, nonprofit U.S. managed care health plan who entered chemical dependency treatment with a workplace mandate (N=75) or without one (N=373); 405 of these individuals were followed up at one year (N=70 and N=335, respectively), and 362 participated in a five-year follow up (N=60 and N=302, respectively). Propensity scores predicting receipt of a workplace mandate were calculated. Logistic regression and ordinary leastsquares regression were used to predict length of stay in chemical dependency treatment, alcohol and drug abstinence, and psychiatric and employment problem severity at one and five years.Results-Overall, participants with a workplace mandate had one-and five-year outcomes similar to those without such a mandate. Having a workplace mandate also predicted longer treatment stays and improvement in employment problems. When other factors related to outcomes were controlledThe authors report no competing interests. for, having a workplace mandate predicted abstinence at one year, with length of stay as a mediating variable. NIH Public AccessConclusions-Workplace mandates can be an effective mechanism for improving work performance and other outcomes. Study participants who had a workplace mandate were more likely than those who did not have a workplace mandate to be abstinent at follow-up, and they did as well in treatment, both short and long term. Pressure from the workplace likely gets people to treatment earlier and provides incentives for treatment adherence.Treatment mandates are a major predictor of entry into chemical dependency treatment (1)(2)(3)(4)(5). In the public sector, individuals are often pressured to enter treatment by criminal justice or welfare agencies; in private programs the pressure is often from employers (1,3). Most research in this area has examined legal mandates, with treatment retention and rearrest as outcomes. Results are mixed, but outcomes are often similar to those of voluntary clients (5-12).Employee substance use problems are a major policy issue for employers, insurers, and health plans, as they affect large numbers of workers and impose a substantial financial burden on employers. Treatment mandates originate from employee assistance programs, unions, or employers (3,4,13). Few recent studies have examined how workplace mandates affect treatment outcomes, but earlier studies found that employees who were mandated to enter treatment and those who sought treatment voluntarily had comparable outcomes (14,15).Problem severity and motivation are robust factors affecting chemical dependency treatment outcome, possibly overriding effects of a mandate. Substance use and psychiatric disorders commonly co-occur among individuals in treatment (16-18), and these complex patients typically do less ...

Levels and predictors of participation in integrated treatment programs for pregnant and parenting women with problematic substance use

“…Specifically, both types of mandates were associated with a prolonged interval between the first and second visits, and legal mandates were associated with a lower overall number of visits. Previous findings on the association between mandates and retention are equivocal: some studies have reported that legal and employer mandates are associated with prolonged retention [26, 67, 68], while others have found that mandates are associated with higher dropout rates [69, 70]. Research into the effectiveness of mandated treatment has emphasized mandates from the legal system; however, only 4.3% of the women in this treatment population were mandated to treatment by the legal system.…”

The Opioid Epidemic and the Role of the Occupational Health Nurse

“…Components include a formal written drug-free workplace policy, employee education, reporting requirements, violations notification and specific response, and ongoing review (SAMHSA, 2015). Companies with a DFWP achieve a significant decrease in workplace injuries compared with companies without a program, have higher rates of abstinence, and demonstrate a performance benefit (Slaymaker & Owen, 2006;Weisner et al, 2009;Wickizer, Kopjar, Franklin, & Joesch, 2004). Many private employers have adopted the standards put in place by this legislation.…”

High‐Deductible Health Plans: Implications for Substance Use Treatment

“…However, SU patients entering treatment are complex patients, who often have significant physical and psychiatric health comorbidities (Mertens et al , 2007, high utilization of health services (particularly injuries and overdose services) (Watt et al 2004;Cherpitel, Ye, and Bond 2005;Cherpitel and Ye 2008), and high overall costs . These patients often defer SU treatment until their SU problems are serious and they are referred by employers, families, or legal sources (Institute of Medicine 2006; Weisner et al 2009Weisner et al , 2010. High deductibles may exacerbate this delay, and SU severity and co-occurring medical and psychiatric comorbidities are at risk of worsening .…”

“…These patients often defer SU treatment until their SU problems are serious and they are referred by employers, families, or legal sources (Institute of Medicine ; Weisner et al. , ). High deductibles may exacerbate this delay, and SU severity and co‐occurring medical and psychiatric comorbidities are at risk of worsening (Mertens et al.…”